The Centers for Medicare & Medicaid Services (CMS) recently announced it is increasing federal oversight over how states use Medicaid funding to provide health insurance to undocumented immigrants.
CMS announced on May 27 that it will increase federal oversight of Medicaid funds to “stop states from misusing federal Medicaid dollars to cover health care for individuals who are in the country illegally.” Increased oversight measures will include forced evaluations of select state Medicaid spending reports, in-depth reviews of state financial management systems, and a review of current eligibility rules and policies to “close loopholes and strengthen enforcement.”
The announcement follows a February 19 executive order from President Donald Trump that claims to end “taxpayer subsidization of open borders.” Undocumented immigrants are generally prohibited from receiving public benefits such as Medicaid, though lawfully present immigrants can become qualified if they have resided in the country for at least 5 years. That period is shorter for immigrants with qualified status, including refugees and asylum seekers.
The announcement could put the state’s HUSKY for immigrants program at risk.
In July 2024, the state expanded state-funded coverage for immigrant children who would otherwise qualify for Medicaid except for their immigration status from under the age of 12 to under the age of 16. The HUSKY for immigrants program has more than doubled projected enrollments, reaching 15,000 in that month. Enrollment for fiscal year 2025 was projected to be 7,000.
The state also recently made it so that recipients of Deferred Action for Childhood Arrivals (DACA), who are otherwise ineligible to enroll in Medicaid and CHIP, were considered “lawfully present” to apply for health insurance coverage through the Access Health CT Marketplace and could enroll in health and dental plans if they met other eligibility requirements.
Currently, the state covers postpartum Medicaid coverage for 12 months regardless of a person’s immigration status. HUSKY B Prenatal also provides coverage to eligible individuals who don’t qualify for Medicaid due to their immigration status and offers Children’s Health Insurance Program (CHIP) benefits during pregnancy. In its first year, the HUSKY B Prenatal program saw 1,604 individuals enroll.
Current federal rules do allow states to provide prenatal and pregnancy-related care to certain low-income individuals regardless of their immigration status through a separate CHIP program. Federal rules also allow states to waive the five-year waiting period for pregnancy care and for children if they are lawfully present.
Currently, states are required to verify the immigration status of Medicaid applicants through the Social Security Administration and the Department of Homeland Security. States are also required to provide Medicaid benefits to applicants for 90 days while their immigration status is being verified, known as a reasonable opportunity period, and are eligible to receive matching funds from the federal government for Medicaid expenditures during that time period.
Broader Medicaid funding has also been an issue during the current legislative session, with the question of cuts the federal government could make to programs the state receives money from raising the possibility of the legislature reconvening this fall.
Earlier this month, Gov. Ned Lamont issued a “Declaration of the Existence of Extraordinary Circumstances” authorizing the legislature to go over the state spending cap to address a $248.3 million Medicaid deficiency for fiscal year 2025. Though votes in both chambers fell on party lines, the measure did meet the 60 percent threshold needed to exceed the spending cap.
During debate on the bill to address the Medicaid deficiency over the past two years, Rep. Jillian Gilchrist, D-West Hartford, said in response to a question from Rep. Joe Hoxha, R-Bristol, that $32 million came from healthcare the state provides to undocumented immigrants.
Gilchrist further stated that, according to fiscal year 2025 estimates, the state has spent an estimated $40 million on healthcare for undocumented immigrants. Of that sum, Gilchrist said $29 million went to care for children; $550,000 went to HUSKY B, which covers CHIP in the state; $11 million went to postpartum care; $6.3 million went to prenatal care; and $28.5 million went to emergency Medicaid expenses.
Republicans both at the federal and state level have called for an end to Medicaid programs for undocumented immigrants.
In testimony submitted on the bill addressing the deficiency, Department of Social Services chief fiscal officer Briana Mitchell listed expanded health coverage for children aged 15 and under regardless of immigration status as an underfunded program contributing to the Medicaid shortfal
A bill to expand the HUSKY for immigrants program to allow income-eligible individuals up to age 26 to receive coverage regardless of immigration status was introduced during the current legislative session but did not receive a public hearing.
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