Republican-Led States Are Increasingly Turning Medicaid Agencies Into Immigration Enforcement Gatekeepers: Report

Republican-led states are increasingly using Medicaid agencies to assist immigration enforcement efforts, expanding beyond federal requirements and prompting concerns from healthcare advocates that immigrant families are avoiding medical care out of fear their information could be shared with federal authorities, as revealed in a new report from KFF Health News.

North Carolina became the latest state to adopt such measures in late April, requiring state health officials to report Medicaid recipients to the Department of Homeland Security if their legal status is considered questionable. Similar laws have already passed in Indiana, Louisiana, Montana and Wyoming, while lawmakers in Oklahoma and Tennessee are considering comparable proposals.

The measures go beyond existing federal rules, which require state agencies to cooperate with immigration authorities only when formally asked for information. Under some of the new state laws, agencies themselves must proactively flag individuals.

"This is an issue that is very much on the political radar right now," Carmel Shachar, a health policy researcher at Harvard Law School, told KFF Health News.

The shift follows broader efforts by the Trump administration to expand data-sharing between healthcare systems and immigration enforcement. In January, the Centers for Medicare & Medicaid Services entered into a new information-sharing agreement with Immigration and Customs Enforcement, raising concerns among health policy experts about how Medicaid data could be used in deportation operations.

Healthcare providers and advocacy groups have warned that the policies are already discouraging immigrants from seeking care. A January KFF analysis found providers feared increased ICE activity around hospitals and clinics could undermine public health by deterring patients from seeking treatment.

In Texas, public health experts told The Texas Tribune in April that undocumented immigrants were increasingly avoiding hospitals and delaying medical treatment because of immigration fears. State data showed hospital visits among undocumented patients fell by 32% between November 2024 and August 2025, with some border-region hospitals reporting declines of nearly 50%.

"If hospitals tell people that their Emergency Medicaid information will be shared with ICE, it is foreseeable that many immigrants would simply stop getting emergency medical treatment," Leonardo Cuello of Georgetown University previously told KFF Health News.

Immigration attorneys say the effects extend beyond undocumented immigrants themselves, particularly in mixed-status households where U.S. citizen children may also lose access to care.

"When you do policies that target an immigrant, you may think that you are just targeting this one person in the family, but it's a really imprecise bomb that takes out the whole household," Cuello said.