WASHINGTON (AP) — Immigration and Customs Enforcement (ICE) 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 on July 16 between the Centers for Medicare and Medicaid Services and the Department of Homeland Security. The agreement has not been announced publicly.

The agreement could have dramatic ramifications in Nevada, which has the largest per-capita undocumented population in the U.S. Although undocumented immigrants are already typically ineligible for federal Medicaid benefits, Nevada is home to the largest share of mixed-status families nationwide and has some 130,000 lawful permanent residents.

Worry has already been brewing among Nevada’s immigrant community. In March, Nevada Medicaid predicted that there would be a 15 percent reduction in Medicaid caseloads from mixed-status families over the next two years because of “increased federal scrutiny.” 

“Fear and distrust is going to grow,” state Sen. Fabian Doñate (D-Las Vegas) told The Nevada Independent in an interview. “If people are scared now to go to the emergency room because they don't want to be a target for ICE, this means that people are going to delay their care even further.” 

Doñate, who chairs the Senate Health and Human Services Committee, has sought in two consecutive sessions to secure more health coverage for undocumented immigrants, although neither of his bills ultimately became law. 

Nevada Medicaid did not return a request for comment on whether it would play a role in sharing the data. 

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 3,000 people daily.

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 an action could ripple widely

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 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 who 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.

Nevada is not among those states. In 2023, the Democrat-controlled Legislature passed a bill to grant Medicaid coverage to some undocumented people who wouldn’t ordinarily qualify for the program, but Republican Gov. Joe Lombardo vetoed the bill, saying Nevada had “insufficient resources to implement this new service.”

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, including Nevada, have since sued over the move, alleging it violated federal health privacy laws.

CMS officials previously fought and failed to stop the data sharing that is now at the center of the lawsuits. Last week, 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 Sen. Adam Schiff (D-CA), 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 are 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.

“I think this is an issue for everyone. It's important for all of us to be wary of this,” Doñate said.