CMS Orders States to Purge Unverified Immigrants from Medicaid Rolls

WASHINGTON — The Centers for Medicare & Medicaid Services on Aug. 19, 2025, kicked off a sweeping oversight initiative targeting Medicaid and Children's Health Insurance Program enrollees whose U.S. citizenship or immigration status cannot be verified through federal databases. CMS now sends states monthly enrollment reports via the Transformed Medicaid Statistical Information System, identifying individuals flagged by the Department of Homeland Security's Systematic Alien Verification for Entitlements system. States must review these cases, request documentation during a 90-day 'reasonable opportunity period,' and disenroll those without satisfactory status, which is limited to citizens, nationals, or qualified noncitizens. "Every dollar misspent is a dollar taken away from an eligible, vulnerable individual," CMS Administrator Dr. Mehmet Oz said in a statement announcing the push. The effort stems from a February 2025 Trump administration executive order aimed at ending "taxpayer subsidization of open borders," mandating stricter verification to exclude unauthorized immigrants from federal benefits. Federal rules already bar most non-qualified immigrants, imposing a five-year wait for many after 1996, though exceptions apply for military families and certain children or pregnant individuals. States face heightened administrative demands, including standardized reporting on reverification outcomes and potential federal funding disallowances for unverified claims. The initiative coincides with the 2025 reconciliation law's mandate for semi-annual eligibility redeterminations starting December 2026 for expansion adults. Critics, including the Kaiser Family Foundation, warn of coverage lapses for eligible citizens and immigrants unable to navigate paperwork, potentially burdening states already strained by system updates due by Oct. 1, 2025, and state plan amendments by Dec. 31. As of the first reports dispatched last August, CMS plans to publish monthly de-identified counts of unverified cases, enforcing compliance through audits akin to ongoing HHS Office of Inspector General reviews. While states must provide limited emergency services to ineligible individuals, full coverage ends upon failed verification, with rights to fair hearings but no continued benefits during appeals. The policy underscores a federal pivot toward program integrity, building on existing SSA and DHS checks at application and renewal.