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The Centers for Medicare and Medicaid Services (CMS) on Tuesday launched a major new initiative to verify the immigration status of Medicaid and Children’s Health Insurance Program (CHIP) enrollees. The effort, which was first reported by CMS officials, is the latest in a series of moves by the Trump administration to block illegal immigrants from receiving taxpayer-funded benefits.

CMS will now issue monthly enrollment reports to every state agency that show Medicaid or CHIP enrollees whose immigration or citizenship status can’t be confirmed by federal data sources. The databases that will be checked include the Social Security Administration and the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program.

The first of those reports was issued on Tuesday. Throughout each month, every state will get its own report and then be required to review any cases that have been flagged. States will then need to report back to CMS, verifying that those remaining in the program are legally entitled to continue coverage.

“We are strengthening oversight of enrollment to protect taxpayer dollars and ensure that these critical programs are serving only those who are eligible by law,” said Health and Human Services Secretary Robert F. Kennedy Jr. in a statement.

CMS Administrator Dr. Mehmet Oz also released a statement touting the importance of the initiative. “Every dollar misspent is a dollar stolen from an eligible, vulnerable individual in need of Medicaid and CHIP,” he said. “This action reiterates our steadfast commitment to program integrity, the protection of taxpayer dollars, and ensuring that benefits are only provided to those who are eligible under the law.”

CMS Effort Part of Trump Administration’s Second Term Strategy

The move from CMS follows several other executive branch efforts to reduce illegal immigrant access to federal programs. One of President Donald Trump’s first executive orders, this term, called on agencies to identify all federal benefit programs that were susceptible to fraud and overpayment. In an executive order signed on February 3rd, Trump gave agencies 45 days to report back with options to make it harder for non-citizens to access public benefits.

A month later, the Trump administration said they were expanding the list of government programs that are considered public benefits. The list went from 31 to 44, which effectively means more programs are now considered public benefits subject to eligibility checks.

CMS Initiative Highlights Political Tension

The CMS report requirement comes at a time when there’s significant tension between Democratic state leaders and Republican leaders in Washington over how the federal government should monitor public benefit programs. Last month, a federal judge ordered the Department of Health and Human Services to stop sharing enrollee data with immigration authorities. The Trump administration had been passing data from enrollment forms to Immigration and Customs Enforcement (ICE) in an effort to help with immigration enforcement and deportation efforts. The court found that this overstepped the department’s authority.

At the same time, states are now subject to new statutory requirements as part of a larger package of Republican spending legislation passed last month. The omnibus spending package includes a requirement for states to conduct eligibility checks for Medicaid enrollees at least twice a year. The previous threshold for eligibility checks was at least once every three years. The money and new requirements came as part of a larger federal spending deal that must be renewed by September.

A group of more than 20 Democratic attorneys general has already filed suit in federal court over this new requirement. Led by New York Attorney General Letitia James, this group of state officials has argued that mandatory verification of immigration status for federally funded programs will deter millions of their residents from accessing public benefits.

“For decades, states like New York have built health, education, and family support systems that serve anyone in need,” James said in a statement last month. “These programs work because they are open, accessible, and grounded in compassion. 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. This is a baseless attack on some of our country’s most effective and inclusive public programs, and we will not let it stand.”

States Fight Back Against Federal Mandates

The lawsuit from New York and other states will continue to move through the courts, but the new CMS enrollment verification requirement will be implemented in the meantime. Under the rules, each state agency will be required to conduct an eligibility review of flagged enrollees and report back to CMS about the decision to remove someone from the Medicaid or CHIP rolls.

While the first set of CMS reports has already been issued, the courts, Congress, and several states are likely to continue to take on the Trump administration over the issue of how, and to what extent, the federal government should verify access to public benefits by legal residents.

Republicans in Washington have placed a heavy emphasis on strengthening program integrity and making sure taxpayer dollars go to only those who are legally eligible for Medicaid and CHIP. Democrats, on the other hand, have focused more on making sure the benefits are accessible to those who need them, including undocumented immigrants and mixed-status families.

Medicaid and CHIP are once again caught in the middle of the partisan battle over the relationship between immigration and public benefits.