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The Centers for Medicare and Medicaid Services (CMS) on Tuesday unveiled a new effort to better monitor public health insurance programs and rid Medicaid and the Children’s Health Insurance Program (CHIP) of illegal immigrants. The policy, which CMS officials first reported, is one of the more aggressive efforts to date from the Trump administration during its second term in office. It will restrict taxpayer-funded health benefits for Medicaid and CHIP to U.S. citizens and immigrants who are lawfully present in the country.

CMS will begin issuing monthly enrollment reports to states that detail Medicaid and CHIP enrollees whose immigration or citizenship status cannot be verified using federal government databases. The agency will initially check three databases to determine citizenship and immigration status: the Social Security Administration and the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program.

The first monthly report, as required by statute, was issued on Tuesday, the agency said. Each month throughout the rest of the year, all states will receive their own report and will be required to review the cases they have been given. The states will then have to report back to CMS with the results of their reviews, confirming whether or not the enrollees in question are eligible for the program.

“We are strengthening enrollment oversight to protect taxpayer dollars and to ensure these critical programs serve only those who are eligible by law,” Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. said in a statement. “Our actions today will lead to states receiving increased program integrity information so they can focus on removing ineligible individuals from these programs and, in turn, open up slots for eligible children and families.”

CMS Administrator Dr. Mehmet Oz reiterated those comments, adding that the move was designed to preserve the integrity of safety-net health programs. “Every dollar that is misspent is one less dollar available for an eligible, vulnerable person who truly needs Medicaid and CHIP,” Oz said. “This action demonstrates our steadfast commitment to program integrity, to protecting taxpayer dollars, and to ensuring that these benefits are reserved only for those who are eligible under the law.”

Rolling out the new effort is part of the Trump administration’s ongoing campaign to end illegal immigrant access to federal benefit programs. Republicans have long tried to limit such access, and Trump moved quickly on that front during his second term. One of his first executive orders this term, signed in February, instructed federal agencies to review all federal benefit programs and develop plans to ensure that non-citizens were not receiving benefits in violation of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act.

The Department of Health and Human Services then expanded the definition of public benefits several weeks later. It increased the number of government programs that were considered public benefits from 31 to 44, which means more programs will now be subject to government verification.

CMS Did Not Directly Respond to Legal Challenges

The CMS effort has not come without legal challenges, however, as federal courts and state governments are already engaged in a legal battle over whether it will implement the change. A federal judge last month ordered the Department of Health and Human Services to stop sharing enrollee information with immigration authorities. In the move, the Trump administration had begun sharing data with Immigration and Customs Enforcement (ICE) to support deportation efforts, but the judge said this action was outside of the department’s authority.

In addition, states now face new statutory requirements tied to Republican spending legislation. Passed last month, the bill also requires states to perform eligibility checks on Medicaid enrollees at least twice each year, an increase from the previous requirements. While backers of the measure say it is necessary to curb fraud and abuse, opponents say it imposes unnecessary red tape on families in need.

In fact, a coalition of more than 20 Democratic attorneys general has already filed a lawsuit against the administration over the new rules. The group of attorneys general, which is led by New York’s Letitia James, says mandatory verification of an immigrant’s status for federally funded programs will impede access to vital services for millions.

“For decades, states like New York have built health, education, and family support systems that serve anyone in need,” James said at the time. “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.”

The lawsuit underscores the ideological schism between the Republican leadership in Washington and states with Democratic governments over issues of immigration policy and safety-net programs. Proponents of the CMS changes say it will ensure that taxpayer-funded benefits go to those who are legally entitled to them. Opponents, meanwhile, say the move is designed to exclude certain communities from the benefits, while also undermining states’ efforts to provide more inclusive care.

The first batch of CMS reports was distributed on Tuesday, but the debate over immigrant access to public benefits is sure to continue in courtrooms and Congress for some time. Republicans in Washington are focused on protecting the integrity of these programs, while Democrats are more focused on access and compassion. Medicaid and CHIP have become the latest battlefields in the ongoing national immigration and public resource debate as a result.