In a win for President Donald Trump’s immigration crackdown, a recent court ruling has cleared the way for U.S. Immigration and Customs Enforcement to resume using states’ Medicaid data to find people who are in the country illegally.
The case is ongoing. But for now, immigrants — including those who are in the country legally — will have to weigh the benefits of gaining health coverage against the risk that enrolling in Medicaid could make them or their family members easier for ICE to find.
Last summer, 22 states and the District of Columbia sued the Trump administration to block information sharing between ICE and Medicaid, the state-federal health insurance program that primarily covers people with low incomes. But at the end of December, a federal judge ruled that ICE can pull some basic Medicaid data to use in its deportation proceedings, including addresses, phone numbers, birth dates and citizenship or immigration status.
The court ruled that in the states that sued, ICE is not allowed to collect information about lawful permanent residents or citizens, nor records about sensitive health information. In the 28 states that didn’t sue, however, the court did not place any limits on the Medicaid information ICE can access.
The U.S. District Court in San Francisco essentially said that government agencies can share some data, including basic identifying information. “That kind of data sharing is clearly authorized by statute,” the decision states.
But the court also ruled that agencies can’t share more sensitive data without adequately explaining why they need it. In his ruling, U.S. District Judge Vince Chhabria wrote that ICE and federal Medicaid information-sharing policies were “totally unclear and do not appear to be the product of a coherent decision-making process.” He said the states had shown they would “suffer irreparable harm from these vague and likely overbroad” policies.
By law, federal Medicaid money cannot be used to cover people who are in the country illegally.
But in recent years, nearly half of states, including some led by Republicans, have chosen to use their own Medicaid money to extend coverage to certain groups of people, such as children and pregnant women, regardless of immigration status.
Advocates for immigrants and some state officials worry that ICE’s use of Medicaid data will cause widespread fear among immigrant families, keeping them from seeking the health care that states have said they’re eligible to receive. California’s health department recently called the administration’s actions “a grave breach of public trust.”
“States have constantly reassured people that their health care information won’t be used against them, and that’s changed,” said Tanya Broder, senior counsel for health and economic justice policy at the National Immigration Law Center, an advocacy organization focused on immigrant rights.
Court filings in the lawsuit illustrate the potential impact of the ruling.
In Chicago, for example, a patient at an Esperanza Health Center delayed her first prenatal visit until her third trimester because she worried enrolling in Medicaid could put her husband at risk of deportation, the clinic reported in a December court filing. By the time she received care, she had complications that could have been addressed with earlier health visits. Another patient refused to apply for Medicaid for her child, a U.S. citizen, because she worried that seeking benefits would allow ICE to locate her.
“The expectation of privacy that we all have when we seek to enroll in a health care program has been compromised,” said Broder.
“Not only undocumented immigrants but people who live in families with immigrants and the broader community are going to feel less comfortable in applying for these health programs, over concerns their information is going to be weaponized against them or their family members.”
An about-face
Several months into Trump’s second term, ICE gained access to the personal data of 79 million Medicaid enrollees as part of its efforts to find people who may be living illegally in the United States.
Data on Medicaid enrollees is routinely exchanged between states and the feds, including to verify eligibility to receive federal funding. But the new agreement marked an about-face from past federal policies of not using such information for immigration enforcement.
The effort is unprecedented at the national level, said Medha Makhlouf, a law professor at Penn State Dickinson Law who specializes in health and immigration.
“Previously the federal government has balanced immigration enforcement interests with the protection of health-related interests,” she said. “Now they’re weighing much more heavily the interests of immigration enforcement.”
That puts the federal government at odds with states that have expanded health coverage as a matter of public health and economic policy, she said. Many states have extended coverage to a wider swath of people on the premise that broader coverage helps prevent the spread of disease, prioritizes preventive care over more costly emergency treatment and reduces economic losses when employees miss work because of illness.
The judge’s order will stand until the case is resolved, as the judge considers what kinds of data can be released for use in immigration enforcement.
California Attorney General Rob Bonta, a Democrat, said in a July statement that the Trump administration’s data-sharing move was illegal and “created a culture of fear that will lead to fewer people seeking vital emergency medical care.”
Federal officials say they’re allowed to use lawfully collected information for immigration enforcement purposes.
The Department of Homeland Security and ICE did not respond to requests for comment.
Broder, of the National Immigration Law Center, said it isn’t clear whether the limited information the court has allowed the Department of Homeland Security to use can be cleanly separated from data belonging to citizens and lawful permanent residents. The ruling says that if that basic data can’t be separated from data that’s still protected, Medicaid can’t share it with ICE.
California’s Department of Health Care Services, which administers the state’s Medicaid program, emphasized that concern in a statement updated earlier this month. The department said the feds haven’t provided any information about how they plan to implement the court’s order.
Meanwhile, some states are looking at their options for protecting their Medicaid data. Oregon Health Authority Director Dr. Sejal Hathi called the move to use Medicaid data for immigration enforcement “disappointing, to say the least” in a public board meeting earlier this month.
She said her agency is “committed to doing all that we can within our authority to protect the health privacy of our members” and is working with health providers to “ensure that Oregonians, no matter their background, can continue to seek and receive quick and responsive health care without worrying about the safety of their health information.”
States step up
In recent years, an increasing number of states have used their own money to extend health insurance coverage under their Medicaid programs to some noncitizens, such as people with green cards, refugees and those with temporary protected status.
For example, 14 states and the District of Columbia cover income-eligible children regardless of immigration status, while seven states and the district offer state-funded coverage to some adults with low incomes, regardless of immigration status. Nearly half of states — including a handful of red states — cover income-eligible pregnant women, regardless of their immigration status.
Makhlouf, of Penn State, directs a legal clinic at her law school where law students assist people who face legal barriers to getting health care and other public benefits. The students have fielded questions from parents — even those who are in the country legally — who have asked if applying for Medicaid for their children, who are U.S. citizens, jeopardizes their own legal status or exposes household members to scrutiny from ICE.
“We see the chilling effects directly,” Makhlouf said. “Folks have many more questions about the risks versus the benefits of applying for government programs. It should be an easy decision for families to accept help, but it’s not easy anymore.”
In the past year, the Trump administration also has ordered states to hand over personal data from sources including voter rolls and food stamps, even as it consolidates information held across federal agencies into a trove of information on people who live in the United States.
In November, a federal judge blocked the IRS from sharing taxpayer information for immigration purposes.
Stateline reporter Anna Claire Vollers can be reached at [email protected].
