Trump Administration Investigates Medicaid Spending On Immigrants In Blue States

The Trump management is taking its migration crackdown to nan wellness attraction information net, launching Medicaid spending probes successful astatine slightest six Democratic-led states that supply broad wellness sum to mediocre and abnormal immigrants surviving successful nan U.S. without imperishable ineligible status.

The Centers for Medicare & Medicaid Services is scouring payments covering wellness attraction for immigrants without ineligible position to guarantee location isn't immoderate waste, fraud, aliases abuse, according to nationalist records obtained by KFF Health News and The Associated Press. While acknowledging that states tin measure nan national authorities for Medicaid emergency and gestation attraction for immigrants without ineligible status, national officials person sent letters notifying authorities wellness agencies successful California, Colorado, Illinois, Minnesota, Oregon, and Washington that they are reviewing national and authorities payments for aesculapian services specified arsenic medicine narcotics and specialty care.

The national agency told nan states it is reviewing claims arsenic portion of its committedness to support Medicaid's fiscal integrity. California is nan biggest target aft nan authorities self-reported overcharging nan national authorities for wellness attraction services delivered to immigrants without ineligible status, wished to beryllium astatine slightest $500 million, spurring nan threat of a lawsuit.

"If CMS determines that California is utilizing national money to salary for aliases subsidize healthcare for individuals without a satisfactory migration position for which national backing is prohibited by law," according to a missive dated March 18, "CMS will diligently prosecute each disposable enforcement strategies, including, accordant pinch applicable law, reductions successful national financial information and imaginable referrals to nan Attorney General of nan United States for imaginable suit against California."

The investigations travel arsenic nan White House and a Republican-controlled Congress slashed payer spending connected migrant wellness attraction done cuts successful President Donald Trump's spending-and-tax rule passed this summer. The management is besides pushing group surviving successful nan U.S. without authorization disconnected Medicaid rolls. Health argumentation experts opportunity these moves could hamper attraction and time off information nett hospitals, clinics, and different providers financially vulnerable. Some Democratic-led states — California, Illinois, and Minnesota — person already had to extremity aliases slim down their Medicaid programs for immigrants owed to ballooning costs. Colorado is besides considering cuts owed to costs overruns.

At nan aforesaid time, 20 states are pushing backmost connected Trump's migration crackdown by suing nan management for handing complete Medicaid information connected millions of enrollees to deportation officials. A national judge temporarily halted nan move. California's lawyer general, Rob Bonta, who led that challenge, says nan Trump management is launching a governmental onslaught connected states that clasp immigrants successful Medicaid programs.

"The full thought that there's waste, fraud, and maltreatment is contrived," Bonta said. "It's manufactured. It's invented. It's a catchall building that they usage to warrant their predetermined anti-immigrant agenda."

Trump targets immigrants

Immigrants lacking imperishable ineligible position are not eligible to enroll successful broad Medicaid coverage. However, states measure nan national authorities for emergency and gestation attraction provided to anyone.

Fourteen states and Washington, D.C., expanded their Medicaid programs pinch their ain costs to screen low-income children without ineligible status. Seven of those states, positive Washington, D.C., person besides provided full-scope sum to immoderate big immigrants surviving successful nan state without authorization.

The Trump management appears to beryllium targeting only states pinch afloat Medicaid sum for some kids and adults without ineligible status. Utah, Massachusetts, and Connecticut, which supply Medicaid sum only to migrant children, person not received letters, for instance. CMS declined to supply a afloat database of states it is targeting.

Federal officials opportunity it is their ineligible correct and work to scrutinize states for misspending connected migrant wellness sum and are taking "decisive action to extremity that."

"It is simply a matter of nationalist interest that immoderate states person pushed nan boundaries of Medicaid rule to connection extended benefits to individuals unlawfully coming successful nan United States," CMS spokesperson Catherine Howden said astir nan agency's probe of selected states. The oversight is intended to "ensure national costs are reserved for legally eligible individuals, not for governmental experiments that break nan law," she said.

Health argumentation researchers and economists opportunity providing Medicaid sum to immigrants for preventive services and curen of chronic wellness conditions staves disconnected much costly attraction for patients down nan road. It besides tamps down security premium increases and nan magnitude of uncompensated attraction for hospitals and clinics.

Francisco Silva, president and CEO of nan California Primary Care Association, said nan Trump management is threatening to thrust up wellness attraction costs and make it much difficult to entree care.

"The effect is emergency rooms would get truthful crowded that ambulances person to beryllium diverted distant and group successful a existent emergency can't get into nan hospital, and nationalist wellness threats for illustration illness outbreaks," Silva said.

California has taken a health-care-for-all approach, providing sum to 1.6 cardinal immigrants without ineligible status. The description , which was rolled retired from 2016 to 2024, is estimated to costs $12.4 cardinal this year. Of that, $1.3 cardinal is paid by nan national authorities for emergency and pregnancy-related care.

As California rolled retired its description , nan authorities erroneously billed nan national authorities for attraction provided to immigrants without ineligible position — specifications that person not antecedently been reported and that erstwhile authorities officials shared pinch KFF Health News and nan AP. The authorities improperly billed for services specified arsenic intelligence wellness and addiction services, medicine drugs, and dental care.

Jacey Cooper, who served arsenic California's Medicaid head from 2020 to 2023, said she discovered nan correction and reported it to national regulators. Cooper said nan authorities had been moving to salary backmost astatine slightest $500 cardinal identified by nan national government.

"Once I identified nan problem, I thought it was really important to study it and we did," Cooper said. "We return waste, fraud, and maltreatment very seriously."

It's not clear whether that money has been repaid. The state's Medicaid agency says it does not cognize really CMS calculated nan overpayments aliases "what is included successful that amount, what clip play it covers, and if aliases erstwhile it was collected," said spokesperson Tony Cava.

California has an enormously analyzable Medicaid program: It serves nan largest organization successful nan federation — astir 15 cardinal group — pinch a fund of astir $200 cardinal this fiscal year.

Matt Salo, a nationalist Medicaid expert, said these types of mistakes hap successful states passim nan state because nan programme is rife pinch overlapping national and authorities rules. Salo and different argumentation analysts agreed that states person nan authority to administer their Medicaid programs arsenic they spot fresh and guidelines retired misuse of national funds.

And Michael Cannon, head of wellness argumentation studies astatine nan libertarian Cato Institute, said nan Trump administration's actions "persecute a number that's unpopular pinch nan powers that be."

"The Trump management cannot support that this effort has thing to do pinch maintaining nan fiscal integrity of nan Medicaid program," Cannon said. "There are truthful overmuch bigger threats to Medicaid's fiscal integrity, that that statement conscionable doesn't wash."

Immigrants’ Medicaid nether attack

National Republicans person targeted wellness spending connected immigrants successful different ways. The GOP spending law, which Trump calls nan "One Big Beautiful Bill," will little reimbursement to states astir nan state successful October 2026. In California, for example, national reimbursement for immigrants without ineligible position will spell to 50% for emergency services, down from 90% for nan Medicaid description population, according to Cava.

The Trump management is besides scaling backmost Medicaid sum to immigrants pinch impermanent ineligible position who were antecedently covered and announced successful August that it would supply states pinch monthly reports pointing retired enrollees whose ineligible position could not beryllium confirmed by nan Department of Homeland Security.

"Every dollar misspent is simply a dollar taken distant from an eligible, susceptible individual successful request of Medicaid," CMS Administrator Mehmet Oz said successful a statement. "This action underscores our unwavering committedness to programme integrity, safeguarding payer dollars, and ensuring benefits are strictly reserved for those eligible nether nan law."

States nether reappraisal opportunity they are pursuing nan law.

"Spending money connected a congressionally authorized aesculapian use programme that helps group get emergency treatments for cancer, dialysis, and anti-rejection medications for organ transplants is decidedly not waste, fraud and abuse," said Mike Faulk, lawman communications head for Washington authorities Attorney General Nick Brown.

Records show Washington Medicaid officials person been inundated pinch questions from CMS astir national payments covering emergency and gestation attraction for immigrants without ineligible status.

Emails show Illinois officials met pinch CMS and sought an hold to stock its data. CMS denied that petition and national regulators told nan authorities that its backing could beryllium withheld.

"Thousands of Illinois residents trust connected these programs to lawfully activity captious wellness attraction without fearfulness of deportation," said Melissa Kula, a spokesperson for nan Illinois Department of Healthcare and Family Services, noting that immoderate national trim would beryllium "impossible" for nan authorities to backfill.

Shastri reported from Milwaukee.

The Associated Press Health and Science Department receives support from nan Howard Hughes Medical Institute's Department of Science Education and nan Robert Wood Johnson Foundation. The AP is solely responsible for each content.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent work of nan California Health Care Foundation.