Republican States Expand Medicaid Reporting to Target Immigrants for Deportation

Republican-led states are taking President Donald Trump’s deportation efforts a step further by using their public health agencies to enforce federal reporting requirements on Medicaid recipients. North Carolina became the latest state to join this growing trend in late April, mandating that its public health department flag Medicaid recipients to the U.S. Department of Homeland Security if their legal status is in question.

Health policy researchers expect this trend to expand among GOP-controlled states eager to align with Trump’s federal crackdown on Medicaid fraud and illegal immigration. At least four other states—Indiana, Louisiana, Montana, and Wyoming—have already passed similar laws, while lawmakers in Oklahoma and Tennessee are considering comparable measures.

In these six states, Republicans hold a power trifecta, controlling both legislative chambers and the governor’s office.

“This is an issue that is very much on the political radar right now.”

Medicaid, the federal and state-run public health program for people with disabilities and low incomes, or its related Children’s Health Insurance Program, covers more than 75 million people. While immigrants without legal status are ineligible for Medicaid benefits, many noncitizens—such as green-card holders, asylees, and refugees—qualify. Additionally, a quarter of children in the U.S., most of them citizens, live with an immigrant.

The new reporting laws add another layer of risk for immigrants seeking healthcare in the U.S., where federal mandates have used Medicaid data to identify and deport individuals. Some state laws, like North Carolina’s, apply only to health agencies. However, Tennessee’s bill, which is headed to Governor Bill Lee’s desk, would be comprehensive, requiring all state agencies to report people suspected of being in the U.S. without legal status.

All seven state measures go beyond federal requirements, which only mandate cooperation with enforcement officers by providing personal information of recipients when requested. In Louisiana, families with mixed immigration statuses have reported that the state’s new law, enacted last year, deters them from applying for Medicaid for their U.S.-citizen children.

“I expect this law will lead to more families asking whether it is safe to seek healthcare, whether information can be shared with immigration authorities, and whether enrolling a child or seeking treatment could expose them to enforcement consequences.”

North Carolina’s Republican lawmakers inserted the mandate for the state’s health department as part of a bill that restored $319 million in Medicaid funds, which the legislature had previously cut due to a budget failure. Starting in October, state employees will ask non-U.S. citizens receiving Medicaid for proof of their immigration status and report those without “satisfactory” legal status to federal authorities.