Article
What has changed
CMS agreed in spring 2025 to give Immigration and Customs Enforcement access to a Medicaid database that includes enrollee addresses and citizenship status. Twenty-two states sued. In December, a federal judge limited what ICE can see in those states to basic information, such as addresses, for people in the country unlawfully, and barred sharing of medical service information. In the other 28 states, deportation officials have access to personal Medicaid information for all enrollees.
A KFF Health News report published Feb. 6 found that hospitals and states are struggling with how to explain this to patients. Some state application materials still describe immigration information as confidential, and at least one state removed similar language after a reporter asked about it. Of the hospitals that responded to KFF Health News, none said it directly warns patients that their information may be shared.
Why it is an executive issue
Emergency Medicaid pays hospitals for emergency and pregnancy care for immigrants who do not qualify for standard Medicaid, including lawfully present people on student or work visas. Federal spending on it was nearly $4 billion in 2023, and about half of cases involve the delivery of babies who are U.S. citizens. Hospital staff typically help patients apply before discharge.
That creates competing risks. Disclosing the data access could lead some patients to decline enrollment, leaving the hospital with uncompensated care. Staying silent could expose patients to consequences they did not anticipate and damage trust if they learn about it later. A November KFF and New York Times poll found that about a third of adult immigrants had skipped or delayed care in the past year, a reminder that avoidance has clinical consequences of its own.
What leadership should decide
There is no single right answer, and the legal picture differs by state. What matters is that the organization makes a deliberate choice rather than leaving it to front-line staff. Executive teams and boards should consider these steps:
- Get a legal read by state. Counsel should explain what data can be shared in each state where you operate, given the December ruling.
- Set one consistent script. Financial counselors and registration staff need approved language that is accurate, neutral and avoids legal advice.
- Audit your materials. Remove any statement in brochures, websites or forms that promises confidentiality the hospital cannot guarantee.
- Track enrollment and payment trends. Watch Emergency Medicaid applications and self-pay emergency volume for shifts that signal avoidance.
- Align with mission and community partners. Coordinate with legal aid groups and community clinics so patients have somewhere to turn for advice.
Boards should ask to see the policy, along with the reasoning behind it.
Archive entry for Feb 6, 2026, added Nov. 11, 2026.