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The Centers for Medicare and Medicaid Services on Tuesday unveiled a new nationwide initiative to police public health insurance programs and prohibit illegal immigrants from using Medicaid and the Children’s Health Insurance Program (CHIP). CMS officials said the effort will provide additional support and resources to states to better manage their Medicaid and CHIP programs and make sure that they “only serve eligible individuals.”

CMS announced that states will receive monthly enrollment reports identifying Medicaid and CHIP enrollees that do not meet eligibility rules because their citizenship or immigration status cannot be verified against federal records.

“This system will provide a monthly report to states, identifying Medicaid and CHIP enrollees who are ineligible for these programs due to unverified or non-verified immigration status,” the agency’s acting administrator, Dr. Coleman Ruyak, told reporters during a conference call. “The report will be sent to each state … at the end of the month. The report will include those enrollees who have not received a positive immigration or citizenship response from one or more of the databases.”

Databases include those held by the Social Security Administration and the Department of Homeland Security’s Systematic Alien Verification for Entitlements, known as SAVE. In the coming weeks, CMS will also begin providing state agencies with a full suite of verification and integrity tools to assist in enrollment processes.

The agency said the effort is part of a broader focus on preserving the integrity of Medicaid and CHIP and preventing illegal immigrants from receiving taxpayer-funded benefits to which they are not entitled. The Trump administration’s new second-term immigration policies have particularly focused on public benefit programs, which Republicans have long sought to restrict to non-citizens. In February signed an executive order directing all federal agencies to conduct a full review of federal benefits and ensure that non-citizens are not able to access programs in violation of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act.

Two months later, the Department of Health and Human Services adopted new regulations expanding the number of government programs that count as “public benefits,” increasing the total from 31 to 44. In the past, only those programs on the list were subject to verification and review.

Now, a new CMS initiative will require all states to compare eligibility data to federal records at least once per month, ensuring that those who have been placed in Medicaid or CHIP but do not verify as citizens or legal residents will be identified and removed. The change was first reported by The Daily Caller News Foundation’s White House correspondent, Christopher Heavener.

States already face a new legal requirement to verify eligibility at least twice per year because of spending legislation enacted last month. The statutory change was included in a Republican spending package that provides support for programs such as CHIP that otherwise would have expired. Republicans used the budget vehicle to add language requiring Medicaid agencies to “determine and verify” eligibility of enrollees at least twice a year. States have reported a significant spike in workloads and staffing requirements as they seek to meet the new requirement.

Opponents have also gone to court to try to stop CMS from requiring states to verify Medicaid and CHIP eligibility data against federal databases. In a lawsuit filed last month by New York Attorney General Letitia James on behalf of a coalition of more than 20 other Democratic attorneys general, states argue that the verification requirements will have a chilling effect on participation by the people who need Medicaid and CHIP the most.

CMS has also been the subject of legal challenges tied to immigration status data. Last month, a federal judge ruled against the administration in a lawsuit over sharing information about Medicaid and CHIP enrollees with immigration authorities. The court said that the Health and Human Services was overstepping its authority by transferring information about enrollees to Immigration and Customs Enforcement (ICE) to aid in deportations. The court gave HHS until Tuesday to cease the practice of providing the data. CMS officials say that Tuesday’s new action is not related to the court order.

CMS action part of broader Republican immigration focus

The Trump administration’s renewed focus on illegal immigrants in safety-net health programs comes after years of emphasis on the issue. Republicans have sought to limit access to safety-net health programs as part of broader immigration enforcement, but Democrats are pushing back.

Opponents of the effort are challenging the administration in federal court, with James calling the verification requirements an “assault” on New York and other states’ health care systems.

“This is just another way that the administration is politicizing the Medicaid program by using its funding to insert itself into our states’ health care system, stoke fear, and intentionally and wrongly create the perception that seeking essential health care services could lead to immigration enforcement,” James said.

James and the other attorneys general have also filed suit to try to prevent the administration from requiring states to verify immigration status against federal records. The Democratic attorneys general argue that data verification is too burdensome and would discourage enrollment, which would hurt patients.

CMS Administrator Dr. Robert Oz said the administration was committed to keeping the programs focused on their core mission of providing services to the most vulnerable in society.

“The Trump administration is committed to ensuring our Medicaid and CHIP programs work for all Americans by safeguarding these taxpayer-funded programs and making sure they serve those who are truly eligible,” Oz said. “We are particularly concerned about non-citizens and individuals with immigration status that is not verified as eligible to receive Medicaid or CHIP.”

CMS Press Secretary Jane Pennington contributed to this report.