Overview: A Sweeping Federal Review Produces Minimal Results
Last August, the Trump administration launched a sweeping effort to detect undocumented immigrants enrolled in Medicaid. Federal authorities sent states the names of hundreds of thousands of Medicaid enrollees. Their instruction was clear: verify each person’s immigration status and terminate coverage for any ineligible enrollees.
Seven months later, however, findings from five states tell a very different story. Reviews shared with KFF Health News show little evidence of the widespread problem the federal government claimed to be addressing. Moreover, the data suggests that most flagged individuals are, in fact, legally eligible U.S. citizens or lawfully present immigrants.
What the State Data Reveals
Texas, Ohio, and Utah: Numbers Tell the Story
State-level results reveal a striking gap between the administration’s expectations and reality. Consider the following outcomes:
- Texas reviewed records of more than 28,000 Medicaid enrollees at the federal government’s request. It terminated coverage for just 77 individuals.
- Ohio checked 65,000 enrollees and disenrolled only 260 people from the program.
- Utah identified 8,000 enrollees for review and removed just 42 from its rolls.
Together, these three states reviewed more than 100,000 enrollees and terminated fewer than 400 — a removal rate of well under 1%.
Pennsylvania and Colorado: Zero Terminations
Results from Pennsylvania and Colorado are even more striking. Both states checked a combined 79,000 names. As of March, neither state had terminated a single enrollee based on immigration status.
Ohio’s Findings: Most Were Already Confirmed Citizens
Ohio’s data further undermines the premise of the federal review. Of the 65,000 names the federal government referred, state records already confirmed 53,000 as U.S. citizens. An additional 11,000 showed appropriate immigration status for Medicaid eligibility. Caseworkers then reviewed only the remaining 1,000 names for additional follow-up.
Why Experts Call the Reviews Redundant
States Already Check Immigration Status at Enrollment
Critics argue the federal review duplicates work states complete during the enrollment process. Leonardo Cuello, a research professor at Georgetown University’s Center for Children and Families, points out that states verify immigration status when people first apply for Medicaid. Therefore, the federal government’s directive to reverify the same data adds no meaningful value.
Cuello described the effort as “burdensome” and “wasteful.” He noted that forcing states to go through the same bureaucratic process twice consumes resources without producing results. Furthermore, he argued the outcome was entirely predictable given the initial enrollment checks already in place.
CMS Defends the Process
Nevertheless, the Centers for Medicare & Medicaid Services (CMS) has defended the reviews. CMS spokesperson Chris Krepich said in a statement that the checks verify eligibility “for certain enrollees whose status could not be confirmed through federal data sources.” However, CMS did not respond to detailed questions about the state-level findings or provide a national summary of results from all 50 states and the District of Columbia.
The Data-Sharing Controversy
DHS Access and Legal Battles
Beyond the reviews themselves, a parallel controversy emerged over how Medicaid data is being used. In June 2025, advisers to HHS Secretary Robert F. Kennedy Jr. directed CMS to share Medicaid enrollee information with the Department of Homeland Security. Several states filed lawsuits, alarmed that the administration would use this data to support its immigration enforcement and deportation campaign.
Court Ruling Sets Limits
A federal judge ruled in December 2025 that Immigration and Customs Enforcement (ICE) workers could access Medicaid data only for individuals confirmed to be in the country without legal authorization. This ruling applied specifically to the Medicaid databases of the states that filed suit.
Despite the legal constraints, CMS continues to send states new lists of names every few months. State officials note that the volume of names has declined since the first large batch arrived last summer.
Who Is Eligible for Medicaid?
Eligibility Rules Are Clear
Medicaid covers health care costs for low-income individuals and people with disabilities. Only U.S. citizens and certain lawfully present immigrants qualify for the program. Undocumented individuals do not qualify for full Medicaid coverage under federal law.
The same eligibility rules apply to Medicare and to health plans sold through Affordable Care Act marketplaces. However, federal law does allow Medicaid to reimburse hospitals for emergency care provided to undocumented individuals, as long as they meet income and other program requirements.
What Happens Next?
An Ongoing but Shrinking Process
CMS shows no signs of halting its review process entirely. The agency continues to send states updated lists of enrollee names for verification. Still, state officials report that the number of names in each new batch is smaller than in previous rounds.
Meanwhile, the administration has not clarified whether it plans to refer the names of terminated enrollees to federal immigration authorities. CMS did not answer questions on this point when approached by KFF Health News.
Burden on States Continues
For states, each new batch of names creates real administrative work. Staff must pull records, verify data, and contact enrollees — all to repeat a process that most states already completed during initial enrollment. As a result, researchers and state advocates continue to question both the cost and the policy rationale behind the ongoing reviews.
