The Department of Homeland Security estimates that over 2.5 million illegal aliens have left the US since Donald Trump returned to office. If a ruling from a federal judge stands up, that may just be the front wave to a tsunami -- or more accurately, the backflow from the four-year tidal wave that preceded it.
To some extent, the Trump administration has attempted to enforce immigration law with one hand tied behind its back. DHS has focused on existing and unresolved deportation orders, criminal records, and other indirect data to detain and deport illegal aliens. Many more have opted to self-deport through the DHS incentive program that pays a bonus and offers an amnesty that would allow for later, legal re-entry. However, the administration had been blocked from using its own data from Health and Human Services to identify illegal aliens, records that would provide a massive boost to its enforcement efforts.
A federal judge ruled Monday that the Trump administration can resume sharing location data about undocumented immigrants receiving public health insurance benefits with Immigration and Customs Enforcement, starting next month.
U.S. District Judge Vince Chhabria’s ruling is a victory for President Donald Trump’s mass-deportation agenda as it allows ICE to use Medicaid data in deportation cases beginning Jan. 6. The agency had been blocked from doing so for months amid a legal challenge from blue states.
“The sharing of such information is clearly authorized by law and the agencies have adequately explained their decisions,” Chhabria wrote in a seven-page order.
The decision marks a significant setback for California Attorney General Rob Bonta and 21 of his Democratic counterparts, who sued in July to prevent the Trump administration from using Medicaid data obtained from the Department of Health and Human Services to target immigrants.
Technically, this should not impact enforcement. Under federal rules, illegal aliens are not eligible for Medicaid funds, a point that came up in the Schumer Shutdown. The One Big Beautiful Bill imposed additional restrictions on Medicaid funding, which Chuck Schumer sought to repeal, even at the cost of $1 trillion over the next decade. That effort failed, even while Democrats sought to downplay its scope.
So how do illegal aliens access Medicaid? Several states allow it, despite the federal prohibition, including the states that lost yesterday in federal court:
Undocumented immigrants are not eligible to enroll in federal Medicaid programs, but California and other blue states — Illinois, Colorado, New York, Washington, Oregon, Minnesota, as well as Washington, D.C. — allow some people to receive state-funded benefits through their Medicaid implementation programs regardless of immigration status.
That, as it turns out, creates a trap by which ICE can ramp up its enforcement efforts. The states complained afterward that the ruling violates the "trust" of these recipients, but Judge Chhabria remained unmoved in his ruling. Not only do the statutes governing Medicaid funding and health care allow for privacy exceptions for law enforcement, but those privacy protections don't apply to illegal aliens in the first place:
The States argue that DHS’s statutory authority to request information does not mean that CMS has the authority to share that information. But the statutes upon which the ICE Memo relies clearly state that the relevant data requested by DHS “shall be made available,” 8 U.S.C. § 1360(b), and that the Secretary “shall . . . have access” to such data. 6 U.S.C. § 122(a)(2). Congress could not have made a clearer statement about DHS’s entitlement to certain data from other agencies, and that entitlement would be meaningless if it did not also obligate agencies to comply with DHS’s legitimate data requests.
The States further argue that the Government engaged in flawed legal analysis by failing to consider the countervailing restrictions imposed by the Affordable Care Act, Privacy Act, HIPAA, and the Social Security Act on HHS’s disclosing certain data. But those authorities do not support setting aside the policies at issue in their entirety. The CMS regulations implementing the ACA prohibit the disclosure of data created or collected by the Exchange, which does not cover the Medicaid data actually requested by ICE. See 45 C.F.R. § 155.260(a); Dkt. No. 133-1. The Privacy Act and the CMS regulations implementing HIPAA permit disclosure of otherwise protected data for law enforcement purposes such as immigration enforcement.2 See 5 U.S.C. § 552a(b)(7) (Privacy Act); 45 C.F.R. § 164.512(f) (HIPAA regulations). And the SSA allows disclosures when “provided by Federal law,” such as the statutes cited in the ICE Memo. 42 U.S.C. § 1306(a)(1).3 Those authorities therefore do not restrict ICE from obtaining Medicaid data pertaining to the basic biographical, contact, and location data of unlawfully present aliens.
Chhabria included a kill shot in his footnote:
In any event, the Privacy Act applies only to citizens and lawful permanent residents, whose data is off limits for the reasons explained later. See 5 U.S.C. 552a(a)(2).
Exactly.
Chhabria also noted that ICE and DHS didn't intend to use actual medical information to find illegal aliens and enforce immigration law. He kept the preliminary injunction in place to protect actual medical data, but created exceptions so that law enforcement could access Medicaid data that identified illegal aliens:
As both sides agree, the Court has authority under the APA to issue relief “as may be required and to the extent necessary to prevent irreparable injury,” including by severing invalid portions of the challenged agency actions. 5 U.S.C. § 705; Nasdaq Stock Market LLC v. SEC, 38 F.4th 1126, 1145 (D.C. Cir. 2022). Accordingly, while this litigation is pending, HHS and CMS are preliminarily enjoined from sharing any information received from the plaintiff States5 with DHS or ICE, unless it (1) is from the Medicaid program, (2) pertains only to aliens who are not lawfully residing in the United States, and (3) divulges only those aliens’ citizenship and immigration status, address, phone number, date of birth, and Medicaid ID.
That's precisely what ICE needs to enforce immigration law. Thanks to the sanctuary and sanctuary-adjacent policies of these states that use federal dollars to cover medical expenses for illegal aliens, those records exist and can be used for investigative purposes. That's a trap that these states created, and that the Trump administration can now use to precisely enforce the law.
This case isn't over yet; it hasn't actually begun in earnest yet. The injunction had been ordered ahead of the full trial of the states' challenge to DHS, ICE, and CMS. It's almost certain that the states involved in this lawsuit will challenge this ruling. However, Chhabria's correct on the law and its application to illegal aliens, and the Supreme Court will almost certainly defer to his relatively brief ruling. The biggest impact in the near time will be to amplify the incentives for self-deportation, which will also allow ICE and DHS to more efficiently use their resources and focus on the most troublesome cases.
