**With ICE Using Medicaid Data, Hospitals and States Are in a Bind Over Warning Immigrant Patients**

The Trump administration's decision to give Immigration and Customs Enforcement (ICE) access to nearly 80 million Medicaid patients' personal information has left hospitals and states struggling with a difficult dilemma. On one hand, they must balance the need to provide emergency medical care to immigrant patients with the risk of their personal data being used for deportation efforts.

Under the agreement between ICE and the Centers for Medicare & Medicaid Services (CMS), ICE officials will have direct access to Medicaid enrollees' addresses, citizenship status, and other sensitive information. This has sparked concerns among hospital administrators and advocacy groups that warning patients about the potential risks could deter them from seeking emergency medical care.

"If hospitals tell people that their Emergency Medicaid information will be shared with ICE, it is foreseeable that many immigrants would simply stop getting emergency medical treatment," said Leonardo Cuello, a research professor at Georgetown University's Center for Children and Families. "Half of the Emergency Medicaid cases are for the delivery of U.S. citizen babies. Do we want these mothers avoiding the hospital when they go into labor?"

For over a decade, hospitals and states have assured patients that their personal information would not be shared with immigration enforcement officials when applying for federal health care coverage. However, the Trump administration's aggressive immigration crackdown has changed this dynamic. Last year, President Donald Trump ordered ICE to access data from various government agencies, including tax information filed with the IRS.

The agreement between CMS and ICE was finalized in spring 2023, allowing ICE officials to access Medicaid enrollees' personal information without prior court approval. Twenty-two states, all but one led by Democratic governors, sued to block the agreement, which a federal judge ultimately upheld in December. The ruling limited what data could be shared with ICE to only basic information, including addresses, about Medicaid enrollees in the 22 states that sued.

Despite this ruling, hospitals and states are still grappling with how to inform patients about the potential risks of seeking emergency medical care through Medicaid. Some hospital systems have declined to comment on whether they've updated their disclosure policies, while others have issued statements assuring patients that their information will be kept confidential.

The California Department of Health Care Services spokesperson Anthony Cava stated in a statement that the agency would "ensure that Californians have accurate information on the privacy of their data, including by revising additional publications as necessary." Similarly, Oregon Health & Science University offers immigrant patients a Q&A document developed by the state Medicaid program for those with concerns about how their information might be used.

Hospitals rely on Emergency Medicaid to reimburse them for treating people who would qualify for Medicaid if not for their citizenship status. This includes immigrants living in the country illegally and lawfully present immigrants, such as those with a student or work visa. The coverage pays only for emergency medical and pregnancy care, making it difficult for patients to understand the potential risks of seeking treatment through this program.

"They need to be telling people that the judge has permitted sharing of information, including their address, for people who are not lawfully residing," said Sarah Grusin, an attorney at the National Health Law Program. "Once this information is submitted, you can't protect it from disclosure at this point."

Experts warn that sharing Medicaid data directly with deportation officials will force even tougher decisions upon some families. According to a KFF/New York Times poll released in November, about a third of adult immigrants reported skipping or postponing health care in the past year due to fear of deportation.

Bethany Pray, the chief legal and policy officer at the Colorado Center on Law and Policy, stated that sharing Medicaid data directly with deportation officials "will force even tougher decisions upon some families." She added, "People should not have to choose between giving birth in a hospital and wondering if that means they risk deportation."

As the Trump administration's immigration crackdown continues, hospitals and states are caught in a difficult position. While they must balance the need to provide emergency medical care with the potential risks of sharing patients' personal information, experts warn that the consequences of this decision will be far-reaching and devastating for immigrant families.