The Trump administration’s decision to grant Immigration and Customs Enforcement access to Medicaid data is causing significant concern among hospitals and states regarding the privacy of immigrant patients.
The Trump administration’s recent decision to allow Immigration and Customs Enforcement (ICE) access to Medicaid data has left hospitals and states grappling with the implications for immigrant patients. This move raises critical questions about patient privacy and the potential chilling effect on healthcare access for vulnerable populations.
Under the new policy, hospitals must consider whether to inform immigrant patients that their personal information, including home addresses, could be used by ICE in deportation efforts. This warning could deter many from enrolling in Emergency Medicaid, a program that reimburses hospitals for emergency treatment provided to immigrants who do not qualify for standard Medicaid coverage.
Leonardo Cuello, a research professor at Georgetown University’s Center for Children and Families, expressed concern over the potential consequences of this policy. “If hospitals tell people that their Emergency Medicaid information will be shared with ICE, it is foreseeable that many immigrants would simply stop getting emergency medical treatment,” he said. Cuello highlighted that a significant portion of Emergency Medicaid cases involve the delivery of U.S. citizen babies, raising the question of whether mothers will avoid hospitals during labor due to fear of deportation.
For over a decade, hospitals and states have assured patients that their personal information, including immigration status, would remain confidential when applying for federal health care coverage. A 2013 ICE policy memo had previously guaranteed that information from health coverage applications would not be used for enforcement activities. However, this assurance has been undermined by recent policy changes under the Trump administration, which has initiated an aggressive immigration crackdown.
Last spring, the Centers for Medicare & Medicaid Services (CMS), part of the Department of Health and Human Services, agreed to provide ICE officials with direct access to a Medicaid database that includes enrollees’ addresses and citizenship status. This decision prompted 22 states, predominantly led by Democratic governors, to file a lawsuit to block the data-sharing agreement. A federal judge ruled in December that ICE could only access information about individuals unlawfully residing in the country from the Medicaid database in those states.
Despite the ruling, many hospitals contacted by KFF Health News declined to comment on whether they have updated their disclosure policies regarding the potential sharing of patient information with ICE. None of the responding hospitals indicated that they are directly warning patients about the risks associated with applying for Medicaid coverage.
Aimee Jordon, a spokesperson for M Health Fairview, a hospital system in Minneapolis, stated, “We do not provide legal advice about federal government data-sharing between agencies. We encourage patients with questions about benefits or immigration-related concerns to seek guidance from appropriate state resources and qualified legal counsel.”
Some states’ Emergency Medicaid applications still ask for a patient’s immigration status while assuring applicants that their information will be kept confidential. For instance, California’s application, as of February 3, included language stating that immigration information is “confidential” and used solely to determine eligibility for health insurance.
California Department of Health Care Services spokesperson Anthony Cava confirmed that the agency will ensure that Californians receive accurate information regarding the privacy of their data. In contrast, Utah’s Medicaid website previously claimed that its Emergency Medicaid program did not share information with immigration officials. Following inquiries from KFF Health News, the state agency promptly removed this misleading language.
Oregon Health & Science University, a hospital system in Portland, provides immigrant patients with a Q&A document developed by the state Medicaid program, addressing concerns about the use of their information. However, this document does not explicitly state that Medicaid enrollees’ information is shared with ICE.
Emergency Medicaid is crucial for hospitals, as it allows them to receive reimbursement for treating individuals who would qualify for Medicaid if not for their citizenship status. This includes both undocumented immigrants and those with legal status, such as students or work visa holders. The coverage is limited to emergency medical and pregnancy care, and hospitals typically assist patients in applying while they are still receiving care.
The main Medicaid program, which serves over 77 million low-income and disabled individuals, does not cover those living in the country illegally. Consequently, Emergency Medicaid enrollment becomes a key avenue for deportation officials to identify immigrants, including those who may not be lawfully present in the U.S.
Rich Danker, a spokesperson for HHS, confirmed that CMS is sharing data with ICE following the judge’s ruling but did not clarify how the agency is ensuring compliance with the requirement to limit information sharing to individuals unlawfully present in the country.
With ICE now having direct access to the personal information of millions of Medicaid enrollees, hospitals face a challenging dilemma. Sarah Grusin, an attorney at the National Health Law Program, emphasized the need for transparency regarding these changes. “They need to be telling people that the judge has permitted sharing of information, including their address, for people who are not lawfully residing,” she stated. “Once this information is submitted, you can’t protect it from disclosure at this point.”
Grusin advised families to carefully weigh the importance of seeking medical care against the risk of having their information shared with ICE. “We want to give candid, honest information even if it means the decision people have to make is really hard,” she said.
Emergency Medicaid coverage was established in the mid-1980s, following a federal law requiring hospitals to treat and stabilize all patients presenting with life-threatening conditions. In 2023, federal spending on Emergency Medicaid reached nearly $4 billion, representing about 0.4% of total federal Medicaid spending.
States are required to report detailed information about Medicaid enrollment and services to the federal government monthly. The December ruling limited the information CMS can share with ICE to basic details, including addresses, for Medicaid enrollees in the states that sued over the data-sharing arrangement. ICE officials are prohibited from accessing information about the medical services received by individuals in those states, as well as data pertaining to U.S. citizens or lawfully present immigrants.
However, deportation officials still have access to the personal Medicaid information of all enrollees in the remaining 28 states. Medicaid experts have raised concerns about the feasibility of separating data to comply with the judge’s order, leading to questions about the Trump administration’s adherence to the ruling.
The implications of these policies on immigrant families seeking healthcare are significant. A recent KFF/New York Times poll revealed that approximately one-third of adult immigrants reported postponing or skipping healthcare in the past year due to fears related to their immigration status. Bethany Pray, chief legal and policy officer at the Colorado Center on Law and Policy, expressed alarm over the potential consequences of sharing Medicaid data with deportation officials. “This is very concerning,” she said. “People should not have to choose between giving birth in a hospital and wondering if that means they risk deportation.”
KFF Health News is a national newsroom dedicated to producing in-depth journalism on health issues and is part of KFF, an independent source for health policy research, polling, and journalism.