On January 12, a masked U.S. Immigration and Customs Enforcement agent knocks on a car window in Minnesota. A up-to-date court ruling allows ICE to employ Medicaid data, alarming some states and advocates who warn it could have a chilling effect on immigrant families receiving health care. (Photo: Nicole Neri/Minnesota Reformer)
A recent court ruling, thanks to President Donald Trump’s victory on immigration, allowed U.S. Immigration and Customs Enforcement to resume using state Medicaid data to find people who are in the country illegally.
The case is ongoing. For now, though, immigrants — including those who are in the country legally — will have to weigh the benefits of obtaining health insurance against the risk that enrolling in Medicaid will make it easier for ICE to find them or their family members.
Last summer, 22 states and the District of Columbia sued the Trump administration to block information sharing between ICE and Medicaid, the state’s federal health insurance program that covers mostly low-income people. But in overdue December, a federal judge ruled that ICE may collect certain basic Medicaid information for employ in deportation proceedings, including addresses, phone numbers, dates of birth, and citizenship or immigration status.
The court ruled that in the states that sued, ICE cannot collect information about lawful enduring residents or citizens, or data relating to sensitive health information. However, in the 28 states that did not file a lawsuit, the court imposed no restrictions on the Medicaid information ICE has access to.
The U.S. District Court in San Francisco essentially held that government agencies can share certain data, including basic identifying information. “This type of data sharing is expressly permitted by law,” the decision states.
But the court also ruled that agencies cannot 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’s information-sharing policies were “wholly unclear and do not appear to be the product of a consistent decision-making process.” He said states have shown they will “suffer irreparable harm from this vague and possibly overreaching” policy.
By law, federal Medicaid funds cannot be used to cover medical costs for people who are in the country illegally.
But in recent years, nearly half of states, including some Republican-led states, have opted to employ their own Medicaid money to expand coverage to certain groups of people, such as children and pregnant women, regardless of immigration status.
Immigrant advocates and some state officials fear that ICE’s employ of Medicaid data will create widespread fear among immigrant families, keeping them from seeking health care that states say they are entitled to. California Department of Health recently called the administration’s actions “a serious breach of public trust.”
“States have consistently assured people that their health care information will not be used against them, and that has changed,” said Tanya Broder, senior adviser for health policy and economic justice at the National Immigration Law Center, an immigrant rights organization.
The court’s conclusions in the lawsuit illustrate the ruling’s potential impact.
In Chicago, for example, an Esperanza health center patient delayed her first prenatal visit until the third trimester because she feared that enrolling in Medicaid might expose her husband to deportation, the clinic says. reported in a December court filing. Before she received care, she developed complications that could have been managed with prior medical visits. Another patient refused to apply for Medicaid for her U.S. citizen child because she feared that applying for benefits would allow ICE to locate her.
“The expectation of privacy that we all have when seeking to enroll in a health care program has been violated,” Broder said.
“Not only undocumented immigrants, but also people living in immigrant households and the broader community will feel less comfortable applying for these health programs due to fear that their information will be used against them or their family members.”
Upside down face
A few months into Trump’s second term, ICE gained access to personal data 79 million people are enrolled in Medicaid as part of their efforts to find people who may be in the United States illegally.
Data on Medicaid enrollees is routinely exchanged between states and federal authorities, including to determine eligibility for federal funds. However, the up-to-date agreement marked a change in previous federal policy of not using such information for immigration enforcement.
The effort is unprecedented nationally, said Medha Makhlouf, a law professor at Penn State Dickinson Law who specializes in health and immigration.
“Previously, the federal government balanced the interests of enforcing immigration law with protecting health interests,” she said. “Now they are paying much more attention to the interests of immigration enforcement.”
That puts the federal government at odds with states that have expanded health insurance coverage as part of public health and economic policy, she said. Many states have expanded protections to a broader group of people on the premise that broader protections facilitate prevent the spread of disease, favor preventive care over more costly emergency treatment, and reduce economic losses when workers miss work due to illness.
The judge’s order will remain in effect pending the outcome of the case, during which the judge will consider what data can be shared for employ in immigration enforcement.
California Attorney General Rob Bonta, a Democrat, said in a July statement that the Trump administration’s decision to share data was illegal and “has created a culture of fear that will lead to fewer people seeking necessary emergency medical care.”
Federal officials say they can employ information collected lawfully 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 was unclear whether the confined information the court allowed the Department of Homeland Security to provide could be clearly separated from data belonging to citizens and lawful enduring residents. The ruling states that if master data cannot be separated from data that is still protected, Medicaid cannot share it with ICE.
The California Department of Health Care Services, which administers the state’s Medicaid program, highlighted this concern in: statement updated earlier this month. The department said the feds have not provided any information on how they plan to implement the court’s order.
Meanwhile, some states are considering options for protecting their Medicaid data. Oregon Health Authority Director Dr. Sejal Hathi called the decision to employ Medicaid data for immigration enforcement “disappointing, to say the least.” public board meeting earlier this month.
She said her agency “is committed to doing everything we can, within its authority, to protect the health privacy of our members” and is working with health care providers to “ensure Oregonians, regardless of their background, can continue to seek and receive timely and efficient health care without having to worry about the security of their health information.”
States are increasing
In recent years, an increasing number of states have used their own money to expand health insurance coverage under Medicaid programs to certain noncitizens, such as green card holders, refugees, and people with transient protected status.
For example, 14 states and the District of Columbia provide care to income-eligible children regardless of immigration status, while seven states and the District offer state-funded care to some low-income adults regardless of immigration status. Nearly half of states – including several red states – cover income-eligible pregnant women, regardless of their immigration status.
The decision to accept facilitate should be uncomplicated for families, but it is not uncomplicated at the moment.
– Medha Makhlouf, professor of law at Penn State Dickinson Law
Penn State’s Makhlouf runs a law clinic at his law school where law students facilitate people who face legal barriers obtain health care and other public benefits. Students fielded questions from parents – even those in the country legally – who asked whether applying for Medicaid for their children who are U.S. citizens would jeopardize their own legal status or expose members of their household to ICE scrutiny.
“We are seeing the chilling effects directly,” Makhlouf said. “People have many more questions about the risks versus benefits of applying for government programs. The decision to accept help should be easy for families, but it’s not easy right now.”
Last year, the Trump administration also ordered states to turn over personal data from sources including: voter rolls AND food stampseven if it consolidates information held in federal agencies source of information about people living in the United States.
In November, a federal judge blocked the IRS from sharing information about taxpayers for immigration purposes.
Stateline reporter Anna Claire Vollers can be reached at: avollers@stateline.org.
This story was originally produced by State linewhich is part of States Newsroom, a nonprofit news network that includes the Ohio Capital Journal and is supported by grants and a coalition of donors as a 501c(3) public charity.
