A masked U.S. Immigration and Customs Enforcement agent knocks on a car window in Minnesota on Jan. 12. A fresh court ruling allows ICE to employ Medicaid data, alarming some states and warning advocates that it could have a chilling effect on immigrant families accessing health care. (Photo by Nicole Neri/Minnesota Reformer)
In a victory for President Donald Trump’s crackdown on immigration enforcement, a recent court ruling has cleared the way for U.S. Immigration and Customs Enforcement to once again employ states’ Medicaid data to track people in the country illegally.
The case is not yet closed. But for now, immigrants — even those who are in the country legally — must weigh the benefits of health insurance against the risk that enrolling in Medicaid could make them or their family members easier to find for ICE.
Last summer, 22 states and the District of Columbia sued the Trump administration to block information sharing between ICE and Medicaid, the federal health insurance program that primarily covers low-income people. But at the end of December a federal judge ruled governed that ICE can obtain some basic Medicaid data to employ in its deportation process, including addresses, phone numbers, dates of birth, and citizenship or immigration status.
The court ruled that ICE cannot collect information about lawful constant residents or citizens or records of sensitive health information in the states that brought suit. However, in the 28 states that did not sue, the court did not place limits on the Medicaid information that ICE can access.
The U.S. District Court in San Francisco essentially said that government agencies could share some data, including basic identifying information. “This type of data sharing is clearly permitted by law,” the decision states.
However, the court also ruled that authorities 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 information sharing policies were “completely unclear and do not appear to be the result of a coherent decision-making process.” He said states had shown they would “suffer irreparable harm” from these vague and likely overbroad policies.
By law, state Medicaid funds cannot be used to cover people who are in the country illegally.
But in recent years, nearly half of states, including some led by Republicans, have opted to employ their own Medicaid funds 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 cause widespread fear among immigrant families and discourage them from seeking the health care states are entitled to provide. The California Department of Public Health recently called The government’s actions were “a serious breach of public trust.”
“States have consistently reassured people that their health information would not be used against them, and that has changed,” said Tanya Broder, senior health and economic justice policy advisor at the National Immigration Law Center, an advocacy group focused on immigrant rights.
Court filings in the lawsuit illustrate the potential impact of the ruling.
In Chicago, for example, a patient at an Esperanza Health Center postponed her first prenatal visit until her third trimester because she feared that enrolling in Medicaid could put her husband at risk of deportation, the clinic said reported in a December court filing. When she was treated, she had complications that could have been resolved with earlier visits to the doctor. Another patient refused to apply for Medicaid for her child, a U.S. citizen, because she feared that seeking services would allow ICE to locate her.
“The expectation of privacy that we all have when we want to enroll in a health program has been compromised,” Broder said.
“Not only undocumented immigrants, but people living in immigrant families and the broader community will feel less comfortable applying for these health programs because they fear that their information could be used as a weapon against them or their family members.”
A turnaround
Several months into Trump’s second term, ICE have received access to the personal data of 79 million Medicaid enrollees as part of its efforts to find people who may be living in the United States illegally.
Data about Medicaid enrollees is routinely shared between states and the federal government, including to verify eligibility to receive federal funds. But the fresh agreement represented a reversal from previous federal policy not to employ such information for immigration enforcement.
The effort is unprecedented on a national level, said Medha Makhlouf, a law professor at Penn State Dickinson Law who specializes in health and immigration.
“So far, the federal government has balanced the interests of immigration control with the protection of health-related interests,” she said. “Now they are weighing up the interests of immigration control much more.”
That puts the federal government at odds with states that have expanded health insurance for public health and economic policy reasons, she said. Many states have expanded insurance coverage to a broader segment of the population, with the belief that more comprehensive insurance coverage will aid prevent the spread of disease, prioritize preventive care over more costly emergency care, and reduce economic losses when employees are absent due to illness.
The judge’s order will remain in place until the case is resolved as the judge considers what types of data can be released for employ in immigration enforcement.
California Attorney General Rob Bonta, a Democrat, said in a statement in July that the Trump administration’s data sharing was illegal and “has created a culture of fear that will lead to fewer people seeking vital emergency medical care.”
Federal officials say they are allowed to employ lawfully collected information for immigration enforcement.
The Department of Homeland Security and ICE did not respond to requests for comment.
Broder, of the National Immigration Law Center, said it was not clear whether the constrained information the court provided to the Department of Homeland Security could be neatly separated from the data of citizens and lawful constant residents. The ruling says that Medicaid cannot turn over this basic data to ICE if it cannot be separated from the data that is still protected.
The California Department of Public Health, which manages the state’s Medicaid program, highlighted this concern in a statement opinion Updated earlier this month. The ministry said federal authorities have not provided any information about how they plan to implement the court’s order.
In the meantime, some states are exploring ways to protect their Medicaid data. Oregon Health Authority Director Dr. Sejal Hathi, called the move 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 to protect the health privacy of our members” and is working with health care providers to “ensure that Oregonians, regardless of their background, can continue to seek and receive prompt and responsive health care without having to worry about the security of their health information.”
States are strengthening themselves
In recent years, a growing number of states have used their own money to expand health insurance coverage under their Medicaid programs to some noncitizens, such as people with green cards, refugees and those with ephemeral protected status.
For example, 14 states and the District of Columbia cover income-eligible children regardless of immigration status, while seven states and the District provide federally funded coverage to some low-income adults regardless of immigration status. Nearly half of states — including a handful of red states — cover income-eligible pregnant women, regardless of their immigration status.
It should be an uncomplicated decision for families to accept aid, but it is no longer uncomplicated.
– Medha Makhlouf, law professor at Penn State Dickinson Law
Penn State’s Makhlouf runs a legal clinic at her law school where law students support people who face legal barriers to obtaining health care and other public benefits. Students answered questions from parents — including those who are 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 household members to ICE scrutiny.
“We see the chilling effects directly,” Makhlouf said. “People have many more questions about the risks versus benefits of applying for government programs. It should be an easy decision for families to accept help, but it is no longer easy.”
Last year, the Trump administration also ordered states to turn over personal information from other sources Voter lists And Food stampseven as it consolidates information stored across various federal agencies a wealth of information about people living in the United States.
In November, a federal judge blocked the IRS from sharing taxpayer information for immigration purposes.
Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.
This story was originally produced by State borderwhich is part of States Newsroom, a nonprofit news network that includes West Virginia Watch, and is a 501c(3) public charity supported by grants and a coalition of donors.
