The administrator for the Center for Medicare and Medicaid Services (CMS), Mehmet Oz, recently claimed that an audit revealed “more than $1bn of federal taxpayer dollars were being spent on funding Medicaid for illegal immigrants”, but experts say the audits were unrelated to immigration, and that rhetoric like this could make immigrant families – regardless of legal status – afraid to seek necessary medical care.
Leo Cuello, a research professor at Georgetown University’s Center for Children and Families, noted that he had not “seen what this audit is”, but “based on the reporting, it appears that it is related to administrative errors in state claiming for matching funds, which is a relatively common occurrence, and which CMS monitors closely as they should”.
For example, it is common for states to ask for federal reimbursement for programs that are supposed to receive state funding exclusively, such as Meals on Wheels. Cuello said these types of audits are “the most vanilla and normal thing that happens all the time. States are constantly sending CMS claims, and CMS is constantly reviewing whether or not they’re paying something properly.” Reporting from Oregon Live and KFF confirms that the audits were routine.
What is not normal is for a CMS administrator, like Mehmet Oz, to post about these audits on social media, Cuello said. In his X post, Oz claimed that “Democrats are demanding the repeal of the President’s Working Families Tax Cuts legislation in order for their votes to reopen the government. This law wisely strengthened our ability to limit federal dollars from being spent on health care for illegal immigrants.”
“The Oz tweet mixes apples and oranges because it talks about a very specific audit, but then tries to put that audit into the context of the broader fight about HR1 [the One Big Beautiful Bill Act] and the Affordable Care Act enhanced premium tax credits and the shutdown,” Cuello said.
But, Cuello added, these audits and the shutdown are completely unrelated.
“More importantly, the Oz tweet repeats an inaccuracy that has been said numerous times at this point,” he continued, which is that Republicans are pushing the One Big Beautiful Bill Act and Affordable Care Act tax credit repeals in order to limit health coverage for undocumented immigrants. These measures would primarily remove coverage for US citizens, not undocumented immigrants, Cuello said.
The CMS did not respond to the Guardian’s request for comment.
Oz’s claim that undocumented immigrants cost the country $1bn in unlawful Medicaid coverage is highly unlikely, says Nina Yamanis, a professor at American University’s School of International Service.
Yamanis added that she “can’t imagine you could” get on Medicaid while undocumented. When verifying Medicaid eligibility, “if a lawful resident does not have a social security number, the state confirms their legal status by checking a database from homeland security, as well as verifying specific immigration documents”, she said.
Even if that $1bn figure were real, Cuello said, it was “about one-tenth of 1% of the trillion dollars that was cut out of the Medicaid program, and those cuts target US citizens”.
While the rhetoric in Oz’s post might be largely untrue, it adds to an atmosphere in which undocumented immigrants are exposed and targeted.
Yamanis said: “It’s exacerbating a problematic situation.” Lawfully present immigrants cannot sign up for Medicaid until they’ve completed a five-year waiting period. Now, Yamanis said, she was hearing accounts of lawfully present immigrants avoiding signing up for newly available Medicaid expansions in North Carolina because they are afraid of being punished by the system.
“It’s really unfortunate,” she said.
Cuello doubts Oz’s X posts about the audits will add too much to this fear: “There’s already such a deafening noise and fear around the [immigrant] community that this is just one more straw on the pile. I don’t see this being a straw that breaks the camel’s back. People are already not going to the doctor because they’re afraid to go to the doctor,” he said.
When people are afraid to access care, it worsens health outcomes for everyone – not just for immigrant communities, Yamanis said. HIV infections have been increasing among Latinos over the last 10 years “where other races and ethnicities remained flat”, she said. That’s due to “access to healthcare, language barriers, fears of deportation and also immigration status”, she added.
“When we have Latinos who are not accessing testing or treatment, it’s problematic, because that means that HIV is spreading among all of us,” she said, before emphasizing that those who are the most at risk are also the most afraid to access healthcare now.
“In the US, gay men and trans women are more at risk for HIV, and if they’re immigrants and Latino, they tend to come from countries where they were discriminated against, often with violence, and they really don’t want to go back,” Yamanis continued. “So the threat of deportation is much worse for that community.”
