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Centers for Medicare and Medicaid Services (CMS) announced a major new initiative on Tuesday to strengthen the integrity of the public health insurance programs. The agency is working to remove illegal immigrants from both Medicaid and the Children’s Health Insurance Program (CHIP) by expanding cross-government verification checks.

CMS officials told reporters Monday the move is one of the most aggressive actions taken to date during the Trump administration’s second term. They promise it will flag and terminate any taxpayer-funded benefits going to ineligible illegal immigrants.

As part of the crackdown, CMS will now send monthly enrollment reports to every state. Reports are designed to identify any Medicaid or CHIP enrollees whose immigration or citizenship status cannot be verified by federal databases. CMS officials say the immigration databases include Social Security Administration records as well as Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program.

“This information will help state Medicaid and CHIP agencies identify instances when they cannot verify an enrollee’s immigration or citizenship status,” the agency wrote in a statement. “CMS has issued the first such report this week and will provide these reports to the states each month for the foreseeable future.”

The Trump administration launched this and several other efforts to strengthen background checks for federal programs during the president’s second term. His first executive order this term, in February, was to review all federal benefit programs. This was done to verify they complied with a 1996 immigration law titled the Personal Responsibility and Work Opportunity Reconciliation Act.

Trump then went on to order other agencies to better ensure non-citizens were not receiving benefits. These policies took effect as early as April when the Department of Health and Human Services (HHS) published an expanded list of public benefits.

This included more than a dozen programs. For example, they changed the definition of “public benefits” for more than 44 federal programs in total, up from 31 programs before.

Politics and Legal Challenges

Tensions continue to run high between the state and federal governments over this issue. A federal court this month ordered HHS to end its practice of sharing Medicaid enrollee data with immigration agencies. The court found that this practice was beyond the scope of the agency’s authority.

At the same time, states now have new statutory requirements placed on them through legislative actions. The Republican tax, spending, and debt ceiling package requires states to check the eligibility of Medicaid enrollees at least twice per year. This was more frequent than states were required to do previously.

Opponents of this process have been gearing up for a legal fight. A coalition of 20+ Democratic state attorneys general announced plans to sue over these new mandates.

Attorney General Letitia James of New York was the first to speak against the mandate. James said such a program would restrict millions of New Yorkers from federal benefit programs.

“The health, education, and family support systems in states like New York are some of the most effective and inclusive in the nation,” James said in a statement. “Federal public benefit programs are working for families across our state. That’s why we’ve built systems that are open and accessible to all New Yorkers in need.”

This effort shows the disconnect between Republican and Democratic leaders on the topic of immigration and the intersection of safety-net programs.“This information will help state Medicaid and CHIP agencies identify instances when they cannot verify an enrollee’s immigration or citizenship status,” the agency wrote in a statement. “CMS has issued the first such report this week and will provide these reports to the states each month for the foreseeable future.”