Sharing of Medicaid enrollees’ information for purposes other than the provision of health coverage and care pose risks for individuals and may jeopardize confidence in the security of data held by agencies

Federal regulations also require states to publicize the confidential nature of information applicants and beneficiaries submit to them. Reflecting this requirement, many states have information on their websites specifying that data shared with Medicaid will be protected.

The Social Security Act and regulations require that the “the use or disclosure of information concerning applicants and beneficiaries” must be restricted to “purposes directly connected” with administering state health coverage programs.

The latest version of the penalty would apply to the 14 states & DC that cover undocumented immigrants with state funds. States that cover other lawfully residing groups through other pathways could be affected.

If states eliminate coverage to avoid the FMAP penalty more than 1.9 million people covered through state-funded programs for immigrants and additional lawfully residing children and pregnant people covered through the Medicaid/CHIP option could lose coverage with most likely becoming uninsured

Additionally, 9 of the 33 states that would be affected by the penalty have laws that automatically end expansion or require changes if the federal match rate drops, meaning the provision could result in funding and coverage losses for the entire ACA Medicaid expansion in these states

The federal Medicaid match penalty for expanding coverage to immigrants, including lawfully residing children and/or pregnant women, could shift $153 billion from the federal government to the 33 affected states and DC over the next 10 years

The revision expanded the penalty from 14 states & DC that cover undocumented immigrants with state funds to 33 states & DC that use a Medicaid/CHIP option to expand coverage for lawfully residing children and/or pregnant people

The reconciliation bill would penalize states that have expanded coverage to immigrants by reducing their federal Medicaid match rate for the ACA expansion group from 90% to 80%

These provisions would likely increase the uninsured rate among immigrant families, including citizen children in those families, and have broader ramifications for the nation’s workforce and economy given the role immigrants play.

Proposed changes include:
*Medicaid FMAP penalty for states covering undocumented immigrants with their own funds
*Eliminating required Medicaid coverage for people while they are verifying immigration status
*Eliminating Marketplace and Medicare eligibility for many lawfully present immigrants

The proposal also raises questions related to the balance of power between the federal government and states and whether the federal government can condition federal Medicaid financing on state actions with their own funds

Federal savings would only be realized if states maintain their programs and have their federal match rate for the Medicaid expansion population reduced from 90% to 80%

If states eliminate their programs, there would likely be increased uninsured rates and barriers to care for immigrant families.

In @kff.org focus groups with Hispanic immigrants who are undocumented or living with an undocumented family member, some said they have become increasingly fearful of going to work and/or that they have noticed fewer workers showing up at their workplaces due to immigration-related fears

@kff.org Survey of Immigrants data show 1 in 5 lawfully present immigrants say they or a family member have limited participation in activities outside the home, including attending church, seeking medical care, or going to work, since January due to immigration concerns

Hispanic immigrants who are undocumented or living with an undocumented family member detail how immigration-related fears have taken a toll on their and their children's mental health and well-being in @kff.org focus groups

@kff.org Survey of Immigrants data show about 1 in 3 immigrants overall say they have experienced negative health repercussions due to worries about their own or a family member’s immigration status since January, rising to 4 in 10 lawfully present immigrants

@kff.org focus groups provide further insights into immigration-related fears experienced among Hispanic immigrants who are undocumented or living with an undocumented family member
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