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The Centers for Medicare and Medicaid Services (CMS) on Tuesday unveiled an ambitious new effort to strengthen enrollment requirements for public health programs, cutting off illegal immigrants from Medicaid and the Children’s Health Insurance Program (CHIP). The policy, which was previewed to CMS officials earlier in the week, would allow the Trump administration to take one of the most decisive enforcement actions yet during President Trump’s second term, ensuring only U.S. citizens and lawful residents have access to taxpayer-funded health insurance.

CMS’s next steps will involve compiling and sending monthly enrollment reports to each state. The documents will track all Medicaid or CHIP enrollees with unverifiable citizenship or immigration status against federal databases, including the Social Security Administration’s database and the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program.

The first set of those reports was delivered on Tuesday, the agency confirmed. Throughout the month, all states will receive a separate report and will be expected to reconcile all unverifiable enrollments. The onus will then fall on the state to respond to CMS, determining whether Medicaid enrollees have been found eligible to remain in the program or not.

“This is just the next step,” CMS Administrator Dr. Mehmet Oz said in a statement on Tuesday. “We know this will strengthen and protect the safety net 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. added.

President Trump, whose executive authority is largely responsible for the administration’s new policies, signed an executive order in February directing all federal agencies to review the means through which illegal immigrants access federal benefits. The order included a call to action to ensure non-citizens were not receiving services from programs deemed to be public benefits.

“The Departments of State, Labor, Justice, and Homeland Security, in consultation with the Administrator of General Services, shall review all federal benefit programs to determine whether they are public benefits, and if so, to take steps to ensure that such benefits are not provided to individuals in violation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996,” the order reads.

Three weeks later, HHS released an update to the categorical list of what are considered to be public benefits. The list, which was published in the Federal Register on March 14, expanded from 31 programs to 44, broadening the scope of the administration’s forthcoming policies.

CMS Latest: Biden Administration Moves to Cut Off Immigrant Access to Social Services

Republicans in Congress have also been active on the issue of illegal immigrant access to public programs, incorporating an enrollment verification requirement as part of a recent spending package for the states. The mandate, which was wrapped into the government funding package signed last month, instructs states to check Medicaid enrollment at least twice per year, a dramatic increase over the previous requirements in place before the bill’s passage.

CMS’s latest announcement comes as the Biden administration remains under fire from all sides of the political spectrum for limiting public benefit access for illegal immigrants. Earlier this month, a federal judge ruled the HHS must cease efforts to share enrollee data with federal immigration authorities.

Attorneys for the Department of Health and Human Services had been passing identifying information of enrollees in Medicaid, CHIP, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to Immigration and Customs Enforcement (ICE) for nearly a year, ostensibly to aid in immigration enforcement. The practice, however, was ruled to be outside the scope of HHS’ authority, and as such had to be immediately terminated.

States sue Trump admin. Over Medicaid plans

Democrats have already prepped their own legal response to the new requirements in the spending package, launching a lawsuit of their own against the federal government. The coalition, which is led by New York Attorney General Letitia James and includes more than two dozen other AGs, decries the change as a mandatory verification of enrollment, ensuring only U.S. citizens are granted access to federally funded programs.

“I will not sit idly by as the Trump Administration forces states like New York to implement this harmful, burdensome policy,” James wrote in a statement. “This is a brazen attack on the safety net programs that serve everyone, regardless of immigration status.”