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The Centers for Medicare and Medicaid Services announced a new enrollment verification system on Tuesday that will attempt to identify and remove illegal immigrants from Medicaid and the Children’s Health Insurance Program (CHIP) across the country.

The sweeping effort, previewed by CMS officials in recent weeks, is one of the most significant developments to date in President Trump’s second-term drive to ensure that government benefits for U.S. citizens and lawful immigrants are protected from illegal immigrant recipients.

Beginning this month, CMS will be sending monthly enrollment reports to all 50 states. Those reports will identify enrollees in Medicaid and CHIP who cannot be verified as eligible through federal databases. Databases include the Social Security Administration’s as well as the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program.

The first such report was issued on Tuesday. According to CMS, each state will receive a monthly report for the duration of the program and will be expected to verify enrollment in cases where status cannot be verified by the department. States will report the outcome of their findings to CMS.

CMS will then process changes to the public insurance programs. “We are tightening oversight of enrollment to safeguard taxpayer dollars and guarantee that these vital programs serve only those who are truly eligible under the law,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement.

CMS Administrator Dr. Mehmet Oz said the enrollment verification system would ensure the “integrity” of safety-net health programs for citizens and legal immigrants.

“Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid and CHIP,” Oz said. “This action underscores our unwavering commitment to program integrity, safeguarding taxpayer dollars, and ensuring benefits are strictly reserved for those eligible under the law.”

Administration Steps Up Efforts on Illegal Immigrants and Public Benefits

The CMS move follows a series of actions from the Trump administration this term focused on preventing illegal immigrants from receiving federal benefits. Shortly after his inauguration, Trump signed an executive order calling for a broad review of all federal programs that issue benefits. The order required agencies to take steps to ensure they were not in violation of a 1996 federal law known as the Personal Responsibility and Work Opportunity Reconciliation Act.

In February, HHS responded to the order by expanding the definition of “public benefits.” The rule increased the number of programs from 31 to 44. The list included housing, education, and employment services, and set the stage for linking federal databases and conducting more oversight.

The CMS effort follows a recent federal court decision that limited the ability of the Department of Health and Human Services to share information with immigration authorities. The Trump administration had begun referring enrollee data to Immigration and Customs Enforcement (ICE) to aid deportation efforts earlier this month, but was blocked from doing so by a federal court order.

Separately, states are set to face new statutory requirements linked to a Republican budget package enacted last month. The spending legislation set new parameters for eligibility checks for Medicaid, requiring that states verify eligibility at least twice per year. Current federal guidance requires checks at a minimum of once every three years.

GOP Fights Back Over Data Sharing with ICE

The requirements form the core of a coalition lawsuit against the Trump administration from over 20 states led by the Democratic attorney general of New York, Letitia James. The Democratic attorneys general, who have previously sued over several HHS rules, argued that a requirement for mandatory verification of immigration status for federally funded public benefits could cut off millions of citizens from vital services.

“The message is simple: keep your hands off our systems,” James said. “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.”

CMS enrollment reporting is set to continue monthly, though it is unclear when the system will hit a steady state or when most states are expected to complete reviews.