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The Centers for Medicare and Medicaid Services (CMS) on Tuesday unveiled a new national initiative to ramp up oversight of public insurance programs and strip illegal immigrants from Medicaid and the Children’s Health Insurance Program (CHIP). The effort, first reported by the CMS, is the latest in a series of moves by the Trump administration to crack down on access to taxpayer-funded social benefits by non-citizens.

Starting next month, CMS said it will send states monthly enrollment reports to identify any Medicaid and CHIP beneficiaries who fail to have a valid immigration or citizenship status that can be confirmed with federal databases. Information sources will include the Social Security Administration and the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program.

CMS officials confirmed to MedPage Today that the first of those monthly enrollment reports was sent to states on Tuesday.

“CMS is tightening oversight of enrollment to protect taxpayer dollars and ensure these critical programs serve only those who are eligible under the law,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement. “States will now have access to a modernized reporting tool that will make the verification of eligibility determinations more efficient for both CMS and the states.”

CMS Administrator Dr. Mehmet Oz (M.D.) also emphasized that the new requirements were a key part of the agency’s effort to preserve the health programs for legal U.S. residents and citizens.

“Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid and CHIP,” Oz said in a statement. “This action will reinforce our ongoing commitment to program integrity and ensure taxpayer dollars are being used for the purposes intended by law.”

CMS’s move follows a flurry of actions since President Donald Trump’s second term began to tighten up access to federal benefits by illegal immigrants, one of the GOP’s longest-running goals.

Last month, Trump signed a $1 trillion spending bill that included a new rule requiring states to conduct eligibility verifications on Medicaid beneficiaries at least twice a year.

CMS and Trump have also moved to expand the types of public benefits available that would trigger verification requirements. Since the start of his second term, the Department of Health and Human Services has expanded the list of public benefits subject to eligibility checks. The list now includes 44 programs, up from 31.

The move has also come in the face of pushback from states and Democrats, who are engaged in a series of legal challenges against the administration over its plans to expand the use of immigration information.

Last month, U.S. District Judge Phyllis J. Hamilton in California ruled that the Trump administration must stop sharing information about enrollees in federal benefit programs with immigration enforcement authorities.

The judge, who is presiding over a lawsuit brought by the Electronic Privacy Information Center (EPIC), said that Health and Human Services had no authority to collect such data and pass it along to Immigration and Customs Enforcement (ICE).

But as those legal and political fights play out, CMS is now making good on its promise to move forward with expanding the use of immigration and eligibility checks in Medicaid and CHIP.

CMS said all states will receive monthly reports going forward and will be expected to conduct a review of flagged records and report back to CMS on how they fared in determining eligibility status.

States that don’t confirm eligibility will be asked to reenroll affected members. States have the option to request additional information from enrollees, a CMS spokesperson told MedPage Today.

Lawmakers and Advocates Fight Back

CMS is already facing a lawsuit from more than two dozen attorneys general over the changes, which also go into effect next month. The Democratic-led group led by New York Attorney General Letitia James claims in the suit that the information-sharing requirements are an illegal overreach by the Trump administration.

James said the administration’s demand that states verify the immigration status of people who access federally funded programs is “reckless and dangerous.”

“For decades, states like New York have built health, education, and family support systems that serve anyone in need,” James said. “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.”

CMS officials have said the new monthly reports will eventually roll into an existing reporting system called the Simplified Reporting System (SRS). Officials said CMS hopes to have the monthly reports eventually tied into that reporting function, but as of Tuesday, the agency was sending monthly reports directly to the states.

CMS has also made it clear it will not tolerate noncompliance, the agency’s spokesperson said. As of the start of the Trump administration’s second term in January, states were given 60 days to comply with the new rule.

CMS will evaluate enforcement options with the states, the spokesperson said, but the agency declined to elaborate further or comment on what types of enforcement it would pursue with states that failed to comply.