The Trump administration is taking its immigration crackdown to the well being care security web, launching Medicaid spending probes in a minimum of six Democratic-led states that present complete well being protection to poor and disabled immigrants residing within the U.S. with out everlasting authorized standing.
The Facilities for Medicare and Medicaid Providers is scouring funds protecting well being look after immigrants with out authorized standing to make sure there isn’t any waste, fraud or abuse, in response to public data obtained by KFF Well being Information and The Related Press. Whereas acknowledging that states can invoice the federal authorities for Medicaid emergency and being pregnant look after immigrants with out authorized standing, federal officers have despatched letters notifying state well being companies in California, Colorado, Illinois, Minnesota, Oregon and Washington that they’re reviewing federal and state funds for medical companies, equivalent to pharmaceuticals and specialty care.
The federal company advised the states it’s reviewing claims as a part of its dedication to keep up Medicaid’s fiscal integrity. California is the most important goal after the state self-reported overcharging the federal authorities for well being care companies delivered to immigrants with out authorized standing, decided to be a minimum of $500 million, spurring the specter of a lawsuit.
“If CMS determines that California is utilizing federal cash to pay for or subsidize healthcare for people with out a passable immigration standing for which federal funding is prohibited by regulation,” in response to a letter dated March 18, “CMS will diligently pursue all accessible enforcement methods, together with, per relevant regulation, reductions in federal monetary participation and doable referrals to the Legal professional Common of america for doable lawsuit towards California.”
The investigations come because the White Home and a Republican-controlled Congress slashed taxpayer spending on immigrant well being care by means of cuts in President Donald Trump’s spending-and-tax regulation handed this summer time. The administration can be pushing individuals residing within the U.S. illegally off Medicaid rolls. Well being coverage consultants say these strikes might hamper care and depart security web hospitals, clinics and different suppliers financially susceptible. Some Democratic-led states — California, Illinois and Minnesota — have already needed to finish or slim down their Medicaid packages for immigrants because of ballooning prices. Colorado can be contemplating cuts because of value overruns.
On the identical time, 20 states are pushing again on Trump’s immigration crackdown by suing the administration for handing over Medicaid information on tens of millions of enrollees to deportation officers. A federal decide briefly halted the transfer. California’s lawyer normal, Rob Bonta, who led that problem, says the Trump administration is launching a political assault on states that embrace immigrants in Medicaid packages.
“The entire concept that there’s waste, fraud and abuse is contrived,” Bonta mentioned. “It’s manufactured. It’s invented. It’s a catchall phrase that they use to justify their predetermined anti-immigrant agenda.”
Trump administration targets immigrants
Immigrants missing everlasting authorized standing will not be eligible to enroll in complete Medicaid protection. Nevertheless, states invoice the federal authorities for emergency and being pregnant care offered to anybody.
Fourteen states and Washington, D.C., expanded their Medicaid packages with their very own funds to cowl low-income youngsters with out authorized standing. Seven of these states, plus Washington, D.C., have additionally offered full-scope protection to some grownup immigrants residing within the nation illegally.
The Trump administration seems to be focusing on solely states with full Medicaid protection for each youngsters and adults with out authorized standing. Utah, Massachusetts and Connecticut, which give Medicaid protection solely to immigrant youngsters, haven’t obtained letters, as an illustration. CMS declined to supply a full checklist of states it’s focusing on.
Federal officers say it’s their authorized proper and duty to scrutinize states for misspending on immigrant well being protection and are taking “decisive motion to cease that.”
“It’s a matter of nationwide concern that some states have pushed the boundaries of Medicaid regulation to supply intensive advantages to people unlawfully current in america,” CMS spokesperson Catherine Howden mentioned in regards to the company’s probe of chosen states. The oversight is meant to “guarantee federal funds are reserved for legally eligible people, not for political experiments that violate the regulation,” she mentioned.
Well being coverage researchers and economists say offering Medicaid protection to immigrants for preventive companies and therapy of power well being situations staves off extra expensive look after sufferers down the street. It additionally tamps down insurance coverage premium will increase and the quantity of uncompensated look after hospitals and clinics.
Francisco Silva, president and CEO of the California Main Care Affiliation, mentioned the Trump administration is threatening to drive up well being care prices and make it harder to entry care.
“The impression is emergency rooms would get so crowded that ambulances should be diverted away and other people in an actual emergency can’t get into the hospital, and public well being threats like illness outbreaks,” Silva mentioned.
California has taken a health-care-for-all strategy, offering protection to 1.6 million immigrants with out authorized standing. The enlargement, which was rolled out from 2016 to 2024, is estimated to value $12.4 billion this 12 months. Of that, $1.3 billion is paid by the federal authorities for emergency and pregnancy-related care.
As California rolled out its enlargement, the state erroneously billed the federal authorities for care offered to immigrants with out authorized standing — particulars that haven’t beforehand been reported and that former state officers shared with KFF Well being Information and the AP. The state improperly billed for companies equivalent to psychological well being and dependancy companies, pharmaceuticals and dental care.
Jacey Cooper, who served as California’s Medicaid director from 2020 to 2023, mentioned she found the error and reported it to federal regulators. Cooper mentioned the state had been working to pay again a minimum of $500 million recognized by the federal authorities.
“As soon as I recognized the issue, I believed it was actually necessary to report it and we did,” Cooper mentioned. “We take waste, fraud and abuse very significantly.”
It’s not clear whether or not that cash has been repaid. The state’s Medicaid company says it doesn’t know the way CMS calculated the overpayments or “what’s included in that quantity, what time interval it covers, and if or when it was collected,” mentioned spokesperson Tony Cava.
California has an enormously sophisticated Medicaid program: It serves the biggest inhabitants within the nation — practically 15 million individuals — with a price range of practically $200 billion this fiscal 12 months.
Matt Salo, a nationwide Medicaid skilled, mentioned all these errors occur in states all through the nation as a result of this system is rife with overlapping federal and state guidelines. Salo and different coverage analysts agreed that states have the authority to manage their Medicaid packages as they see match and root out misuse of federal funds.
And Michael Cannon, director of well being coverage research on the libertarian Cato Institute, mentioned the Trump administration’s actions “persecute a minority that’s unpopular with the powers that be.”
“The Trump administration can’t preserve that this effort has something to do with sustaining the fiscal integrity of the Medicaid program,” Cannon mentioned. “There are a lot larger threats to Medicaid’s fiscal integrity, that that argument simply doesn’t wash.”
Immigrants’ Medicaid beneath assault
Nationwide Republicans have focused well being spending on immigrants in numerous methods. The GOP spending regulation, which Trump calls the “One Huge Lovely Invoice,” will decrease reimbursement to states across the nation in October 2026. In California, for instance, federal reimbursement for immigrants with out authorized standing will go to 50% for emergency companies, down from 90% for the Medicaid enlargement inhabitants, in response to Cava.
The Trump administration can be scaling again Medicaid protection to immigrants with non permanent authorized standing who had been beforehand lined and introduced in August that it will present states with month-to-month studies stating enrollees whose authorized standing couldn’t be confirmed by the Division of Homeland Safety.
“Each greenback misspent is a greenback taken away from an eligible, susceptible particular person in want of Medicaid,” CMS Administrator Mehmet Oz mentioned in a press release. “This motion underscores our unwavering dedication to program integrity, safeguarding taxpayer {dollars}, and guaranteeing advantages are strictly reserved for these eligible beneath the regulation.”
States beneath overview say they’re following the regulation.
“Spending cash on a congressionally licensed medical profit program that helps individuals get emergency remedies for most cancers, dialysis and anti-rejection drugs for organ transplants is decidedly not waste, fraud and abuse,” mentioned Mike Faulk, deputy communications director for Washington state Legal professional Common Nick Brown.
Data present Washington Medicaid officers have been inundated with questions from CMS about federal funds protecting emergency and being pregnant look after immigrants with out authorized standing.
Emails present Illinois officers met with CMS and sought an extension to share its information. CMS denied that request and federal regulators advised the state that its funding could possibly be withheld.
“Hundreds of Illinois residents depend on these packages to lawfully search essential well being care with out concern of deportation,” mentioned Melissa Kula, a spokesperson for the Illinois Division of Healthcare and Household Providers, noting that any federal lower could be “inconceivable” for the state to backfill.
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Shastri reported from Milwaukee.
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KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF — the unbiased supply for well being coverage analysis, polling and journalism.
The Related Press Well being and Science Division receives assist from the Howard Hughes Medical Institute’s Division of Science Schooling and the Robert Wooden Johnson Basis. The AP is solely liable for all content material.
