In December, a court decision allowed federal Immigration and Customs Enforcement (ICE) agents to use states’ Medicaid data to identify where people — including immigrants — live as part of enforcement actions. This decision could have profound implications for patient trust, access to care and public health reporting.
In the decision on Dec. 29, U.S. District Court Judge Vince Chhabria for the Northern District of California, denied a motion from 22 mostly Democratic states, writing that the personal information of Medicaid members is basic biographical, location and contact information that is “clearly authorized by law.”
Under that ruling, the federal Centers for Medicare & Medicaid Services (CMS) can share certain Medicaid enrollee data with ICE, including contact information and where enrollees live. The rationale from federal officials is that sharing addresses and contact information helps identify individuals in the U.S. unlawfully who might be receiving benefits.
For journalists, here’s what the ruling means
Leonardo Cuello, J.D., a lawyer and research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families who was not involved in the case, said it’s important to understand how narrow the policy is on paper — and how broad the consequences may be in practice.
“This is very narrow sharing,” Cuello said. “It is, number one, only Medicaid; and, number two, it’s only undocumented. So that means the entirety of the Medicaid program is not relevant, only emergency Medicaid, because that’s the only place where the undocumented could be.”
“So emergency Medicaid does not equal undocumented,” Cuello added. “Plenty of lawfully present immigrants are not eligible for full Medicaid and are in this emergency Medicaid.”
What is emergency Medicaid — and why it matters
Emergency Medicaid exists because federal law requires hospitals to stabilize anyone who comes through the emergency room doors, regardless of immigration status. States then use emergency Medicaid to reimburse hospitals for that care.
“The hospital has to provide treatment,” Cuello said. “It gets paid by the state, and then the state draws some federal matching dollars for that emergency Medicaid.”
Emergency Medicaid does not require applicants to disclose immigration status. The state and federal data systems do not distinguish between undocumented patients and many lawfully present immigrants who are ineligible for full Medicaid. The information-sharing policy means ICE’s access to such data would include the names and addresses of U.S. citizens and lawful residents, including those in mixed-status families.
Ripple effects explained
Critics of the policy argue that sharing such information breaks long-standing expectations about patient privacy and confidentiality, according to this KFF report. In a Nov. 25 notice in The Federal Register, CMS said it would share Medicaid data with ICE in some states.
If data-sharing is limited, fear spreads far beyond the small group technically affected.
“What we’re talking about here is very broad fear about using medical care, applying for coverage for immigrants,” Cuello said. “That is going to have really negative ripple effects.”
Recent data suggest that fears about data sharing and immigration enforcement are already influencing care-seeking behavior. A recent KFF/New York Times survey found that roughly half of immigrant adults were “very” or “somewhat” concerned that health officials or providers would share information with agents from ICE or federal Customs and Border Protection.
And you should be aware that about 14% of respondents said they or a family member avoided medical care since early last year due to immigration-related concerns. This matters for health outcomes — especially for people with chronic conditions who rely on consistent management, and for pregnant patients.
Half of emergency Medicaid is labor and delivery
About half of all emergency Medicaid spending nationally is tied to labor and delivery, Cuello noted. That means the policy could disproportionately affect prenatal and birth care. Delayed prenatal care is linked to higher rates of complications, preterm birth and maternal morbidity — consequences that extend well beyond immigration policy debates.
Clinics and health centers in communities with large immigrant populations have long reported deep patient concerns about privacy and information sharing. Research from KFF shows that in earlier discussions about the need for changes to the public-charge rule, patients became reluctant to provide identifying information or to enroll in federal or state health care programs.
In response to these concerns, some providers have shielded patient identities by minimizing the collection of sensitive information, training staff on privacy protections and adopting alternative outreach methods, as KFF reported Jan. 14. But health systems vary widely in their capabilities and legal obligations, and the federal Health Insurance Portability and Accountability Act doesn’t necessarily restrict federal agencies from accessing administrative data after it’s collected, according to guidance from the federal Department of Health and Human Services.
Questions for journalists to consider
For reporters, here are some questions to pursue:
- Are hospitals revising intake practices?
- Are staff being trained to minimize unnecessary documentation of immigration-related details?
- Are states adjusting how Medicaid data is stored and transmitted?
- The biggest unanswered question may be whether federal agencies will follow court limits on data sharing — and whether journalists will be able to detect violations.
Here are some additional developments to monitor:
- Litigation and policy shifts: A federal judge has already blocked broader data sharing until the government justifies it; tracking ongoing lawsuits and administrative changes will be crucial.
- Clinic and health center responses: Are providers changing intake practices or messaging to reassure patients?
- Care utilization trends: Look for data on missed prenatal visits, delayed chronic care, or drops in Medicaid enrollment that correlate with policy announcements.
- Demographic impacts: Pay special attention to pregnant and postpartum people — populations where delayed care can have lifelong consequences.
Resources
- With ICE Using Medicaid Data, Hospitals and States Are in a Bind Over Warning Immigrant Patients Phil Galewitz and Amanda Seitz, KFF, Feb. 6, 2026
- ICE and Palantir: US agents using health data to hunt “illegal immigrants,” Luke Taylor, BMJ, Jan. 27, 2026
- Report: ICE Using Palantir Tool That Feeds On Medicaid Data, Josh Richman, Electronic Frontier Foundation, Jan. 15, 2026
- ICE is using Medicaid data to find out where immigrants live, Anna Claire Vollers, Stateline, Jan. 20, 2026
- Potential Implications of the New Medicaid Data Sharing Agreement Between CMS and ICE, KFF, Jan. 14, 2026
- ICE can use Medicaid data to find people without legal status for deportation cases, Jasmine Garsd and Steve Inskeep, NPR, Jan. 5, 2026
- Potential “Chilling Effects” of Public Charge and Other Immigration Policies on Medicaid and CHIP Enrollment, KFF, Dec. 2, 2025
- Notice of Medicaid Information Sharing Between the Centers for Medicare & Medicaid Services and the Department of Homeland Security, Federal Register, Nov. 25, 2025
- Recent Trump Administration Policies that Impact Health Coverage and Care for Immigrant Families, KFF, Oct. 8, 2025
- Trump administration cuts undocumented immigrants’ access to range of federally funded programs, Isabella Cueto, STAT News, July 11, 2025
- What Privacy and Protection Standards are in Place for Medicaid Enrollees’ Personal Data? , KFF, June 23, 2025
- Health Insurance Portability and Accountability Act of 1996 (HIPAA), Centers for Disease Control and Prevention, Sept. 10, 2024
- Restrictions on Government Access to Health Information, federal Department of Health and Human Services, April 3, 2003
