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Immigration and Customs Enforcement officials will be given access to the personal data of the nation’s 79 million Medicaid enrollees, including home addresses and ethnicities, to track down immigrants who may not be living legally in the United States, according to an agreement obtained by The Associated Press.

The information will give ICE officials the ability to find “the location of aliens” across the country, says the agreement signed Monday between the Centers for Medicare and Medicaid Services and the Department of Homeland Security. The agreement has not been announced publicly.

The extraordinary disclosure of millions of such personal health data to deportation officials is the latest escalation in the Trump administration’s immigration crackdown, which has repeatedly tested legal boundaries in its effort to arrest 

Lawmakers and some CMS officials have challenged the legality of deportation officials’ access to some states’ Medicaid enrollee data. It's a move, first reported by the AP last month, that Health and Human Services officials said was aimed at rooting out people enrolled in the program improperly.

But the latest data-sharing agreement makes clear what ICE officials intend to do with the health data.

“ICE will use the CMS data to allow ICE to receive identity and location information on aliens identified by ICE,” the agreement says.

Such disclosures, even if not acted upon, could cause widespread alarm among people seeking emergency medical help for themselves or their children. Other efforts to crack down on illegal immigration have made schools, churches, courthouses and other everyday places feel perilous to immigrants and even U.S. citizens who fear getting caught up in a raid.

HHS spokesman Andrew Nixon would not respond to the latest agreement. It is unclear, though, whether Homeland Security has yet accessed the information. The department’s assistant secretary, Tricia McLaughlin, said in an emailed statement that the two agencies “are exploring an initiative to ensure that illegal aliens are not receiving Medicaid benefits that are meant for law-abiding Americans.”

The database will reveal to ICE officials the names, addresses, birth dates, ethnic and racial information, as well as Social Security numbers for all people enrolled in Medicaid. The state and federally funded program provides health care coverage program for the poorest of people, including millions of children.

The agreement does not allow ICE officials to download the data. Instead, they will be allowed to access it for a limited period from 9 a.m. to 5 p.m., Monday through Friday, until Sept. 9.

“They are trying to turn us into immigration agents,” said a CMS official did not have permission to speak to the media and insisted on anonymity.

Immigrants who are not living in the U.S. legally, as well as some lawfully present immigrants, are not allowed to enroll in the Medicaid program that provides nearly-free coverage for health services. Medicaid is a jointly funded program between states and the federal government.

But federal law requires all states to offer emergency Medicaid, a temporary coverage that pays only for lifesaving services in emergency rooms to anyone, including non-U.S. citizens. Emergency Medicaid is often used by immigrants, including those who are lawfully present and those who are not.

Many people sign up for emergency Medicaid in their most desperate moments, said Hannah Katch, a previous adviser at CMS during the Biden administration.

“It’s unthinkable that CMS would violate the trust of Medicaid enrollees in this way,” Katch said. She said the personally identifiable information of enrollees has not been historically shared outside of the agency unless for law enforcement purposes to investigate waste, fraud or abuse of the program.

Trump team has pursued information aggressively

Trump officials last month demanded that the federal health agency’s staffers release personally identifiable information on millions of Medicaid enrollees from seven states that permit non-U.S. citizens to enroll in their full Medicaid programs.

The states launched these programs during the Biden administration and said they would not bill the federal government to cover the health care costs of those immigrants. All the states — California, New York, Washington, Oregon, Illinois, Minnesota and Colorado — have Democratic governors.

That data sharing with DHS officials prompted widespread backlash from lawmakers and governors. Twenty states have since sued over the move, alleging it 

CMS officials previously fought and failed to stop the data sharing that is now at the center of the lawsuits. On Monday, CMS officials were once again debating whether they should provide DHS access, citing concerns about the ongoing litigation.

In an email chain obtained by the AP called “Hold DHS Access — URGENT,” CMS chief legal officer Rujul H. Desai said they should first ask the Department of Justice to appeal to the White House directly for a “pause” on the information sharing. In a response the next day, HHS lawyer Lena Amanti Yueh said that the Justice Department was “comfortable with CMS proceeding with providing DHS access.”

Dozens of members of Congress, including Democratic Sen. Adam Schiff of California, sent letters last month to DHS and HHS officials demanding that the information-sharing stop.

“The massive transfer of the personal data of millions of Medicaid recipients should alarm every American. This massive violation of our privacy laws must be halted immediately,” Schiff said in response to AP’s description of the new, expanded agreement. “It will harm families across the nation and only cause more citizens to forego lifesaving access to health care.”

The new agreement makes clear that DHS will use the data to identify, for deportation purposes, people who in the country illegally. But HHS officials have repeatedly maintained that it would be used primarily as a cost-saving measure, to investigate whether non-U.S. citizens were improperly accessing Medicaid benefits.

“HHS acted entirely within its legal authority – and in full compliance with all applicable laws – to ensure that Medicaid benefits are reserved for individuals who are lawfully entitled to receive them,” Nixon said in a statement responding to the lawsuits last month.

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U.S. Immigration and Customs Enforcement officials will gain access to personally identifiable information for all of the nation’s 79 million Medicaid enrollees. That's according to an agreement obtained by The Associated Press.

Trump administration hands over Medicaid recipients' personal data, including addresses, to ICE

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