SACRAMENTO, Calif. — The Trump administration is taking its immigration crackdown to the well being care security internet, launching Medicaid spending probes in at the very least 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 & 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, based on 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 providers comparable to pharmaceuticals and specialty care.
The federal company informed the states it’s reviewing claims as a part of its dedication to keep up Medicaid’s fiscal integrity. California is the largest goal after the state self-reported overcharging the federal authorities for well being care providers delivered to immigrants with out authorized standing, decided to be at the very least $500 million, spurring the specter of a lawsuit.
“If CMS determines that California is using federal money to pay for or subsidize healthcare for individuals without a satisfactory immigration status for which federal funding is prohibited by law,” based on a letter dated March 18, “CMS will diligently pursue all available enforcement strategies, including, consistent with applicable law, reductions in federal financial participation and possible referrals to the Attorney General of the United States for possible lawsuit against 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 legislation handed this summer season. The administration can also be pushing individuals residing within the U.S. with out authorization off Medicaid rolls. Well being coverage consultants say these strikes might hamper care and depart security internet hospitals, clinics, and different suppliers financially weak. 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 also be contemplating cuts as a result of price overruns.
On the similar 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 decide quickly 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 whole idea that there’s waste, fraud, and abuse is contrived,” Bonta stated. “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 should not eligible to enroll in complete Medicaid protection. Nonetheless, 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 with out authorization.
The Trump administration seems to be concentrating 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 acquired letters, as an illustration. CMS declined to supply a full checklist of states it’s concentrating on.
Federal officers say it’s their authorized proper and accountability to scrutinize states for misspending on immigrant well being protection and are taking “decisive action to stop that.”
“It is a matter of national concern that some states have pushed the boundaries of Medicaid law to offer extensive benefits to individuals unlawfully present in the United States,” CMS spokesperson Catherine Howden stated in regards to the company’s probe of chosen states. The oversight is meant to “ensure federal funds are reserved for legally eligible individuals, not for political experiments that violate the law,” she stated.
Well being coverage researchers and economists say offering Medicaid protection to immigrants for preventive providers and remedy of power well being circumstances 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 Major Care Affiliation, stated the Trump administration is threatening to drive up well being care prices and make it tougher to entry care.
“The impact is emergency rooms would get so crowded that ambulances have to be diverted away and people in a real emergency can’t get into the hospital, and public health threats like disease outbreaks,” Silva stated.
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 12 months. 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 providers comparable to psychological well being and dependancy providers, pharmaceuticals, and dental care.
Jacey Cooper, who served as California’s Medicaid director from 2020 to 2023, stated she found the error and reported it to federal regulators. Cooper stated the state had been working to pay again at the very least $500 million recognized by the federal authorities.
“Once I identified the problem, I thought it was really important to report it and we did,” Cooper stated. “We take waste, fraud, and abuse very seriously.”
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 is included in that amount, what time period it covers, and if or when it was collected,” stated 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 knowledgeable, stated 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, stated the Trump administration’s actions “persecute a minority that’s unpopular with the powers that be.”
“The Trump administration cannot maintain that this effort has anything to do with maintaining the fiscal integrity of the Medicaid program,” Cannon stated. “There are so much bigger threats to Medicaid’s fiscal integrity, that that argument just doesn’t wash.”
Immigrants’ Medicaid Below Assault
Nationwide Republicans have focused well being spending on immigrants in several methods. The GOP spending legislation, which Trump calls the “One Big Beautiful Bill,” 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 providers, down from 90% for the Medicaid growth inhabitants, based on Cava.
The Trump administration can also be scaling again Medicaid protection to immigrants with momentary authorized standing who have been beforehand lined and introduced in August that it might present states with month-to-month stories mentioning enrollees whose authorized standing couldn’t be confirmed by the Division of Homeland Safety.
“Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid,” CMS Administrator Mehmet Oz stated in an announcement. “This action underscores our unwavering commitment to program integrity, safeguarding taxpayer dollars, and ensuring benefits are strictly reserved for those eligible under the law.”
States underneath overview say they’re following the legislation.
“Spending money on a congressionally authorized medical benefit program that helps people get emergency treatments for cancer, dialysis, and anti-rejection medications for organ transplants is decidedly not waste, fraud and abuse,” stated Mike Faulk, deputy communications director for Washington state Lawyer Common 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 informed the state that its funding may very well be withheld.
“Thousands of Illinois residents rely on these programs to lawfully seek critical health care without fear of deportation,” stated Melissa Kula, a spokesperson for the Illinois Division of Healthcare and Household Providers, noting that any federal reduce could be “impossible” 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 Information, which publishes California Healthline, an editorially impartial service of the California Well being Care Basis.
