Trump Administration Takes Action on Illegal Immigrants Getting Medicaid

Newsweek

28-05-2025

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The Centers for Medicare & Medicaid Services (CMS) has announced heightened oversight to stop states from using federal Medicaid funds to provide nonemergency health care to undocumented migrants.
The policy change, linked to an executive order President Donald Trump signed in February, places states on notice for potential recoupment of funds spent in violation of federal law.
Newsweek has contacted the CMS for comment via email.
Why It Matters
This effort marks a significant escalation in federal and state tensions over the boundaries of Medicaid eligibility and the use of taxpayer funds, particularly as debates over immigration policy and public program funding sharpen nationwide.
Medicaid, which serves tens of millions of low-income Americans, operates with shared funding and regulatory authority by both federal and state governments. The new measures could affect state budgets and access to care for some populations in states with broader interpretations of Medicaid eligibility.
A stock image of migrants gathering for a rally at the U.S.-Mexico border.
A stock image of migrants gathering for a rally at the U.S.-Mexico border.
Aimee Melo/dpa via AP
What To Know
The CMS said in a news release on Tuesday, "Under federal law, federal Medicaid funding is generally only available for emergency medical services for noncitizens with unsatisfactory immigration status who would otherwise be Medicaid-eligible, but some states have pushed the boundaries, putting taxpayers on the hook for benefits that are not allowed."
The heightened federal oversight includes focused evaluations of selected state Medicaid spending reports, in-depth reviews of states' financial management systems and assessments of eligibility policies to close loopholes.
States found to have misallocated funds would face federal recoupment.
The CMS announcement did not specify which states were under review or directly affected by the new enforcement, simply citing "select states."
Currently, 14 states and Washington, D.C., offer health coverage to undocumented migrants: California, New York, Illinois, Washington, New Jersey, Oregon, Massachusetts, Minnesota, Colorado, Connecticut, Utah, Rhode Island, Maine and Vermont.
These states offer different kinds of support for those without legal status in the U.S. Some offer coverage to those over 65 years old, while others offer covered care to children and pregnant women.
The agency's action focuses specifically on states using federal Medicaid dollars, not state funding only, in ways CMS deems improper.
CMS urged all states to immediately review and update internal controls, eligibility systems and cost allocation policies to ensure federal compliance.
The agency made clear that "any improper spending on noncitizens will be subject to recoupment of the federal share."
The CMS announcement directly ties the initiative to Trump's Ending Taxpayer Subsidization of Open Borders executive order, which seeks to ensure that federal programs serve only those eligible under law.
What People Are Saying
Dr. Ben Sommers, a professor of health care economics at Harvard T.H. Chan School of Public Health, Boston, told Newsweek: "Federal law already prohibits Medicaid funds for nonemergency care for undocumented immigrants. I have not seen any data to suggest that what the administration is discussing here is a substantial problem. Emergency Medicaid (which is legal) already represents a very small share of Medicaid spending, which suggests that this additional enforcement is unlikely to yield any notable savings. It sounds more like a political message and posturing about immigration, rather than a genuine attempt to detect fraud or improve the financial circumstances of the Medicaid program."
He added: "More notably, when you couple this with the ongoing legislative efforts in the Congressional Budget Bill to cut millions of people from Medicaid, it appears that the administration is more interested in cutting health care services and satisfying its conservative anti-immigrant base than in making health care more affordable for people."
Tiffany Joseph, a professor of sociology and international affairs at Northeastern University, told Newsweek: "This move will have a significant impact on the health care access and health of undocumented and even documented immigrants in states that use their own funds to provide nonemergency care to these populations. As those states will be under more scrutiny from the federal government, they will have to make hard choices between complying with the law and extending care to some of the most vulnerable in their states. The targeting of immigrants will have ripple effects for naturalized and U.S.-born citizens in mixed-status families and deter those individuals from applying for and using Medicaid and other social safety nets for which they are eligible due to fear of increased surveillance."
She added: "If people do not have access to health coverage through Medicaid or some other means, they will have less access to regular preventive care and go to emergency rooms for care with more severe health problems. As this is the most expensive form of health care, this will increase health care costs for everyone and significantly increase already very long wait times in emergency departments around the country. Though focused on immigrants, this enhanced federal oversight will negatively affect health care access for the broader population. This decision alongside the proposed Medicaid cuts in the recently approved GOP House Budget Bill show that the Trump administration and supporting legislators are not concerned about health care access or the collective health of people living in the United States."
Alexandra Filindra, a professor of political science and psychology at the University of Illinois, Chicago, told Newsweek: "If people are excluded from routine care, they may not get vaccinated for all kinds of contagious diseases, increasing the risk of disease for children and susceptible adults. People may delay care until their symptoms are acute, landing in the ER. Emergency care is far more expensive than routine care, and the costs will either have to be absorbed by hospitals, leading to financial trouble, or states, leading to higher taxes. Pregnant women may not get necessary prenatal care leading to health problems in American citizen babies that will have to be addressed by the health care system for the next century. Excluding undocumented people from health insurance will not make them self-deport, it will make Americans less healthy and poorer. It is also cruel and unbecoming of a civilized, democratic society."
Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, said in a news release: "Medicaid is not, and cannot be, a backdoor pathway to subsidize open borders. States have a duty to uphold the law and protect taxpayer funds. We are putting them on notice—CMS will not allow federal dollars to be diverted to cover those who are not lawfully eligible."
He told Fox News' Sunday Morning Futures: "We do have to support Americans who are most vulnerable. That stated, we have to make the program sustainable. We have to protect it."
"There's much we can do as a country. It's a shared responsibility. We have to do it together. But the buck stops here. We've got to clean up the system. We're not paying $200 million for housekeeping anymore a year. We're not going to pay for illegal immigrants in states that are submitting those claims. Why should people living in Mississippi, Texas, or Florida be paying for illegal immigrants getting health care in California?"
Drew Snyder, the deputy administrator of the CMS, said in the news release: "Medicaid funds must serve American citizens in need and those legally entitled to benefits. If states cannot or will not comply, CMS will step in."
What Happens Next
CMS said it would continue "to act decisively to ensure Medicaid dollars serve their true purpose—protecting people eligible for the program under federal law."