Recent federal policy changes have impacted healthcare access and personal data privacy for immigrant populations across the United States. These shifts include new restrictions on Medicare eligibility for certain lawfully present immigrants and a revised approach to Medicaid data sharing with immigration enforcement agencies.
Medicaid Data Sharing Policy Changes
A federal court ruling in December modified a long-standing policy regarding the sharing of personal information from Medicaid with immigration enforcement agencies. Previously, applicants for Medicaid were assured that their data, including names, addresses, and immigration status, would not be used for immigration enforcement purposes. This policy, explicitly stated on government websites, aimed to enable eligible immigrants to access healthcare without concerns about their immigration status.
Cindy Mann, who oversaw Medicaid during the Obama administration, described the change, initiated by the Trump administration last year, as a significant policy reversal.
The ruling now permits Medicaid to share identifying information with immigration officials concerning individuals who are in the country unlawfully. In 28 states, including Texas, Kentucky, and Utah, there are no limitations on the Medicaid data that can be shared with Immigration and Customs Enforcement (ICE) and other entities.
The policy shift has raised concerns among families and communities regarding potential risks of detention or deportation. Some patients at clinics, such as the Venice Family Clinic in Los Angeles, have inquired about the security of their Medicaid enrollment, with one patient reportedly dropping coverage temporarily due to fear before reinstating it for health reasons.
In response, 22 states, including Arizona, Michigan, and New Jersey, have initiated lawsuits to prevent federal health agencies from sharing Medicaid data with the Department of Homeland Security. Additionally, in August of last year, the Centers for Medicare & Medicaid Services (CMS) launched an initiative to review the immigration status of Medicaid enrollees, sending monthly enrollment reports to states for verification.
ICE also rescinded a 2013 policy that had previously stated CMS and HHS data would not be utilized for immigration enforcement. An attorney with Health Law Advocates suggested that individuals already enrolled might not face additional risk, as the federal government likely possesses their information.
Medicare Eligibility Restrictions
Federal legislation signed into law in July has ended Medicare coverage for an estimated 100,000 lawfully present immigrants in the United States, with disenrollment for those already in the program scheduled by January 4.
The legislation specifically bars several categories of lawfully present immigrants from Medicare, including:
- Temporary Protected Status (TPS) holders
- Refugees
- Asylum-seekers
- Survivors of domestic violence
- Trafficking victims
- Individuals with work visas
Prior to this change, Medicare eligibility was generally limited to citizens, lawful permanent residents, Cuban and Haitian nationals, and individuals covered under Compacts of Free Association.
Republican lawmakers and former President Trump cited the need to rein in Medicare spending, arguing that taxpayer funds should not cover healthcare for certain immigrant groups. The Congressional Budget Office estimates these Medicare restrictions will reduce federal spending by $5.1 billion by 2034. Conversely, the Institute on Taxation and Economic Policy reported that undocumented immigrants contributed an estimated $6.4 billion to Medicare and $25.7 billion to Social Security in 2022.
Health experts, including Drishti Pillai, director of immigrant health policy at KFF, note that this marks the first instance of Congress removing Medicare eligibility from any group, impacting individuals who have contributed to the system for decades.
Clinicians anticipate that older adults losing coverage may delay necessary care, potentially leading to an increase in severely ill patients, particularly in emergency rooms. Theresa Cheng, an emergency physician, highlighted seniors' vulnerability to rapid health decline if routine care is postponed.
At the state level, California, which has a significant population of immigrant seniors, has frozen enrollment for adults aged 19 and older who are TPS holders, asylum-seekers, or undocumented. The state cited an annual cost of $1.1 billion and budget shortfalls as reasons. While some Democratic lawmakers are seeking legislative solutions to expand Medi-Cal to cover these individuals, the California Department of Finance has stated it cannot backfill the federal cuts.
Among those affected is Rosa María Carranza, a 67-year-old child development professional from El Salvador with Temporary Protected Status, who has contributed to Medicare and Social Security for 24 years. Carranza, recently diagnosed with high blood pressure and having experienced a fall, expressed concerns about losing access to affordable medical care.