- Federal agencies exchanged Medicaid records for roughly 80 million people to support immigration enforcement goals.
- Five states enacted laws requiring health employees to report recipients with questionable immigration status to authorities.
- A 2026 court filing alleges CMS improperly shared data regarding U.S. citizens and lawful permanent residents.
The Trump administration is pressing health agencies to turn Medicaid records into deportation leads, while states including North Carolina, Indiana, Louisiana, Montana and Wyoming are building reporting duties into their own programs.
The federal effort covers roughly 79–80 million enrollees, under a July 9, 2025, agreement between the Centers for Medicare and Medicaid Services and the Department of Homeland Security. The records can include addresses, phone numbers, banking information, citizenship and immigration status.
The arrangement has already triggered court fights. In July 2026, court filings disclosed that CMS had sent a “large and complex” dataset to immigration authorities in January, including information about U.S. citizens and lawful permanent residents.
Some states are moving beyond federal cooperation. Their laws require agencies to identify recipients and report people whose immigration status raises questions.
North Carolina enacted its law in late April 2026. Beginning in October, state employees are expected to ask non-U.S. citizens receiving Medicaid for proof of immigration status and report people without “satisfactory” legal status to federal authorities.
Indiana, Louisiana, Montana and Wyoming have passed comparable measures. Oklahoma and Tennessee are considering similar legislation, while Governor Bill Lee’s administration in Tennessee moved toward a “comprehensive” reporting bill in mid-2026.
A federal data agreement put millions of records within ICE’s reach
Executive Order 14218, issued on February 19, 2025, directed federal agencies to combine datasets in support of the administration’s “mass deportation” agenda. CMS and DHS then signed the Information Exchange Agreement on July 9, 2025.
The agreement opened access to the CMS Integrated Data Repository. ICE could retrieve home addresses, phone numbers, banking details, routing and account numbers, citizenship information and immigration status.
The administration formalized the policy in 2025. The records involve approximately 80 million people.
A June 13, 2025, statement from HHS spokesman Andrew Nixon described the transfer as “legal.” Nixon did not specify how the information would be used.
The enforcement campaign has expanded alongside the data effort. White House officials reportedly set a target of 3,000 ICE arrests per day in May 2025, and Kristi Noem, the homeland security secretary, reportedly co-signed the demand.
Stephen Miller, the White House deputy chief of staff and homeland security adviser, was identified in internal reports as the policy’s primary architect. In June 2026, he reportedly demanded direct reports from immigration authorities to ensure arrest quotas were met.
Tom Homan, the White House border czar, said in a January 5, 2025, interview, “If we find you, we’re going to arrest you.” He later warned in January 2026 that the administration had “zero tolerance” for interference with enforcement operations.
A California judge limited some uses, then allowed others
The federal sharing policy became a central issue in litigation brought by 21 states and the District of Columbia. A preliminary injunction issued in August 2025 restricted the use of Medicaid information obtained from the plaintiff states for immigration enforcement.
The case later produced a narrower ruling. On December 29, 2025, U.S. District Judge Vince Chhabria allowed officials to share certain information about immigrants without lawful status with ICE, including addresses, birth dates and immigration status.
He barred officials from sharing information about U.S. citizens and lawful permanent residents.
Chhabria wrote that “The sharing of such information [basic biographical and location data] is clearly authorized by law and the agencies have adequately explained their decisions.”
The ruling did not end the dispute. July 2026 court filings said CMS had improperly shared records that included protected information about citizens and lawful residents.
ICE then shared that dataset with Palantir, according to the filings and investigative findings. The company integrated the information into an application called “ELITE,” which agents used to map noncitizens’ addresses.
That transfer placed the company inside the dispute over whether immigration officials handled the records within the limits set by the court.
State laws turn Medicaid offices into reporting channels
The federal baseline generally involves responding to an immigration agency’s request. The newer state measures impose affirmative duties on health administrators.
North Carolina’s law illustrates the difference. State employees will ask certain non-U.S. citizens for immigration documents, assess whether the proof is “satisfactory,” and send information about people who fail that check to federal authorities.
The law passed in April. Its practical implementation begins in October.
Indiana, Louisiana, Montana and Wyoming have enacted similar reporting provisions. Oklahoma and Tennessee are weighing comparable bills, creating a second track of enforcement outside the federal database.
The measures make immigration screening part of Medicaid administration itself. Health agencies would not simply answer requests from federal officials; they would help identify recipients for referral.
Their legal status remains contested. Lawsuits focus on privacy, statutory authority and how far agencies may go in sharing information collected to administer health benefits.
Advocates warn that patients may avoid care
Health advocates have described a chilling effect on medical treatment. Leonardo Cuello, a Georgetown University researcher, said in February 2026 that 50% of Emergency Medicaid cases involve the delivery of U.S. citizen babies.
He warned that mothers could avoid hospitals during labor because they fear ICE will locate them there.
A 2025 survey by KFF and the New York Times found that roughly half of adults likely lacking legal status had avoided medical care because of enforcement fears. The survey measured behavior before the latest state reporting laws took effect.
The potential consequences extend beyond the person whose status is questioned. Emergency care involving citizen children can also place parents in contact with systems now tied to immigration enforcement.
The administration’s arrest totals have added pressure to the debate. Senator Alex Padilla said July 2026 produced 51,000 ICE arrests, the largest single-month total in DHS history.
“ICE arrested 51,000 people in July. the vast majority are not dangerous, violent criminals.”
Padilla, a Democrat from California, made the statement on August 6, 2026. The administration’s reported February 2026 custody figures included 24,495 people with no previous criminal charges, up from 858 in early 2025.
The data dispute now reaches beyond federal agencies
The federal program began with a centralized record-sharing agreement. State laws now add local screening and reporting requirements.
That expansion creates separate legal questions in each jurisdiction. A federal court may assess the CMS agreement, while state challenges may examine whether a legislature authorized its health agency to verify and report immigration status.
The California litigation also leaves a concrete boundary in place: the December ruling permitted certain biographical and location data about people without lawful status, while barring information about citizens and lawful permanent residents.
The January 2026 transfer, as described in court filings, is at the heart of the latest challenge because the dataset reportedly included both groups protected by that boundary.
The administration’s use of data has also drawn congressional scrutiny. Padilla’s August 6 statement linked the records dispute to the scale of enforcement, while the state laws show how the policy is moving into routine benefits administration.
North Carolina’s October implementation date is the next scheduled step. By then, employees may be required to ask applicants for immigration documents before reporting cases to federal authorities.
This article provides general information and is not legal advice. Consult a qualified immigration attorney about your specific case.
