The Trump administration violated federal privacy laws when it turned over Medicaid data on millions of enrollees to deportation officials, a group of 20 states allege in a lawsuit.
Last month advisers to the secretary of the Department of Heath and Human Services (HHS), Robert F Kennedy Jr, ordered the release of a dataset that includes the private health information of people living in California, Illinois, Washington state and Washington DC to the Department of Homeland Security (DHS).
All allow non-US citizens to enroll in Medicaid – a jointly funded federal and state health insurance programme for lower-income individuals and underserved groups – to pay for their healthcare expenses using only state taxpayer dollars.
On Tuesday, California’s attorney general, Rob Bonta, and 19 other states’ attorneys general sued over the move. They alleged that the Trump administration’s data release infringes on federal health privacy protection laws, including the Health Insurance Portability and Accountability Act (Hipaa).
“This is about flouting seven decades of federal law policy and practice that have made it clear that personal healthcare data is confidential and can only be shared in certain narrow circumstances that benefit the public’s health or the Medicaid programme,” Bonta said during a press conference.
The complaint argues that if “members of our community cannot trust that the government will keep their medical history and other personal data safe, they will think twice about going to the doctor when needed”. This loss of trust will lead to “irreparable damage due to increased morbidity and mortality”.
The White House has sought to arm deportation officials with more data on immigrants as they accelerate enforcement efforts across the country. Experts warn that it could be used to help the DHS locate migrants in its mass deportation campaign.
The new “department of government efficiency” (Doge) enlisted technology company Palantir to build a massive repository of data pulled from multiple federal agencies for the purpose of immigration enforcement, according to media reports.
In May, a federal judge refused to block the Internal Revenue Service from sharing immigrants’ tax data with Immigration and Customs Enforcement (Ice) to help agents find and detain people living without legal status in the US.
The move to shore up the federal government’s data on immigrant Medicaid enrollees appears to have been set in motion in May, when the Centers for Medicare and Medicaid Services (CMS) announced it would be reviewing some states’ rolls to ensure federal funds have not been used to pay for coverage for people with “unsatisfactory immigration status”.
As part of the review, the CMS asked California, Washington and Illinois to share details about non-US citizens who have enrolled in their state’s Medicaid program, according to a 6 June memo signed by Medicaid deputy director Sara Vitolo that was obtained by the Associated Press (AP).
CMS officials attempted to fight the data-sharing request from homeland security, saying that to do so would violate federal laws, including the Social Security Act and the Privacy Act of 1974, according to the memo.
But the legal arguments outlined in the memo were not persuasive to Trump appointees at HHS, which oversees the Medicaid agency. Four days after the memo was sent, on 10 June, HHS officials directed the transfer of “the data to DHS by 5:30 ET today”, according to email exchanges obtained by the AP.
HHS is “aggressively cracking down on states that may be misusing federal Medicaid funds”, agency spokesman Andrew Nixon said in a statement. The agency has not provided details on the DHS’s role in the effort. Nixon also defended the legality of releasing the data to the DHS.
“HHS acted entirely within its legal authority – and in full compliance with all applicable laws – to ensure that Medicaid benefits are reserved for individuals who are lawfully entitled to receive them,” he said in the statement.
But in Tuesday’s lawsuit, the coalition of attorneys general contend that the White House’s actions are sowing fear and confusion that will lead non-citizens and their family members to disenroll, or refuse to enroll, in emergency Medicaid for which they are otherwise eligible, leaving states and their safety net hospitals to foot the bill for federally mandated emergency healthcare services.
Bonta said in a statement: “The Trump administration has upended longstanding privacy protections with its decision to illegally share sensitive, personal health data with Ice. In doing so, it has created a culture of fear that will lead to fewer people seeking vital emergency medical care.”
He added: “I’m sickened by this latest salvo in the president’s anti-immigrant campaign. We’re headed to court to prevent any further sharing of Medicaid data – and to ensure any of the data that’s already been shared is not used for immigration enforcement purposes.”
