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A masked U.S. Immigration and Customs Enforcement agent knocks on a car window in Minnesota on Jan. 12. A new court ruling allows ICE to use Medicaid data, alarming some states and advocates who warn it could have a chilling effect on immigrant families accessing health care. (Photo by Nicole Neri\/Minnesota Reformer)<\/p>\n
In a win for President Donald Trump\u2019s immigration crackdown, a recent court ruling has cleared the way for U.S. Immigration and Customs Enforcement to resume using states\u2019 Medicaid data to find people who are in the country illegally.<\/p>\n
The case is ongoing. But for now, immigrants \u2014 including those who are in the country legally \u2014 will have to weigh the benefits of gaining health coverage against the risk that enrolling in Medicaid could make them or their family members easier for ICE to find.<\/p>\n
Last summer, 22 states and the District of Columbia sued the Trump administration to block information sharing between ICE and Medicaid, the state-federal health insurance program that primarily covers people with low incomes. But at the end of December, a federal judge ruled<\/a> that ICE can pull some basic Medicaid data to use in its deportation proceedings, including addresses, phone numbers, birth dates and citizenship or immigration status.<\/p>\n The court ruled that in the states that sued, ICE is not allowed to collect information about lawful permanent residents or citizens, nor records about sensitive health information. In the 28 states that didn\u2019t sue, however, the court did not place any limits on the Medicaid information ICE can access.<\/p>\n The U.S. District Court in San Francisco essentially said that government agencies can share some data, including basic identifying information. \u201cThat kind of data sharing is clearly authorized by statute,\u201d the decision states.<\/p>\n But the court also ruled that agencies can\u2019t share more sensitive data without adequately explaining why they need it. In his ruling, U.S. District Judge Vince Chhabria wrote that ICE and federal Medicaid information-sharing policies were \u201ctotally unclear and do not appear to be the product of a coherent decisionmaking process.\u201d He said the states had shown they would \u201csuffer irreparable harm from these vague and likely overbroad\u201d policies.<\/p>\n By law, federal Medicaid money cannot be used to cover people who are in the country illegally.<\/p>\n But in recent years, nearly half of states, including some led by Republicans, have chosen to use their own Medicaid money to extend coverage to certain groups of people, such as children and pregnant women, regardless of immigration status.<\/p>\n Advocates for immigrants and some state officials worry that ICE\u2019s use of Medicaid data will cause widespread fear among immigrant families, keeping them from seeking the health care that states have said they\u2019re eligible to receive. California\u2019s health department recently called<\/a> the administration\u2019s actions \u201ca grave breach of public trust.\u201d<\/p>\n \u201cStates have constantly reassured people that their health care information won\u2019t be used against them, and that\u2019s changed,\u201d said Tanya Broder, senior counsel for health and economic justice policy at the National Immigration Law Center, an advocacy organization focused on immigrant rights.<\/p>\n Court filings in the lawsuit illustrate the potential impact of the ruling.<\/p>\n In Chicago, for example, a patient at an Esperanza Health Center delayed her first prenatal visit until her third trimester because she worried enrolling in Medicaid could put her husband at risk of deportation, the clinic reported<\/a> in a December court filing. By the time she received care, she had complications that could have been addressed with earlier health visits. Another patient refused to apply for Medicaid for her child, a U.S. citizen, because she worried that seeking benefits would allow ICE to locate her.<\/p>\n \u201cThe expectation of privacy that we all have when we seek to enroll in a health care program has been compromised,\u201d said Broder.<\/p>\n \u201cNot only undocumented immigrants but people who live in families with immigrants and the broader community are going to feel less comfortable in applying for these health programs, over concerns their information is going to be weaponized against them or their family members.\u201d<\/p>\n Several months into Trump\u2019s second term, ICE gained access to the personal data<\/a> of 79 million Medicaid enrollees as part of its efforts to find people who may be living illegally in the United States.<\/p>\n Data on Medicaid enrollees is routinely exchanged between states and the feds, including to verify eligibility to receive federal funding. But the new agreement marked an about-face from past federal policies of not using such information for immigration enforcement.<\/p>\n The effort is unprecedented at the national level, said Medha Makhlouf, a law professor at Penn State Dickinson Law who specializes in health and immigration.<\/p>\n \u201cPreviously the federal government has balanced immigration enforcement interests with the protection of health-related interests,\u201d she said. \u201cNow they\u2019re weighing much more heavily the interests of immigration enforcement.\u201d<\/p>\n That puts the federal government at odds with states that have expanded health coverage as a matter of public health and economic policy, she said. Many states have extended coverage to a wider swath of people on the premise that broader coverage helps prevent the spread of disease, prioritizes preventive care over more costly emergency treatment and reduces economic losses when employees miss work because of illness.<\/p>\n The judge\u2019s order will stand until the case is resolved, as the judge considers what kinds of data can be released for use in immigration enforcement.<\/p>\n California Attorney General Rob Bonta, a Democrat, said in a July statement that the Trump administration\u2019s data-sharing move was illegal and \u201ccreated a culture of fear that will lead to fewer people seeking vital emergency medical care.\u201d<\/p>\n Federal officials say they\u2019re allowed to use lawfully collected information for immigration enforcement purposes.<\/p>\n The Department of Homeland Security and ICE did not respond to requests for comment.<\/p>\n Broder, of the National Immigration Law Center, said it isn\u2019t clear whether the limited information the court has allowed the Department of Homeland Security to use can be cleanly separated from data belonging to citizens and lawful permanent residents. The ruling says that if that basic data can\u2019t be separated from data that\u2019s still protected, Medicaid can\u2019t share it with ICE.<\/p>\n California\u2019s Department of Health Care Services, which administers the state\u2019s Medicaid program, emphasized that concern in a statement<\/a> updated earlier this month. The department said the feds haven\u2019t provided any information about how they plan to implement the court\u2019s order.<\/p>\n Meanwhile, some states are looking at their options for protecting their Medicaid data. Oregon Health Authority Director Dr. Sejal Hathi called the move to use Medicaid data for immigration enforcement \u201cdisappointing, to say the least\u201d in a public board meeting<\/a> earlier this month.<\/p>\n She said her agency is \u201ccommitted to doing all that we can within our authority to protect the health privacy of our members\u201d and is working with health providers to \u201censure that Oregonians, no matter their background, can continue to seek and receive quick and responsive health care without worrying about the safety of their health information.\u201d<\/p>\n In recent years, an increasing number of states have used their own money to extend health insurance coverage under their Medicaid programs to some noncitizens, such as people with green cards, refugees and those with temporary protected status.<\/p>\n For example, 14 states and the District of Columbia cover income-eligible children regardless of immigration status, while seven states and the district offer state-funded coverage to some adults with low incomes, regardless of immigration status. Nearly half of states \u2014 including a handful of red states \u2014 cover income-eligible pregnant women, regardless of their immigration status.<\/p>\n It should be an easy decision for families to accept help, but it\u2019s not easy anymore.<\/p>\n<\/div>\n \u2013 Medha Makhlouf, a law professor at Penn State Dickinson Law<\/b><\/p>\n<\/div>\n<\/div>\n<\/div>\n Makhlouf, of Penn State, directs a legal clinic at her law school where law students assist people who face legal barriers to getting health care and other public benefits. The students have fielded questions from parents \u2014 even those who are in the country legally \u2014 who have asked if applying for Medicaid for their children, who are U.S. citizens, jeopardizes their own legal status or exposes household members to scrutiny from ICE.<\/p>\n \u201cWe see the chilling effects directly,\u201d Makhlouf said. \u201cFolks have many more questions about the risks versus the benefits of applying for government programs. It should be an easy decision for families to accept help, but it\u2019s not easy anymore.\u201d<\/p>\n In the past year, the Trump administration also has ordered states to hand over personal data from sources including voter rolls<\/a> and food stamps<\/a>, even as it consolidates information held across federal agencies into a trove of information on people who live in the United States<\/a>.<\/p>\n In November, a federal judge blocked the IRS from sharing taxpayer information<\/a> for immigration purposes.<\/p>\n Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org<\/a>.<\/em><\/p>\nAn about-face<\/h4>\n
States step up<\/h4>\n
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