Sacramento, California (AP) – The Trump administration is taking it Immigrant suppression In Healthcare Safety Net, We will launch Medicaid spending probes in at least six democratically driven states that provide comprehensive health insurance for poor and disabled immigrants living in the United States without permanent legal status.
According to public records obtained by KFF Health News and the Associated Press, the Centers for Medicare and Medicaid Services are scrutinizing payments to cover health care for immigrants without legal status, covering health care for immigrants without legal status. While states allowed federal government to claim for immigrant Medicaid emergency and pregnancy care without legal status, federal authorities sent letters notifying state health agencies in California, Colorado, Illinois, Minnesota, Oregon and Washington.
The federal agency told the state it is considering claims as part of its commitment to maintaining Medicaid’s financial integrity. California is its biggest goal after the federal government overcharges the federal government for medical services delivered to immigrants without legal status. At least $500 millionspurs the threat of litigation.
“If CMS decides that California uses federal funds to pay or subsidize medical expenses for individuals who have no satisfactory immigration status that federal funds are prohibited by law,” according to a letter dated March 18, “CMS pursues all available enforcement strategies, including reductions in applicable laws, including references to applicable laws, and to California’s financial participation.
The investigation comes when the White House and Republican-controlled Congress have significantly reduced taxpayer spending on immigrant health care Through the cut President Donald Trump’s Expenses and Tax Law passed this summer. The same goes for the government Pushing people I live in the United States illegally from Medicaid Roll. Health policy experts say these moves could hinder care and leave safety net hospitals, clinics and other providers Financially vulnerable. Some democratically driven states – California, Illinois, Minnesota – Due to balloon costs, the Medicaid program for immigration had to be completed or slimmer. Colorado is also considering reducing costs through cost overruns.
At the same time, 20 states are pushing back Trump’s immigration crackdown By sue Government for Pass your Medicaid data Millions of registered users to deportation staff. Federal judge It has been temporarily stopped Movement. California Attorney General Rob Bonta, who led the challenge, says the Trump administration is launching political attacks on states that accept immigration into the Medicaid program.
“The whole idea is that there is waste, fraud, and abuse,” Bonta said. “It’s manufactured. It was invented. It’s a catch-all phrase they use to justify a given anti-immigrant agenda.”
Trump administration targets immigrants
Immigrants who lack permanent legal status are not eligible to register for comprehensive Medicaid compensation. But the state is charging the federal government for emergency and pregnancy care provided to everyone.
14 states and Washington DCexpanded the Medicaid program with its own funding to cover low-income children with no legal status. Seven of these states and Washington, DC also offer full-scope compensation to some adult immigrants who illegally live in the country.
The Trump administration appears to only target states with full Medicaid coverage for both children and adults without legal status. Utah, Massachusetts and Connecticut offer Medicaid compensation Only for immigrant childrenfor example, I have not received a letter. CMS refused to provide a complete list of states it was targeting.
Federal officials scrutinise the state for errors in immigrant health insurance and say it is their legal right and responsibility to “take decisive action to stop it.”
“It is a matter of national concern that some states have pushed the boundaries of Medicaid law and provided widespread benefits to individuals who are illegally present in the United States,” CMS spokesman Katherine Howden said about investigating agencies in selected states. Surveillance aims to “ensure federal funds are reserved for legally eligible individuals, not political experiments that violate the law.”
Health policy researchers and economists say they provide Medicaid compensation to immigrants for preventive services and provide treatment for chronic health conditions. It also reduces the amount of uncompensated care at hospitals and clinics.
Francisco Silva, President and CEO California Primary Care Associationsaid the Trump administration is threatening to reduce healthcare costs and make access to care more difficult.
“The emergency rooms are so crowded that ambulances have to be diverted, people in real emergency situations can’t enter the hospital, and there is a public health threat like an outbreak of illness,” Silva said.
California is Healthcare for All An approach that provides compensation to 1.6 million immigrants without legal status. The expansion, which was rolled out between 2016 and 2024, is estimated to cost $12.4 billion this year. Of that, $1.3 billion will be paid by the federal government for emergency and pregnancy-related care.
As California expanded, the state accidentally charged the federal government for care provided to immigrants without legal status. The state was inappropriately charged for services such as mental health and addiction services, prescription medications and dental care.
Jaycee Cooper, who served as California’s Medicaid director from 2020 to 2023, said he discovered the error and reported it to federal regulators. Cooper said the state was working to repay at least $500 million, which was identified by the federal government.
“I thought it was really important to have identified an issue and report it,” Cooper said. “We take waste, fraud and abuse very seriously.”
It is not clear whether the money was paid back. The state’s Medicaid agency says CMS doesn’t know what’s in that amount, what it covers, how long it calculates, if it was collected, or when it was collected.
California has a very complex Medicaid program. It serves the largest population in the country. 15 million people – I have almost a budget $200 billion this year.
Matt Saro, a national Medicaid expert, said these types of mistakes are happening in states around the country. SALO and other policy analysts agreed that states have the authority to administer the Medicaid program to root out fit and misuse of federal funds.
And Michael Cannon, director of health policy research at the Libertarian Cato Institute, said the Trump administration’s actions would “perse powerful, unpopular minorities.”
“The Trump administration cannot argue that this effort has something to do with maintaining the financial integrity of the Medicaid program,” Cannon said. “There is a huge threat to Medicaid’s financial integrity and that debate will not be washed away.”
Immigrants’ Medicaid attacks
National Republicans target health spending on immigrants in a variety of ways. The GOP spending laws that Trump calls “one big beautiful bill” will reduce state rebates Around the country For example, in California, federal rebates for immigrants without legal status will be 50% for emergency services, down from 90% of the Medicaid expanded population.
The Trump administration is also expanding Medicaid compensation to immigrants with previously covered temporary legal status Announced in August Provide states with monthly reports pointing out those who cannot verify legal status by the Department of Homeland Security.
“All dollar errors are dollars taken away from eligible and vulnerable individuals who require Medicaid,” CMS administrator Mehmet Oz said in a statement. “This action underscores the integrity of the program, protection of taxpayer dollars, and an unwavering commitment to being strictly reserved for eligible people under the law.”
The state under review says they are following the law.
“We’re a great leader in communications,” said Mike Falk, assistant director of communications for Washington Attorney General Nick Brown.
Records show that Medicaid officials in Washington are flooded with questions from CMS about federal payments covering immigrant emergency situations and pregnancy care without legal status.
The email shows Illinois officials met with the CMS and asked for an extension to share the data. The CMS denied the request, saying federal regulators could have withheld the funds in the state.
“We’ve seen a lot of people who have had a lot of trouble with us,” said Melissa Kura, a spokesman for the Illinois Department of Healthcare and Family Services.
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Shastri reported from Milwaukee.
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