CMS Mobilizes the House’s Attack on Immigrants

Perhaps inspired by the song “Month of May” on The Suburbs album by Arcade Fire, the Centers for Medicare & Medicaid Services (CMS) is coming off quite a prolific month. It produced four new Newsroom releases since Monitor Mondays’ last airing, and 11 total during the month of May¹. They are all potentially consequential in their own right, but one in particular² bears an uncanny temporal association with something else recently happening in the U.S. House of Representatives.

On May 21, the House passed a budget reconciliation bill³ proposing substantial reductions in federal Medicaid spending⁴. For reasons many of you may be acutely aware of, eliminating this source of public insurance for millions of Americans is politically unsavory. So, how else could this administration levy cuts without enraging its base?

The answer? Target a different vulnerable population: immigrants. The bill’s architects’ reductions in the federal Medicaid “match”³ for states are targeting those states that have been investing their own Medicaid dollars in legal, expanded coverage for immigrants. 

Under the proposed bill, states with current state-furnished Medicaid programs for immigrants would be penalized by reducing the federal matching funds from 90 percent down to 80 percent of qualifyingAffordable Care Act expenditures⁵. Said another way: this bill penalizes states that use their own money to ensure humane medical care for all persons living within their borders.

A study on May 22 by the Kaiser Family Foundationestimated that this technique could reduce federal Medicaid spending by $11 billion over the next decade. Although this only amounts to a drop in the total Medicaid budget, it would balloon individual state Medicaid spending by over $92 billion, as 1.9 million immigrants⁵ across our country seek care – where care can be found.

If this bill³ is passed in its current form by the U.S. Senate, then Congress needs someone to go out there and find who is providing care to the immigrants who help keep our economy and society functioning. And who better than the agency that collects the receipts, even if they’re not necessarily directly paying the bills?

In a May 27 CMS Newsroom posting, agency Administrator Dr. Mehmet Oz took a decidedly partisan tone, saying “Medicaid is not, and cannot be, a backdoor pathway to subsidize open borders”². Former Deputy Administrator and Director of the Center for Medicaid & Children’s Health Insurance Program (CHIP) Services Drew Snyder focused more on the core function of CMS, stating that “Medicaid funds must serve American citizens in need and those legally entitled to benefits”². Snyder detailed in an official May 27 letter to state Medicaid offices mechanisms by which the agency would like to accomplish these goals, by evaluating state Medicaid spending reports – known as CMS-64 form submissions – and state eligibility criteria⁶.

But if they had done their homework, Dr. Oz and former Deputy Director Snyder may have found that such mechanisms already exist, with the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) already in the midst of a two-year assessment of states’ CMS-64 reports due out later this year⁷ and Medicaid itself detailing CMS-64 form reconciliations dating back to 1997, publicly available on its website⁸.

Now, in fairness, the Kaiser Family Foundation performed a data integrity analysis of Form CMS-64 back in 2006, and it found that the individual states’ data sources were not ideal. They lacked granularity⁹, and, if the Interim Acting Director, Caprice Knapp, is hoping that these readily available reports will offer insight into actual areas of improper spending, she may find the process shockingly manual.

But, after the incoming Interim Director is able to perform “focused reviews of Medicaid expenditures reported by states on the quarterly CMS-64 and in-depth financial management reviews (FMRs),” as detailed in former Director Snyder’s letter⁶, I suspect that what she will find is precisely in line with what many clinicians already know: when a person presents on our doorstep needing care, we help them. When healthcare professionals see a person in need, we use our skills to heal them.

And, as the May 27 letter affirms, according to Section 1903 of the Social Security Act, if such treatment is for an emergency medical condition⁶ – even if it has become such because some in our society have chosen to turn a blind eye, resulting in the unfortunate, late-stages of disease – federal Medicaid funding is perfectly legal⁶.

There is no fraud, waste, or abuse here, simply the need to care, and the need to treat. As state Medicaid offices partner with federal Medicaid officials, I sincerely hope this is reaffirmed, and perhaps a more inclusive, humane tone will be voiced in future CMS communications.

References

1. Centers for Medicare & Medicaid Services. Newsroom, accessed June 6, 2025.  https://www.cms.gov/about-cms/contact/newsroom

2. Centers for Medicare & Medicaid Services. “CMS Increasing Oversight on States Illegally Using Federal Medicaid Funding for Health Care for Illegal Immigrants”. Newsroom, May 27, 2025. https://www.cms.gov/newsroom/press-releases/cms-increasing-oversight-states-illegally-using-federal-medicaid-funding-health-care-illegal

3. 119^th Congress. “House Resolution 1”. 1^st Session Act 1, May 22, 2025. https://www.congress.gov/bill/119th-congress/house-bill/1/text

4. Congressional Budget Office. “Estimated Budgetary Effects of a Bill to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14, the One Big Beautiful Bill Act”. Cost Estimate, May 20, 2025. https://www.cbo.gov/publication/61420

5. Williams E et al. “Proposed Medicaid Federal Match Penalty for States that Have Expanded Coverage for Immigrants: State-by-State Estimates”. KFF, May 22, 2025. https://www.kff.org/medicaid/issue-brief/proposed-medicaid-federal-match-penalty-for-states-that-have-expanded-coverage-for-immigrants-state-by-state-estimates/

6. Snyder D. “SUBJECT: Ending Taxpayer Subsidization of Open Borders”. Center for Medicaid & CHIP Services, May 27, 2025. https://www.cms.gov/files/document/open-borders-eo-notification-states.pdf

7. U.S. Dept of Health & Human Services. “CMS Oversight of States’ Preparation of the CMS-64 Report”. Office of Inspector General Reports & Publications, accessed June 2, 2025. https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000787.asp#:~:text=CMS%20is%20responsible%20for%20reviewing,correct%20amount%20of%20Federal%20funds.

8. Medicaid. “Expenditure Reports From MBES/CBES”. State Budget & Expenditure Reporting for Medicaid and CHIP, accessed June 2, 2025. https://www.medicaid.gov/medicaid/financial-management/state-expenditure-reporting-for-medicaid-chip/expenditure-reports-mbescbes 9. The Kaiser Commission on Medicaid and the Uninsured. “Overview of Differences between Data Sources: CMS-64 and MSIS”. Kaiser Commission on Medicaid Facts, Jan 2006. https://www.kff.org/wp-content/uploads/2013/01/overviewmedicaiddatasources.pdf