Why It Matters
A federally directed review of Medicaid eligibility based on immigration status has produced minimal findings of ineligible enrollees across five states, raising questions about the scope and necessity of the initiative. Kentucky and other states across the country rely heavily on Medicaid to provide health coverage to low-income residents, and the reviews represent a significant administrative burden on state agencies already managing complex enrollment systems.
The results carry implications for ongoing federal efforts to restrict Medicaid access and for the broader national debate over immigration enforcement intersecting with public benefit programs.
What Happened
In August 2025, the Trump administration directed states to review hundreds of thousands of Medicaid enrollees to determine whether any were ineligible due to immigration status. The federal Centers for Medicare and Medicaid Services (CMS) provided states with lists of names and ordered them to conduct the checks.
Seven months later, findings from five states shared with KFF Health News show that the reviews have uncovered little evidence of widespread improper enrollment. Under federal law, only U.S. citizens and certain lawfully present immigrants are eligible for Medicaid and the closely related Children’s Health Insurance Program (CHIP), both of which are administered at the state level.
Health and Human Services Secretary Robert F. Kennedy Jr. announced the reviews, stating the administration was “tightening oversight of enrollment to safeguard taxpayer dollars and guarantee that these vital programs serve only those who are truly eligible under the law.”
By the Numbers
Data from the five states that shared results with KFF Health News reveal a low rate of terminations relative to the number of records reviewed:
- Pennsylvania and Colorado reviewed a combined 79,000 enrollee records and found zero individuals who needed to be removed from Medicaid as of March 2026.
- Texas reviewed more than 28,000 enrollee records and terminated coverage for 77 individuals, according to the Texas Department of Human Services — a termination rate of roughly 0.27 percent.
- Ohio reviewed 65,000 enrollee records and disenrolled 260 people, according to the Ohio Department of Medicaid — approximately 0.4 percent of those reviewed.
- Utah reviewed 8,000 records flagged by the federal government and terminated coverage for 42 individuals, representing about 0.5 percent of those reviewed.
Across all five states combined, more than 180,000 records were reviewed, resulting in fewer than 400 total terminations — an overall termination rate of less than one quarter of one percent.
Zoom Out
The findings align with how Medicaid enrollment verification has historically functioned. States are already required to verify immigration status at the point of enrollment, meaning most ineligible applicants would be screened out before receiving coverage. Experts note this is why the additional federal review layer produced limited new findings.
Leonardo Cuello, a research professor at Georgetown University’s Center for Children and Families, said the federal reviews were duplicative. “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 had already done the reviews once, and CMS was forcing them to do it again.”
The initiative is part of a broader federal immigration enforcement strategy that has extended into public benefit programs. Similar eligibility verification efforts have been announced or implemented in connection with other federal assistance programs, including housing and nutrition assistance.
In Kentucky, separate reporting has indicated that proposed changes to Medicaid eligibility rules and funding structures could leave thousands of residents without health insurance — a concern that consumer advocacy groups have raised as federal Medicaid policy continues to evolve.
What’s Next
It remains unclear whether CMS will expand the review mandate to additional states or require states that have already completed reviews to conduct follow-up audits. Federal officials have not publicly indicated whether the low termination rates will alter the scope or continuation of the program.
Congress is separately debating potential cuts to Medicaid funding as part of broader budget negotiations, which could have a more direct impact on enrollment numbers than the immigration-based reviews. States will continue to administer eligibility determinations under existing federal guidelines while awaiting further direction from CMS.
Advocates and state Medicaid administrators are expected to monitor whether additional federal directives expand the review criteria or introduce new compliance requirements tied to immigration enforcement.