Why It Matters
A federal initiative requiring states to audit Medicaid enrollee eligibility based on immigration status has produced limited findings of ineligible participants, according to data from five states reviewed by KFF Health News. The results raise questions about the scope and resource cost of the reviews, which affect Medicaid and Children’s Health Insurance Program (CHIP) administration in states including Indiana and across the country.
Medicaid, the joint federal-state health coverage program for low-income individuals and people with disabilities, serves tens of millions of Americans. Only U.S. citizens and certain lawfully present immigrants qualify for enrollment, and states are responsible for administering the program under federal guidelines.
What Happened
Last August, the Trump administration directed states to review hundreds of thousands of Medicaid enrollees to determine whether any were ineligible due to immigration status. The reviews were ordered as part of the administration’s broader immigration enforcement agenda, with the Centers for Medicare & Medicaid Services (CMS) providing states with specific lists of names to investigate.
Health and Human Services Secretary Robert F. Kennedy Jr. framed the initiative as a fiscal accountability measure. “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,” Kennedy said at the time of the announcement.
Seven months after the reviews began, findings from five states shared with KFF Health News indicate that confirmed ineligibility has been rare. In several cases, enrollees initially flagged by the federal government were found to be U.S. citizens after state-level review.
By the Numbers
The data from five states tells a consistent story across a combined review of more than 180,000 enrollees:
- Pennsylvania and Colorado reported finding zero enrollees requiring termination after checking a combined 79,000 names flagged by the federal government.
- Texas reviewed more than 28,000 enrollee records and terminated coverage for 77 individuals, according to the Texas Department of Human Services — a removal rate of roughly 0.27 percent.
- Ohio checked 65,000 enrollees and disenrolled 260 people, according to the Ohio Department of Medicaid — approximately 0.4 percent of those reviewed.
- Utah examined 8,000 flagged enrollees and terminated coverage for 42 individuals, representing about 0.5 percent of the reviewed population.
- Across all five states combined, fewer than 380 individuals were removed from coverage out of more than 180,000 records reviewed — a combined ineligibility rate of under 0.25 percent.
Zoom Out
The findings align with how Medicaid enrollment verification is designed to function. States are already required to check immigration status at the point of enrollment, meaning enrollees on the federal review lists had previously passed eligibility screening before being flagged for re-examination.
Leonardo Cuello, a research professor at Georgetown University’s Center for Children and Families, told KFF Health News that the reviews were redundant given existing state verification practices. “It is entirely predictable that all of these burdensome reviews that the federal government is forcing upon states would yield no pay dirt,” Cuello said. “The states have already done this work.”
The Medicaid immigration review effort is one of several public benefits oversight initiatives pursued by the Trump administration in 2025 and 2026. Congress has also taken up related discussions, with Senate Republicans advancing a legislative agenda focused on eligibility requirements across multiple public assistance programs, including Medicaid and SNAP.
States bear the administrative costs of conducting these reviews, which require staff time and resources to cross-reference enrollment records with immigration data. While the federal government provides the flagged name lists, the review burden falls on state agencies.
What’s Next
It is not yet known whether CMS plans to expand the review mandate to additional states or issue further guidance based on the results to date. States that have completed initial reviews may face follow-up directives depending on how the federal agency evaluates the program’s outcomes.
Medicaid advocacy organizations and state health officials are expected to continue monitoring whether additional enrollees are removed from coverage during ongoing reviews, and whether any terminated individuals successfully appeal reinstatement to their state programs. Congressional debate over Medicaid funding and eligibility requirements is expected to continue as the Senate advances its public assistance policy agenda through 2026.