(COLORADO) Colorado is still refusing to hand over detailed records on emergency Medicaid care for undocumented immigrants, five months after the Trump administration set a federal deadline and warned states to cooperate with a sweeping review of Medicaid spending on non‑citizens.
Federal request and deadline
In June 2025, federal officials at the Centers for Medicare & Medicaid Services (CMS) sent Colorado a wide‑ranging request for Medicaid data. The request covered claims linked to undocumented immigrants who received emergency care, and asked for personal details and immigration status information for each case.
CMS gave Colorado until July 30, 2025 to respond as part of an investigation ordered by Executive Order 14218, which President Trump signed on February 19, 2025.
As of November 27, 2025, Colorado has still not confirmed that it has sent any of the requested data to Washington.
State response and legal concerns
The state’s Department of Health Care Policy and Financing (HCPF), which runs Medicaid in Colorado, said in June that officials were “currently evaluating the requests” from CMS. The department also stressed that the federal document was “lengthy and more detailed” than what Colorado had seen before.
Since that statement, state leaders have been largely silent in public, and no record of compliance has been released.
“Currently evaluating the requests” — HCPF (June 2025)
Advocates and policy staff say the mix of state and federal funding for immigrant health programs creates hard legal questions when Washington asks for detailed records tied to immigration status. Colorado has passed privacy protections for health data, including for immigrants, that may limit what state officials feel they can share.
The HCPF’s early comment suggested that in‑house lawyers are weighing how to respect those state laws while complying with a direct CMS order under the executive action.
What CMS is seeking and the federal rationale
According to the federal request, CMS is trying to build a national picture of how states use Medicaid funds when hospitals and clinics treat undocumented immigrants who arrive in life‑threatening situations and have no other way to pay.
The Trump administration tied the CMS data request to Executive Order 14218, signaling that it views emergency Medicaid spending on undocumented immigrants as a matter of federal control and cost containment. The order directed agencies to review how federal funds are spent on people “not lawfully present” and to seek ways to narrow those costs.
For CMS, this began with collecting detailed data to map:
- which states are billing emergency Medicaid for undocumented immigrants
- the number of cases and the amounts billed
- personal and immigration status details tied to each emergency visit
CMS describes federal rules requiring states to pay for emergency treatment if a person would otherwise be eligible for Medicaid except for their immigration status on its page explaining emergency medical conditions under Medicaid.
Which states have complied (and which have not)
The stand‑off places Colorado among a shrinking group of states that have not turned over such records. Some states have already sent their data; others have not.
- States that have sent data: California, Washington, Illinois, and the District of Columbia
- States that remain non‑responders (including Colorado): Colorado, New York, Oregon, and Minnesota
(These classifications come from the federal request and subsequent reporting.)
Community concerns and immigration fears
Community groups and immigrant families report anxiety over the request’s scope. When CMS asks for names, dates of birth, addresses, and immigration details tied to emergency room visits, many worry those records could be used for immigration enforcement rather than health planning, even though the administration has not said it will hand data to immigration officers.
A common community concern:
- Families fear that using emergency Medicaid could place them on a federal list, despite legal protections that say otherwise.
The order’s emphasis on undocumented immigrants has increased anxiety among clinics and hospitals that serve mixed‑status families.
Colorado as a possible test case
According to analysis by VisaVerge.com, Colorado’s delay has made the state a test case of how far a state can go in resisting a federal demand that intersects health policy and immigration.
Colorado’s history of protecting access to care for undocumented immigrants — including the use of state‑only funding streams for programs that fill gaps when regular Medicaid is unavailable because of immigration status — makes its stance closely watched by:
- lawyers
- hospital systems
- immigrant families
If Colorado ultimately refuses outright or sends only limited records, other states may follow its example when facing similar federal requests.
Potential federal consequences
Colorado’s position could have real consequences beyond the current standoff.
Possible federal actions if CMS deems the state noncompliant:
- Threaten to withhold some Medicaid administrative funds
- Issue formal compliance notices to the state
- Pursue court action to force disclosure
Such a clash would pit Colorado’s broader immigrant‑health approach against the Trump administration’s effort to limit benefits tied to undocumented immigrants. It would also create more uncertainty for hospitals that rely on emergency Medicaid payments when treating uninsured patients in urgent need.
Current public record and next steps
There is no public sign of a legal showdown so far. Instead, the dispute has unfolded largely through silence after the July 30 deadline:
- CMS has not published a definitive list of which states are fully compliant.
- Colorado has not posted an update beyond its June statement about reviewing the request.
Health policy watchers say that lack of transparency makes it harder for patients, providers, and lawmakers to know:
- what risks the state is willing to take to protect immigrant privacy, and
- how far the federal government is prepared to go to obtain the requested records.
Colorado officials have urged anyone concerned to follow updates from the Colorado Department of Health Care Policy and Financing, which would be responsible for any official change in position.
Immediate impact on immigrants and providers
Until the state either confirms it has sent the data or officially declares it will not, undocumented immigrants who rely on emergency Medicaid remain in uncertainty.
Key practical consequences:
- Patients face a choice between seeking urgent care and worrying about potential later review of their records in Washington.
- Hospitals and clinics face uncertainty about future audit risk or changes in federal funding tied to emergency Medicaid claims.
Until the state either confirms that it has sent the data or declares that it will not, undocumented immigrants who rely on emergency Medicaid will remain in a state of uncertainty.
Colorado has not confirmed compliance with a CMS request for detailed emergency Medicaid records tied to undocumented immigrants, despite a July 30, 2025 deadline under Executive Order 14218. The state’s HCPF is evaluating the lengthy request and citing state privacy protections. CMS seeks personal, immigration, billing, and case data to assess federal costs. Some states complied; Colorado’s stance raises potential federal actions, including funding consequences or litigation, and creates uncertainty for patients and providers.
