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In a new effort to tighten eligibility and verify benefits enrollment, the Centers for Medicare and Medicaid Services (CMS) has announced a new action to review all Medicaid and Children’s Health Insurance Program (CHIP) records. A sweeping, nationwide audit is set to begin that will match every enrollee in these programs with federal immigration and citizenship databases. Any beneficiaries that cannot be validated through this system will be recommended for removal from the programs.

On Tuesday, CMS officials announced a series of new verification requirements, which would effectively flag any Medicaid and CHIP beneficiaries whose citizenship and immigration status could not be confirmed through federal government databases. CMS would then refer these cases to states for a formal eligibility review, at which point states must determine whether the individual is “lawfully present” and eligible to receive benefits.

“This new action to ensure Medicaid and CHIP only cover individuals who are lawfully present is an example of the Trump administration’s commitment to prioritizing citizenship and immigration status verification across the federal government,” said CMS Administrator Dr. Chip Roy.

CMS will begin sending enrollment records every month to every state, highlighting those enrollees that require further review. Among the federal databases that CMS will be using to conduct eligibility checks are those held by the Social Security Administration as well as the Department of Homeland Security’s Systematic Alien Verification for Entitlements program, according to CMS.

The first set of such reports was sent to the states on Tuesday, with further sets to be sent each month. “CMS is enhancing oversight of program enrollment and strengthening actions to remove illegal aliens from Medicaid and CHIP by sending monthly data reports to states that flag beneficiaries whose citizenship or immigration status cannot be verified,” the agency said.

Responding to the announcement, Health and Human Services Secretary Xavier Becerra said the action was aimed at better ensuring taxpayer-funded programs serve only those people who are truly eligible.

“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,” Becerra said in a statement. “By taking this action, we are helping ensure taxpayer-funded programs are reserved for those who are lawfully present in the U.S., just as the law intended.”

CMS chief Carole Johnson also noted that the efforts are part of the administration’s efforts to limit illegal immigrant access to public programs. The president, Johnson said, “has made clear that these programs should be reserved for those lawfully present in the United States, and we are taking this action to help ensure that’s the case.”

CMS’s action is part of a broader effort by the administration to limit illegal immigrant access to public programs. President Donald Trump, in his first executive order of his second term, ordered federal agencies to conduct a top-to-bottom review of all benefit programs and to take action to ensure only eligible, legal residents are allowed to receive federal benefits.

As part of that process, the Department of Health and Human Services (HHS) recently expanded the number of benefits that are treated as public benefits for eligibility purposes. In the past, 31 programs were considered public benefits, but the latest changes from HHS boosted that number to 44.

Immigration remains a flashpoint issue in Washington, with Democrats and Republicans generally divided on how these programs should be administered. A federal judge recently ordered HHS to stop sharing enrollment data with immigration authorities. HHS had begun sharing that information with Immigration and Customs Enforcement (ICE), but a federal judge has now put an end to those practices.

In addition, states are now under a new statutory requirement due to the Republican spending package, which passed last month and requires states to conduct at least bi-annual eligibility checks on Medicaid beneficiaries. That compares to the previous standard of only having to check when a beneficiary applied for benefits and on an annual basis thereafter.

As part of its ongoing litigation strategy, a coalition of over 20 Democratic attorneys general has sued the Trump administration over its new rules. Led by New York Attorney General Letitia James, the coalition argues that the administration’s mandatory verification of immigration status when receiving federally funded benefits illegally interferes with state governments’ right to provide health care.

“For decades, states like New York have built health, education, and family support systems that serve anyone in need,” James said in a statement. “These programs work because they are open, accessible, and grounded in compassion. Now, the federal government is pulling that foundation out from under us overnight, jeopardizing cancer screenings, early childhood education, primary care, and so much more. This is a baseless attack on some of our country’s most effective and inclusive public programs, and we will not let it stand.”

CMS notes that the first report of its new system has already been completed, but the legal and political battles over immigrant access to public programs will likely continue.