SACRAMENTO, Calif. — The Trump administration is taking its immigration crackdown to the well being care security internet, launching Medicaid spending probes in no less than six Democratic-led states that present complete well being protection to poor and disabled immigrants dwelling within the U.S. with out everlasting authorized standing.
The Facilities for Medicare & Medicaid Providers is scouring funds overlaying well being look after immigrants with out authorized standing to make sure there isn’t any waste, fraud, or abuse, in line with public information 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 resembling prescribed drugs and specialty care.
The federal company instructed the states it’s reviewing claims as a part of its dedication to take care of 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 no less than $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 and not using a passable immigration standing for which federal funding is prohibited by legislation,” in line with a letter dated March 18, “CMS will diligently pursue all out there enforcement methods, together with, in line with relevant legislation, reductions in federal monetary participation and potential referrals to the Lawyer Basic of the US for potential lawsuit towards California.”
The investigations come because the White Home and a Republican-controlled Congress slashed taxpayer spending on immigrant well being care by cuts in President Donald Trump’s spending-and-tax legislation handed this summer season. The administration can be pushing folks dwelling within the U.S. with out authorization off Medicaid rolls. Well being coverage consultants say these strikes may hamper care and go away security internet 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 as a result of ballooning prices. Colorado can be contemplating cuts as a result of price overruns.
On the identical time, 20 states are pushing again on Trump’s immigration crackdown by suing the administration for handing over Medicaid knowledge on hundreds of thousands of enrollees to deportation officers. A federal choose quickly halted the transfer. California’s legal professional common, 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 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 kids with out authorized standing. Seven of these states, plus Washington, D.C., have additionally offered full-scope protection to some grownup immigrants dwelling within the nation with out authorization.
The Trump administration seems to be focusing on solely states with full Medicaid protection for each children and adults with out authorized standing. Utah, Massachusetts, and Connecticut, which offer Medicaid protection solely to immigrant kidshaven’t acquired letters, for example. CMS declined to supply a full listing 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 legislation to supply intensive advantages to people unlawfully current in the US,” CMS spokesperson Catherine Howden mentioned concerning 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 legislation,” she mentioned.
Well being coverage researchers and economists say offering Medicaid protection to immigrants for preventive companies and therapy of power well being circumstances staves off extra pricey look after sufferers down the highway. 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 Major Care Affiliationmentioned the Trump administration is threatening to drive up well being care prices and make it harder to entry care.
“The affect is emergency rooms would get so crowded that ambulances need to 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 method, offering protection to 1.6 million immigrants with out authorized standing. The growth, which was rolled out from 2016 to 2024, is estimated to price $12.4 billion this yr. Of that, $1.3 billion is paid by the federal authorities for emergency and pregnancy-related care.
As California rolled out its growth, 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 resembling psychological well being and dependancy companies, prescribed drugs, 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 no less than $500 million recognized by the federal authorities.
“As soon as I recognized the issue, I assumed it was actually essential to report it and we did,” Cooper mentioned. “We take waste, fraud, and abuse very critically.”
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 — almost 15 million folks — with a price range of almost $200 billion this fiscal yr.
Matt Salo, a nationwide Medicaid professional, 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 Underneath Assault
Nationwide Republicans have focused well being spending on immigrants in numerous methods. The GOP spending legislation, which Trump calls the “One Massive Stunning 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 growth inhabitants, in line with Cava.
The Trump administration can be scaling again Medicaid protection to immigrants with momentary authorized standing who had been beforehand lined and introduced in August that it will present states with month-to-month studies declaring 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 an announcement. “This motion underscores our unwavering dedication to program integrity, safeguarding taxpayer {dollars}, and guaranteeing advantages are strictly reserved for these eligible beneath the legislation.”
States beneath overview say they’re following the legislation.
“Spending cash on a congressionally licensed medical profit program that helps folks 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 Lawyer Basic Nick Brown.
Data present Washington Medicaid officers have been inundated with questions from CMS about federal funds overlaying 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 knowledge. CMS denied that request and federal regulators instructed the state that its funding might 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 “unimaginable” for the state to backfill.
Shastri reported from Milwaukee.
The Related Press Well being and Science Division receives help 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.
This text was produced by KFF Well being Informationwhich publishes California Healthlinean editorially impartial service of the California Well being Care Basis.
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—an impartial supply of well being coverage analysis, polling, and journalism. Be taught extra about Kff.
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