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The Centers for Medicare and Medicaid Services (CMS) announced on Tuesday a new effort to crack down on illegal immigration and force states to cut unauthorized immigrants from Medicaid and the Children’s Health Insurance Program (CHIP). According to CMS officials, the move represents one of the Trump administration’s most aggressive actions to date in its second term to prevent taxpayer dollars from going to people who are not eligible to receive federal benefits.

CMS will send monthly enrollment reports to each state under the new policy. The reports will identify Medicaid and CHIP enrollees for whom “status could not be confirmed” in federal databases. The agency will check immigration and citizenship status against databases managed by the Social Security Administration, as well as the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program.

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

Dr. Mehmet Oz, the CMS administrator, said in a statement that the effort was “critical” to the integrity of safety-net health programs. “Every dollar spent improperly is a dollar that has been diverted from an eligible, vulnerable person in need of Medicaid and CHIP,” Oz said. “This action reflects our steadfast commitment to program integrity and our determination to protect taxpayer dollars and ensure that benefits go only to those eligible under the law.”

Federal Crackdown on Illegal Aliens

The announcement is the latest in a series of moves from the Trump administration to limit the ability of illegal immigrants to collect federal benefits. It comes just weeks after the Justice Department unveiled a new rule requiring cities that accept certain Justice Department grants to prove they cooperate with federal immigration enforcement.

Republicans have long pushed for greater oversight of safety-net programs and better controls to prevent unauthorized immigrants from accessing taxpayer-funded benefits. The Trump administration has put in place a series of measures to ensure more stringent eligibility verification since President Donald Trump took office for a second term earlier this year. One of the president’s first executive orders this term, for instance, required federal agencies to review all government benefit programs in February. The executive order directed agencies to take steps to ensure that people were not receiving benefits in violation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

The HHS Department added new benefits to the list of “public benefits” just a few weeks later. Programs added to the list included 13 additional programs, bringing the total number of government benefits agencies to 44. It is still not clear which programs the Trump administration plans to target in future efforts to improve program integrity.

Federal Judges Block Information Sharing with ICE

CMS’s new effort comes at a time of legal and partisan conflict over how far the government should go in tying public benefit programs to immigration enforcement. A federal judge ruled last month that HHS could not share information about enrollees in these programs with Immigration and Customs Enforcement (ICE) to assist with deportation efforts. The Trump administration began the practice of sharing data with ICE for three months, but a court ruled that such actions were beyond HHS’s authority.

In addition, the federal government is now requiring states to step up eligibility checks for Medicaid. A package of Republican spending legislation passed last month, a statutory requirement that each state run eligibility checks on Medicaid enrollees twice a year. States were previously required to verify Medicaid eligibility only every three years.

“We all know these programs work because they are open, accessible, and grounded in compassion,” James said. “But now the federal government is pulling that foundation out from under us overnight and jeopardizing everything from cancer screenings to early childhood education to 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 Reports Go to States, But Legal Challenge Continues

The CMS report is the first major step toward enforcement of these new legal requirements, though it has yet to be put into effect. States have been given until mid-June to complete their data submissions. The first CMS reports were already sent out on Tuesday, though it remains to be seen whether these reports will actually lead to enforcement actions against individual enrollees.

CMS said in a statement that it sent its first report to states on Tuesday and would send additional reports throughout June. Each state is receiving its own enrollment report and will be required to respond to each report about the status of each enrollee. It will then send that information back to CMS for final review.

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

CMS administrator Dr. Mehmet Oz said in a statement that the effort would be “critical” to the integrity of safety-net health care. “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 steadfast commitment to program integrity and our determination to protect taxpayer dollars and ensure that benefits go only to those eligible under the law.”

CMS reports began to roll out on Tuesday, but states have until mid-June to provide data. It is unclear what kind of reports states will receive, or whether CMS will take any enforcement actions against individual enrollees.