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On Tuesday, the Centers for Medicare and Medicaid Services (CMS) announced a new, nationwide effort to crack down on the eligibility of enrollees in the Medicaid and Children’s Health Insurance Program (CHIP). The new system, which CMS officials announced Monday, requires states to review the eligibility of any Medicaid or CHIP enrollee whose immigration or citizenship status CMS cannot independently verify. Federal databases that will be consulted include those of the Social Security Administration and the Department of Homeland Security’s Systematic Alien Verification for Entitlements, also known as SAVE.

CMS on Tuesday will begin distributing monthly enrollment reports to each of the states. Throughout each month, the states will receive their own reports and are required to take action on the individuals’ flagged statuses by verifying their eligibility and certifying their enrollees to CMS.

“In an effort to strengthen the integrity of Medicaid and CHIP and ensure that only eligible individuals enroll in these programs, CMS will be issuing monthly reports on Medicaid and CHIP enrollment that include individuals for whom CMS could not verify citizenship or immigration status,” CMS stated in a press release. “CMS is taking this step to help States further strengthen their programs, and will work closely with all States to make this new reporting requirement a success.”

CMS Administrator Dr. Mehmet Oz said that the rollout of the new system was a key to preserving the access of safety-net programs for people who actually need them.

“We have a responsibility to protect taxpayer dollars and ensure that our safety-net programs are there for those who need them most,” Oz said in a press statement. “Today’s action will help keep Medicaid and CHIP focused on their intended purpose. Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid and CHIP.”

Oz added in a statement to reporters that the program could lead to the removal of potentially hundreds of thousands of illegal immigrants from both Medicaid and CHIP. He further said that the program was an expansion of an effort that had already been ongoing within the federal government for some time. “You can think about it as starting small and big states all got up to speed very quickly,” Oz said.

CMS officials have not yet provided estimates for how many illegal immigrants could be removed from Medicaid and CHIP as a result of the effort. Sources within the department, however, have indicated that the number could reach the hundreds of thousands. The CMS report distribution is the latest in a series of moves in Trump’s second term designed to limit the access of illegal immigrants to taxpayer-funded benefits. Within the first months of his second term, Trump signed an executive order directing agencies to review all federal benefit programs in an effort to close perceived loopholes in eligibility rules. The order, issued in February, targets violations of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act, which bars illegal immigrants from receiving certain public benefits.

In the months since then, Trump’s administration has expanded the definition of which programs are considered “public benefits” under the law. In May, the HHS added 13 federal benefit programs to the list. That brought the number of programs that were required to be verified for immigrant status to a total of 44, from 31 previously.

CMS and Medicaid Eligibility Verification Legal Battle Continues

Tuesday’s report launch comes just days after a federal judge ruled that the Department of Health and Human Services must stop collecting enrollee data for immigration enforcement. In May, the Trump administration ordered HHS to turn over enrollee data to Immigration and Customs Enforcement (ICE) in an effort to assist with deportation. A coalition of more than a dozen states filed suit, and U.S. District Judge Alison Nathan, an Obama appointee, ruled in their favor on May 29, the Washington Post reported.

The decision, however, could be rendered moot by new eligibility verification requirements included in a recent spending package. Republican leaders of Congress attached a rider to the spending bill last month that requires states to check the eligibility of Medicaid enrollees at least twice a year. Before that bill, state agencies had no minimum requirement for verification checks. The new eligibility requirements have been tied to eligibility verification standards as well.

CMS’s new program, which would have begun even without the new eligibility requirements, still has some hurdles. Democratic state governments, many of them led by left-wing AGs, have already sued over the new eligibility requirements, and a coalition of more than two dozen of them have vowed to file suit over the CMS requirements as well.

“Millions of New Yorkers rely on federal funding to access critical support services, but those resources are only as good as the government’s ability to get them to the people who need them,” New York Attorney General Letitia James said in a May press release. “For decades, states like New York have built health, education, and family support systems that serve anyone in need. These programs work because they are open, accessible, and grounded in compassion. Now the federal government is pulling that foundation out from under us overnight, jeopardizing cancer screenings, early childhood education, primary care, and so much more. This is a baseless attack on some of our country’s most effective and inclusive public programs, and we will not let it stand.”