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The Centers for Medicare and Medicaid Services (CMS) announced a major new initiative to crack down on public health insurance programs and purge illegal immigrants from Medicaid and the Children’s Health Insurance Program (CHIP). The effort will begin with regular monthly enrollment reports to states, CMS officials announced Tuesday.

The new enforcement effort is a major effort by the CMS to expand immigration and citizenship status checks. The agency will send reports to every state every month listing Medicaid or CHIP enrollees whose eligibility status is in doubt. The CMS said that enrollment information for every enrollee will be compared to several federal databases that can confirm an individual’s immigration or citizenship status. Databases maintained by the Social Security Administration and the DHS Systematic Alien Verification for Entitlements (SAVE) database will both be used in this effort.

The first such report was delivered to all states on Tuesday. Going forward, CMS will send a monthly report to every state and then await the results of each state’s determinations about those individuals listed on the report, according to an agency announcement.

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

CMS Administrator Dr. Mehmet Oz said that the federal government’s safety net health programs were meant for those who are eligible, and this effort would prevent illegal immigrants from taking benefits from others.

“Our action will ensure that taxpayer dollars are protected and benefits reserved for eligible citizens and individuals lawfully present in the United States,” Oz said. “Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid and CHIP.”

Federal Crackdown on Illegal Immigrants’ Access to Benefits

The CMS action is part of a larger crackdown by the federal government on illegal immigrants’ access to federally funded public benefits, long a goal of many Republican policymakers. Since President Donald Trump’s second term began, his administration has worked to implement a series of executive orders, regulatory measures, and legislation that required the executive branch to ensure individuals were eligible for federal programs before they received them.

In February, one of Trump’s first actions in his second term was an executive order directing federal agencies to begin the process of ensuring non-citizens were not improperly receiving federal benefits. That order was issued in order to enforce the 1996 Personal Responsibility and Work Opportunity Reconciliation Act, which sought to make clear that those without legal status were not eligible for certain programs. The HHS quickly complied with Trump’s order and expanded the list of benefits programs that are considered “public benefits” under federal law. The list had grown from 31 programs to 44.

CMS Announces Crackdown on Illegal Immigrants’ Access to Medicaid and CHIP Enrollment

CMS Administrator Dr. Mehmet Oz and HHS Secretary Robert F. Kennedy Jr. address reporters about a new effort to prevent illegal immigrants from using public benefits in February.

While CMS said that these new monthly reports are only to ensure eligibility of those currently enrolled in Medicaid or CHIP, a major political and legal fight is brewing over illegal immigrants’ access to public benefits. Last month, a federal judge ordered the Department of Health and Human Services to stop sharing enrollee information with immigration authorities. The Trump administration had begun sharing such data with Immigration and Customs Enforcement (ICE) officials to assist in deportation and removal efforts. The judge determined that the department did not have the authority to do this.

CMS’s efforts also come with other new statutory requirements placed on the federal government and the states in connection with a Republican spending package passed last month. That package required that states check eligibility for Medicaid enrollees at least twice per year. States were previously required to do so only at the time of enrollment. The expansion was a key part of the Republican effort to ensure that programs like Medicaid were not being fraudulently used.

Democrats are already taking the Trump administration to court over these new rules, with a coalition of more than 20 Democratic attorneys general arguing that the requirement to verify the immigration status of those applying for federally funded programs threatened the health care and well-being of millions of residents. New York Attorney General Letitia James is leading the effort and said that states had built public systems designed to be available to all those in need. James and other Democrats have said they were worried these public programs would be undermined by federal rules.

“Now, the federal government is pulling that foundation out from under us overnight, jeopardizing cancer screenings, early childhood education, primary care, and so much more,” James said last month. “This is a baseless attack on some of our country’s most effective and inclusive public programs, and we will not let it stand.”

The efforts by CMS and other federal agencies are just the beginning of what is expected to be a major political fight over public benefits and immigrants’ eligibility for them. While the initial reports from CMS are now being issued to the states, the larger war over these programs will play out in Congress and the courts for some time to come.