Feds direct states to check immigration status of their Medicaid enrollees

Anna Claire Vollers, Stateline.org on Aug 22, 2025

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This week, the Trump administration’s Centers for Medicare & Medicaid Services (CMS) announced an effort to check the immigration status of people who get their health insurance through Medicaid and the Children’s Health Insurance Program.

Medicaid is the public health insurance program for people with low incomes that’s jointly funded by states and the federal government. For families that earn too much to qualify for Medicaid but not enough to afford private insurance, CHIP is a public program that provides low-cost health coverage for their children.

The feds will begin sending states monthly enrollment reports that identify people with Medicaid or CHIP whose immigration or citizenship status can’t be confirmed through federal databases. States are then responsible for verifying the citizenship or immigration status of individuals in those reports. States are expected to take “appropriate actions when necessary, including adjusting coverage or enforcing non-citizen eligibility rules,” according to a CMS press release.

“We are tightening oversight of enrollment to safeguard taxpayer dollars and guarantee that these vital programs serve only those who are truly eligible under the law,” Robert F. Kennedy Jr., who oversees CMS as secretary of the U.S. Department of Health and Human Services, said in a press release announcing the new program.

As of April, roughly 71 million adults and children nationwide have Medicaid coverage, while another 7 million children have insurance through CHIP. Immigrants under age 65 are less likely to be covered by Medicaid than U.S.-born citizens, according to an analysis from health research organization KFF.

Immigrants who are in the country illegally aren’t eligible for federally funded Medicaid and CHIP. Only citizens and certain lawfully present immigrants — green card holders and refugees, for example — can qualify.

But some states have chosen to expand Medicaid coverage for immigrants with their own funds. Twenty-three states offer pregnancy-related care regardless of citizenship or immigration status, according to KFF. Fourteen states provide coverage for children in low-income families regardless of immigration status, while seven states offer coverage to some adults regardless of status.

The tax and spending package President Donald Trump last month cuts federal spending on Medicaid by more than $1 trillion, leaving states to either make up the difference with their own funds or reduce coverage. But the new law also includes restrictions on coverage for certain immigrants, including stripping eligibility from refugees and asylum-seekers.

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Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.