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The Centers for Medicare and Medicaid Services (CMS) on Tuesday announced a sweeping new initiative to tighten oversight of public health insurance programs and boot illegal immigrants off Medicaid and the Children’s Health Insurance Program (CHIP). The effort, first reported by CMS officials, is among the most aggressive moves yet by the Trump administration in its second term to restrict taxpayer-funded benefits to eligible U.S. citizens and lawful residents.

CMS will begin sending monthly enrollment reports to states. Those reports will identify Medicaid or CHIP enrollees whose immigration or citizenship status cannot be verified using federal databases. Among the government data sources that will be checked is the Social Security Administration’s database, as well as the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) system.

The first of those reports was issued Tuesday, according to the agency. Throughout each month, states will receive their own report and then be required to review the cases. States will be required to report back to CMS on the results of those reviews to determine if enrollees are legally eligible to remain in the program.

“We are tightening oversight of enrollment to safeguard taxpayer dollars and ensure that these vital programs serve only those who are truly eligible under the law,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement.

CMS Administrator Dr. Mehmet Oz echoed that point, saying the move was necessary to protect the integrity of the safety-net health programs. “Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid and CHIP,” Oz said. “This action underscores our unwavering commitment to program integrity, safeguarding taxpayer dollars, and ensuring benefits are strictly reserved for those eligible under the law.”

The CMS announcement is part of the administration’s broader effort to reduce illegal immigrant access to federal benefits, a long-running Republican priority. Since President Donald Trump’s second term began, the administration has put a series of measures in place to strengthen the checks that states must perform before individuals can enroll in federal programs. One of Trump’s first executive orders in his second term, for instance, was signed in February and directed agencies to review all federal benefit programs and take steps to ensure that non-citizens were not receiving benefits in violation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

The administration has moved on to other fronts as well. Several weeks after the executive order, the Department of Health and Human Services expanded the list of government programs deemed to be public benefits. The list grew from 31 programs to 44, meaning more programs will now face eligibility and verification checks.

Federal lawsuits, state pushback

The CMS initiative comes at a time of heightened partisan tension over how far the federal government should go in tying public benefit programs to immigration enforcement. Just last month, a federal judge ordered the Department of Health and Human Services to stop sharing enrollee information with immigration authorities. The Trump administration had begun passing data to Immigration and Customs Enforcement (ICE) to assist with deportation efforts, but the court ruled the practice went beyond the department’s authority.

At the same time, the states are now facing new statutory requirements tied to the Republican spending bill. That package, which was passed last month, requires states to conduct eligibility checks on Medicaid enrollees at least twice a year, a sharp ramp-up from prior requirements. Supporters of the measure say it is necessary to root out fraud and abuse, but critics say it creates new bureaucratic hurdles for families that are already struggling.

More than 20 Democratic attorneys general have already sued the administration over these new rules. Led by New York Attorney General Letitia James, the coalition argues that requiring the verification of immigration status as a condition of receiving federally funded benefits threatens access to those benefits for millions of residents.

“For decades, states like New York have built health, education, and family support systems that serve anyone in need,” James said last month. “These programs work because they are open, accessible, and grounded in compassion. Now, the federal government is pulling that foundation out from under us overnight, jeopardizing cancer screenings, early childhood education, primary care, and so much more. This is a baseless attack on some of our country’s most effective and inclusive public programs, and we will not let it stand.”

The lawsuit, which was filed last month, highlights the deep division between Republican leaders in Washington and Democratic-led states over immigration policy and the role of safety-net programs. While supporters of the CMS initiative say it will ensure taxpayer-funded benefits go to those who are legally entitled to them, critics say the measures are designed to exclude vulnerable communities and to undermine state efforts to provide inclusive care.

While the first round of CMS reports has now gone out, the broader fight over immigrant access to public benefits is likely to continue in both the courts and Congress in the coming months. Republicans in Washington are focused on program integrity, while Democrats are emphasizing access and compassion, meaning Medicaid and CHIP have once again become battlegrounds in the broader national debate over immigration and public resources.