The Trump administration has ordered states to investigate some people on Medicaid to determine whether they are ineligible for the program because of their immigration status. The five states reported that together they had received more than 170,000 names, an “unprecedented” move by the federal government that ensnares the federal state health care program in the president's crackdown on immigration.
Advocates say the move burdens states with duplicate checks and could lead to people losing coverage simply because paperwork deadlines are missed. But Centers for Medicare and Medicaid Services Administrator Mehmet Oz said in a post on social media platform X on Oct. 31 that more than $1 billion “of federal taxpayer dollars was spent funding Medicaid for undocumented immigrants” in five states and Washington, D.C.
Total Medicaid spending in fiscal year 2024 exceeded $900 billion.
It was not clear from Oz's statement or the accompanying video what period the spending was for, and CMS officials did not immediately respond to questions about either an earlier version of this article or after Oz's statement was published.
Only U.S. citizens and some legal immigrants are eligible for Medicaid, which covers low-income and disabled people, and the closely related Children's Health Insurance Program. Individuals without legal status are not eligible for federally funded health insurance, including Medicaid, Medicare, and plans through the Affordable Care Act marketplaces.
At least one state said it disagreed with Oz's comments.
“Our insurance benefits for the undocumented are consistent with state and federal laws,” said Mark Williams, a spokesman for the Colorado Department of Health Care Policy and Financing, which administers the state's Medicaid program. “The $1.5 million figure cited by federal leaders today is based on incorrect preliminary findings and has been refuted by corroborating evidence from our department's experts.”
He added: “It is disappointing that the administration is declaring this figure final when it is clearly too high and the conversations are largely in the learning and discussion phase.”
In August, CMS began sending states the names of people enrolled in Medicaid who the agency suspects may not be eligible, requiring state Medicaid agencies to verify their immigration status.
In October, KFF Health News reached out to Medicaid agencies in 10 states. Five of them provided estimates of the number of names they have received from the Trump administration and expect more to come: Colorado provided about 45,000 names, Ohio 61,000, Pennsylvania 34,000, Texas 28,000 and Utah 8,000. More than 70 million people are enrolled in Medicaid.
Most of these states declined to comment further. Medicaid agencies in California, Florida, Georgia, New York and South Carolina declined to say how many names they were ordered to review or did not respond.
Oz said in his X post that California wasted $1.3 billion on caring for people not eligible for Medicaid, while Illinois spent $30 million, Oregon $5.4 million, Washington State $2.4 million, Washington D.C. $2.1 million, and Colorado $1.5 million.
“We notified the states and many started returning the money,” he said. “What if we never asked?”
Washington, D.C., Medicaid Director Melisa Byrd said CMS identified administrative costs for the county program, which covers people regardless of immigration status, that should not have been billed to the federal government, and her agency has already addressed some of those areas. “We run a large, very complex program, and when bugs or bugs happen, we fix them,” she said.
The program plans to return $654,014 to CMS by mid-November.
All five states, plus Washington, D.C., are led by Democrats, and President Donald Trump won none of them in the 2024 election.
In recent days, Deputy Secretary of Health and Human Services Jim O'Neill started posting pictures According to him, X number of people are convicted felons living in the US without authorization and receiving Medicaid benefits.
O'Neill could not be reached for comment.
“We're very concerned because, frankly, this seems like a waste of government resources and furthers the administration's anti-immigrant agenda,” said Ben D'Avanzo, senior health advocacy strategist at the National Immigration Law Center, an advocacy group. “This duplicates what states are already doing,” he said.
As part of the administration's crackdown on people in the U.S. without authorization, President Donald Trump in February directed federal agencies to take action to ensure they do not receive benefits in violation of federal law.
In June, advisers to Health and Human Services Secretary Robert F. Kennedy Jr. ordered CMS to share information about Medicaid enrollees with the Department of Homeland Security, prompting a lawsuit from some states concerned that the administration would use the information for its deportation campaign against unauthorized residents.
In August, a federal judge ordered HHS stop sharing information with immigration authorities.
State Medicaid agencies use databases maintained by the Social Security Administration and the Department of Homeland Security to verify the immigration status of enrollees.
If states have to contact individuals to reconfirm their citizenship or immigration status, it could cause some to unnecessarily fall off the rolls—for example, if they don't see a letter requesting documentation or don't meet deadlines to respond.
“I'm not sure the data suggests there's really a need for this additional review,” said Marian Jarlenski, a professor of health policy at the University of Pittsburgh School of Public Health.
Oz made it clear that the Trump administration does not agree with this.
“Whether consciously or not, the states' behavior underscores the horrific reality that American taxpayers are footing the bill for Medicaid coverage of illegal immigrants, despite many Democrats and the media insisting otherwise,” Oz said in his X post.
In an August press release, CMS said it would ask states to confirm program eligibility for enrollees whose immigration status could not be verified through federal databases. “We expect states to take swift action and will monitor progress monthly,” the agency said.
Leonardo Cuello, a research professor at Georgetown University's Center for Children and Families, called the CMS order to states “unprecedented” in the 60-year history of the Medicaid program.
He said the federal government may have been unable to verify the immigration status of some individuals because names were misspelled or outdated, such as when a beneficiary is identified by a maiden name rather than a woman's last name. The names may also include people benefiting from Emergency Medicaid, a program that covers the costs of emergency hospital care, including labor and childbirth, for people regardless of immigration status.
“CMS is conducting pointless immigration status checks on people whose hospital bills were paid by Emergency Medicaid,” Cuello said.
Oz noted in his post that federal law “does allow states to use Medicaid dollars for emergency care, regardless of the citizenship or immigration status of patients,” and that states can “legally create Medicaid programs for undocumented immigrants using their own state tax dollars, as long as no federal tax dollars are used.”
States of Oz mentioned everything manage your own such programs.
The audits create an additional burden for state Medicaid agencies already busy preparing to implement the tax and policy law Trump signed into law in July. The measure, which Republicans call the One Big Beautiful Bill Act, makes many changes to Medicaid, including adding a work requirement in most states starting in 2027. The law also requires most states to review the eligibility of many adult Medicaid enrollees more frequently—at least twice a year.
“My fear is that states may do unnecessary tests that will create a burden on some members who will lose health insurance when they shouldn’t,” Cuello said. “This will be a lot of work for CMS and states for very little cost.”
Cuello said the effort may have “more political value than actual value.”
Brandon Qualina, a spokesman for the Pennsylvania Department of Human Services, which administers Medicaid in the state, said the state already requires each Medicaid applicant to prove their citizenship or, if applicable, their immigration status.
However, he said, the CMS directive “represents a new process and DHS is carefully reviewing the list to take appropriate action.”
Oz did not name Pennsylvania, which Trump won in 2024, in his post.
If a legal resident doesn't have a Social Security number, the state confirms their legal status by checking the Department of Homeland Security database as well as checking specific immigration documents, he said.
Other state Medicaid agencies said they also need to regroup before reaching out to enrollees.
“Our teams just received this notice and are working on the process by which we will conduct these reviews,” Jennifer Strohecker, then Utah's Medicaid director, told the state advisory board in August.
Renuka Rayasam and Ray Ellen Beachell contributed reporting.
