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Health agencies under the Trump administration will begin efforts to remove illegal immigrants from the Medicaid and Children’s Health Insurance Program next month. The CMS move, which was first reported by The Hill, is one of the administration’s most comprehensive efforts to date to ensure taxpayer-funded benefits are reserved for eligible citizens.

CMS is now set to begin sending monthly enrollment reports to every state, which will then be used to target any Medicaid or CHIP enrollees that the federal government cannot verify are eligible. According to CMS officials, the agency will be consulting with several federal databases to ensure program integrity, including those run by the Social Security Administration and the Department of Homeland Security’s Systematic Alien Verification for Entitlements, or SAVE program.

The first batch of those enrollment reports was sent on Tuesday, a spokesperson for the agency told The Hill. CMS will continue to issue monthly reports to all 50 states, which are then required to conduct case-by-case reviews of all flagged enrollees. States will then have to certify the reviews to CMS, confirming the enrollees’ eligibility status.

“Today, we are increasing oversight of enrollment to ensure these critical programs are serving only those who are eligible under the law, so we can protect taxpayer dollars,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement. “We are committed to maintaining the integrity of Medicaid and CHIP by implementing commonsense improvements that allow states to meet this goal.”

CMS Administrator Dr. Mehmet Oz issued a similar statement in support of the new policy. “This action will ensure federal taxpayer dollars go to only those eligible under the law and are not misspent on ineligible individuals,” Oz said. “It also underscores our commitment to strengthening program integrity and protecting taxpayer dollars by maintaining the integrity of these safety-net programs. Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid and CHIP.”

The CMS announcement is part of a wider Republican push to limit federal benefits for illegal immigrants. Since President Donald Trump’s second term began, his administration has moved to implement a number of new enforcement measures. Trump’s first executive order of his new term, which he signed in February, also focused on program integrity for safety-net health programs. That order required every agency to conduct a review of all federal benefit programs and take appropriate steps to make sure non-citizens are not receiving benefits in violation of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act.

A few weeks later, HHS expanded the government’s definition of public benefits, taking several additional programs into account. The new list, which was also created by agency officials, included 44 programs instead of the previous 31.

CMS Announcement Comes as Administration Faces Court Challenge, Political Backlash

CMS’s plan to send out monthly reports is the latest move by the Trump administration to tie eligibility for federal benefits to citizenship verification. A federal judge last month ordered HHS to cease sharing enrollee information with federal immigration authorities.

In an order, the judge wrote that the administration had moved to share enrollee information with ICE as part of deportation and enforcement efforts, but that decision was outside the agency’s legal authority. An appeal is likely, but the policy remains on hold for the time being.

CMS and HHS also face new statutory requirements from congressional Republicans, thanks to a spending package that passed last month. The measure, which was sponsored by House Republicans, included a new provision requiring states to conduct eligibility checks on Medicaid recipients at least twice per year, a significant change from the previous requirement. The changes would also put a new onus on Medicaid recipients to provide the necessary documentation.

A coalition of Democratic attorneys general is now suing the administration over these new rules. Led by New York Attorney General Letitia James, the coalition argues that the requirements will make it harder for states to offer federally funded benefits.

“The strength of our health care system has always been that it is open and accessible to all New Yorkers,” James said in a statement. “We have joined together with 21 other states to challenge the administration’s unlawful and harmful rules, which will make it harder for millions of people to access basic health care services they desperately need.”

CMS Reports Will Be Used to Audit Enrollees Nationwide

The CMS announcement follows up on one of Trump’s first executive orders from his second term, which required a broad review of federal programs. In February, Trump had tasked every agency with auditing and reviewing its benefits programs.

CMS was one of the first agencies to move on those instructions, though the rollout had been delayed by legal challenges and partisan disputes over the requirement. The CMS order in question was first issued late last year and is set to go into effect at the start of next month.

CMS was quick to announce the first set of reports had been issued, following up on its initial announcement with a release to reporters on Tuesday evening. The first reports were issued on the same day, according to the agency, and states will continue to receive those updates every month.

CMS has also announced that HHS’ Office for Civil Rights and Office of Inspector General are on hand to assist, as is the Administration for Children and Families’ Office of Program Integrity. The agency has also established a helpline for states, though it has not yet been publicly released.

CMS has stated that it wants to remove illegal immigrants from the Medicaid and CHIP programs, but has not said whether that data would be made available to ICE for enforcement purposes. The Trump administration is currently in court over a similar issue, after a federal judge ruled that the administration was unlawfully sharing enrollee information with ICE.