On July 14, 2025, a highly controversial agreement was quietly signed between the Centers for Medicare and Medicaid Services (CMS) and the Department of Homeland Security (DHS), granting Immigration and Customs Enforcement (ICE) officials access to the personal data of 79 million Medicaid enrollees across the United States. This unprecedented move, obtained exclusively by The Associated Press, allows ICE to access sensitive information including home addresses, ethnicities, names, birth dates, and Social Security numbers, with the stated purpose of tracking down immigrants who may be residing in the country illegally.
The agreement, which has not been publicly announced, marks a significant escalation in the Trump administration's aggressive immigration crackdown. The administration has set a goal of arresting 3,000 people daily, often pushing legal boundaries in its efforts. The data-sharing arrangement permits ICE officials to locate "the location of aliens" nationwide, according to the document signed on Monday. However, the access to such a vast trove of personal health data has raised alarm among lawmakers, CMS officials, and immigrant advocates alike.
While ICE officials are not allowed to download the data, they can access it during limited hours—9 a.m. to 5 p.m., Monday through Friday—until September 9, 2025. This access window is intended to facilitate identification and location of individuals for deportation purposes. The breadth of information includes not only basic identity markers but also racial and ethnic data, which critics argue could lead to discriminatory enforcement practices.
Medicaid, a jointly funded state and federal program, provides health coverage to some of the poorest Americans, including millions of children. Federal law bars immigrants who are not legally residing in the U.S. and some lawfully present immigrants from enrolling in the full Medicaid program. However, emergency Medicaid coverage, which pays for lifesaving services in emergency rooms, is available to all individuals regardless of immigration status. Many immigrants, including those lawfully present and those without legal status, rely on emergency Medicaid during critical moments.
Hannah Katch, a former adviser at CMS during the Biden administration, expressed deep concern over the data sharing. "It’s unthinkable that CMS would violate the trust of Medicaid enrollees in this way," she said, emphasizing that personally identifiable information has historically been shared only for law enforcement investigations into waste, fraud, or abuse—not for immigration enforcement.
The Trump administration's push for this data access began in June 2025, when officials demanded personally identifiable information on millions of Medicaid enrollees from seven states—California, New York, Washington, Oregon, Illinois, Minnesota, and Colorado—that allow non-U.S. citizens to enroll in their full Medicaid programs. All seven states are governed by Democrats, and they have refused to bill the federal government for the costs of immigrant coverage. This data request sparked widespread backlash, leading twenty states to file lawsuits alleging violations of federal health privacy laws.
CMS officials have been internally conflicted over providing DHS access amid ongoing litigation. An email chain obtained by the AP reveals CMS chief legal officer Rujul H. Desai suggested seeking a "pause" on information sharing by appealing to the White House through the Department of Justice. However, HHS lawyer Lena Amanti Yueh responded the following day that the Justice Department was "comfortable with CMS proceeding with providing DHS access." This internal debate underscores the tension between legal concerns and political pressure within the administration.
Dozens of members of Congress, including Democratic Senator Adam Schiff of California, have condemned the data sharing. Schiff called the "massive transfer of the personal data of millions of Medicaid recipients" a violation that "should alarm every American" and demanded it be "halted immediately." He warned that it would "harm families across the nation and only cause more citizens to forego lifesaving access to health care." Schiff’s letter reflects fears that immigrant communities and others might avoid seeking medical help out of concern that their information could be used against them.
Despite these concerns, HHS spokesman Andrew Nixon defended the administration’s actions last month, stating that HHS "acted entirely within its legal authority—and in full compliance with all applicable laws—to ensure that Medicaid benefits are reserved for individuals who are lawfully entitled to receive them." Yet, the expanded agreement clearly states that DHS will use the data to identify individuals for deportation, a fact that contradicts earlier assurances that the data was primarily for cost-saving investigations.
Meanwhile, on July 16, 2025, Vice President JD Vance traveled to a machine shop in eastern Pennsylvania, a crucial swing state, to promote the Trump administration’s signature domestic policy legislation, often referred to as the "Megabill." Vance highlighted provisions such as tax cuts, preservation of overtime pay, and the creation of $1,000 savings accounts for newborns. He described the legislation as "transformational for the American people" and promised ongoing investment in American workers and families.
However, Vance notably omitted any mention of the bill’s cuts to Medicaid and nutritional assistance programs—key safety net components that many of Trump’s own supporters depend on. Democrats have framed the legislation as an attack on the middle class, and even some Republicans have voiced concerns about the bill’s impact on vulnerable populations. Polls indicate that the legislation is broadly unpopular, suggesting that selling the bill will be an uphill battle for the administration ahead of next year’s midterm elections.
Vance’s visit to Pennsylvania, a state pivotal in recent elections, was clearly an attempt to rebrand the legislation by focusing on its benefits while downplaying its more controversial aspects. Signs reading "No tax on tips" and "America is back" served as the backdrop to his remarks, underscoring the administration’s messaging strategy targeting working-class voters.
The juxtaposition of these two developments—the expansive data sharing to enforce immigration laws and the push to promote legislation that cuts Medicaid—paints a complex picture of the current administration’s priorities. On one hand, there is a drive to tighten immigration enforcement using sensitive health data, raising profound privacy and ethical questions. On the other, there is a push to reshape domestic policy in ways that critics argue undermine the safety net for many Americans.
As the September 9 deadline for ICE’s data access approaches, and as the administration continues to advocate for its domestic policy agenda, the debate over privacy, immigration enforcement, and social welfare programs is likely to intensify. The stakes remain high for millions of Medicaid enrollees and for the broader American public, who must grapple with the implications of these policy choices on healthcare access, civil liberties, and social equity.
