President Donald Trump's administration has required states to screen recipients of Medicaid, a program that covers people with low incomes or people with disabilities, to see if they meet eligibility requirements based on their immigration status.
So far, five states have reported that they have already received a total of more than 170,000 names, an unprecedented move by the federal government that would involve the federal state health care program in the president's anti-immigration campaign.
Immigrant rights advocates warn the decision puts an additional burden on states by having to duplicate checks and could lead some people to lose health insurance simply by failing to submit paperwork on time.
However, Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services (CMS), said in a post on the social platform. [que pagan impuestos federales] in Funding Medicaid for Undocumented Immigrants” in five states and Washington, DC.
In fiscal year 2024, total Medicaid spending exceeded $900 billion.
Neither Oz's statement nor the accompanying video detailed the period during which those costs were incurred, and CMS officials did not immediately respond to questions asked.
Federal rules limit eligibility for Medicaid and the Children's Health Insurance Program (CHIP) to U.S. citizens and some immigrants who legally reside in the country.
People without legal immigration status cannot receive any federally funded health insurance, including Medicaid, Medicare, and plans purchased through the insurance exchanges created by the Affordable Care Act (ACA).
Several states said they disagreed with Oz's statements.
“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 inaccurate preliminary findings and is refuted by our agency’s experts.”
He added: “It is disappointing that the administration is declaring this figure final when it is clearly exaggerated and negotiations are still at the information and debate stage.”
Illinois Medicaid officials sharply criticized the CMS chief's comments.
“The Trump administration is once again spreading misinformation about the routine use of Medicaid funds,” said Illinois Medicaid spokeswoman Melissa Kula.
“This is not a reality show, and there is no conspiracy to circumvent federal law and provide health care to people who are not eligible. Dr. Oz needs to stop promoting conspiracy theories and focus on improving health care for Americans,” Kula said.
The Washington State Department of Health Services, which administers the state's Medicaid program, also had harsh words. “The numbers Dr. Oz posted on social media are inaccurate,” spokeswoman Rachelle Alongi said. “We were very surprised to see Dr. Oz's message, especially as we continue to work in good faith with the Centers for Medicare and Medicaid Services (CMS) to answer their questions and clear up any confusion.”
In August, CMS began sending states the names of Medicaid enrollees the agency suspects are ineligible, requiring state program agencies to confirm their immigration status.
KFF Health News contacted 10 state Medicaid agencies in October. Five of them provided an estimate of the number of names they have received from the Trump administration to date, but they estimate there will be more: Utah has received 8,000 names; Colorado – 45,000; Pennsylvania – 34,000; Ohio, 61,000; and Texas – 28,000.
There are currently more than 70 million people covered by Medicaid.
Most of these states declined to comment further. Another five — California, New York, Georgia, Florida and South Carolina — declined to say how many names they were asked to review or did not respond at all.
Oz stated in his
“We have notified the states and many have already started returning the money,” he said. “But what would have happened if we had never asked?”
Washington, D.C., Medicaid Director Melisa Byrd said CMS identified administrative costs for the county program, which covers people regardless of their immigration status, that should not have been billed to the federal government, and that her agency has already corrected some of those errors.
“We manage a large and very complex program, and when errors occur, we fix them,” he said. The program plans to reimburse CMS $654,014 by mid-November.
All five states, plus Washington, D.C., are governed 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 publishing on a social platform
O'Neill could not be reached for comment.
“We're very concerned because, frankly, this seems like a waste of government resources and reinforces the administration's anti-immigrant agenda,” said Ben D'Avanzo, senior health policy strategist at the National Immigration Law Center, an immigrant rights organization. “This duplicates what states are already doing,” he added.
As part of a crackdown on people without legal status, the President in February directed federal agencies to ensure that people without legal status do not receive benefits that violate federal law.
In June, Health and Human Services (HHS) Secretary Robert F. Kennedy ordered CMS to share information about people on Medicaid with the Department of Homeland Security (DHS). This prompted legal action from several states concerned that the information would be used for deportation campaigns.
In August, a federal judge ordered HHS stop sharing this information with immigration authorities.
State Medicaid agencies typically use databases managed by Social Security, the Department of Homeland Security and other government agencies to verify applicants' immigration status.
If states have to recontact enrollees to double-check their immigration status or citizenship, some may unnecessarily lose coverage, for example, if they do not see a letter requesting documentation or do not respond in a timely manner.
“I’m not sure there’s enough evidence to justify 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.
In an August statement, CMS explained that it is asking states to verify eligibility for people whose immigration status cannot be verified through federal databases. “We expect states to act quickly and will monitor progress month by month,” 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 people because their names were misspelled or outdated, such as when a beneficiary is listed with a maiden name rather than a married name.
The lists may also include people who receive Emergency Medicaid, which covers emergency hospital care, including labor and delivery, regardless of immigration status.
“CMS is conducting unnecessary immigration status checks on people whose hospital expenses were covered by Emergency Medicaid,” Cuello explained.
Oz noted in his post that federal law “allows states to use Medicaid funds 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 taxes, as long as no federal funds are used.”
All the states Oz mentioned They run their own programs this type.
The changes place an additional burden on state Medicaid agencies, which are already busy preparing to implement the tax and spending law Trump signed into law in July.
The legislation, which Republicans have dubbed the “One Big Beautiful Bill,” makes numerous changes to Medicaid, including introducing work requirements in most states starting in 2027. It also requires them to review participants' eligibility for the program at least twice a year.
“My fear is that states will do unnecessary audits that will put a burden on some beneficiaries who will lose health insurance when they shouldn’t,” Cuello explained. “This will be a lot of work for CMS and states with very little real results.”
Because the new policy allows the agency to release data, Cuello said the effort has more political than practical value.
Brandon Qualina, a spokesman for the Pennsylvania Department of Human Services, which administers the Medicaid program, said the state already requires each applicant to prove their citizenship or, if applicable, their immigration status.
“However, the list of names and instructions issued by CMS last month is a new process, and the agency is carefully reviewing the list for appropriate action,” he explained.
In his post, Oz did not mention Pennsylvania, a state that Trump won in 2024.
When a legal resident does not have a Social Security number, the state verifies their status using the Department of Homeland Security database, in addition to checking specific immigration documents, he added.
Other state Medicaid agencies said they have not yet begun contacting participants.
“We are developing a process for doing these reviews,” Jennifer Strehecker, Utah's Medicaid director, said during an August meeting with the state advisory board.
Renuka Rayasam and Ray Ellen Beachell contributed to this article..
