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The Centers for Medicare and Medicaid Services (CMS) announced Tuesday a new national effort to improve oversight of public health insurance programs and deport illegal immigrants from Medicaid and the Children’s Health Insurance Program (CHIP). The initiative, which was first reported by CMS officials, is the latest and most sweeping measure taken yet by the Trump administration in its second term to limit access to taxpayer-funded benefits for people not legally entitled to them in the United States.

The program will see CMS begin to transmit monthly enrollment reports to each state government, which will highlight Medicaid or CHIP enrollees whose immigration or citizenship status cannot be immediately verified via federal data banks. The sources of these databases, CMS announced, would include the Social Security Administration and the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program.

CMS Administrator Dr. Mehmet Oz said the first of those reports was sent out on Tuesday. The agency noted that over the course of each month, every state will receive its own report and then be required to take further action on the cases listed in those reports. After conducting their own reviews of the enrollees in question, the states will have to report back to CMS as to the status of those cases.

“In the coming days, we will continue this process with monthly data exchanges on enrollees who may not meet citizenship and immigration eligibility requirements,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a prepared statement. “CMS is committed to ensuring that these programs serve only those who are eligible under the law, and we are strengthening our enrollment oversight to protect these vital programs and the American taxpayer.”

In that same statement, CMS Administrator Dr. Mehmet Oz said the initiative was necessary to ensure safety-net health care programs only serve their intended purpose. “We must do everything we can to protect taxpayer dollars and prevent fraud in these critical programs,” Oz said. “Every misspent dollar is a dollar that is taken away from an eligible, vulnerable individual who needs Medicaid and CHIP. The action we are taking today is one more important step in our ongoing work to strengthen program integrity and preserve these vital programs for those who are eligible.”

The initiative follows through on part of the strategy of Trump’s second term to limit illegal immigrants’ access to federal benefits, a policy that is also a long-running goal of many in the Republican Party. Since his second term began, Trump has issued a series of orders and directives aimed at increasing oversight and verification of eligibility in all federal programs.

The very first executive order he signed, in February, was an order directing every agency to begin a comprehensive review of all benefit programs offered by the federal government and to take steps where necessary to ensure that non-citizens were not improperly receiving benefits in violation of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act.

The Department of Health and Human Services followed up on that order a few weeks later by issuing a formal rule expanding the number of government programs considered to be public benefits. The new list, which went from 31 programs to 44 total, would now be subject to review and verification.

Background Litigation and Pressure from Democrats

The CMS announcement, however, comes after a series of federal lawsuits and legal action have put increasing pressure on the administration from state officials and Democrats on immigration enforcement issues.

Late last month, a federal judge ruled that the Department of Health and Human Services was effectively prohibited from using enrollee data from Medicaid and CHIP for any other use than that which was stated in the language of those programs. The Trump administration had begun sharing some of that data with Immigration and Customs Enforcement (ICE) as part of an effort to round up immigrants in the country illegally.

But U.S. District Judge Henry E. Lockwood, Jr. of the District of Vermont found the practice went far beyond the Department of Health and Human Services’s authority. “Defendants’ actions in passing along enrollee information … to ICE personnel in support of DHS’s immigration enforcement activities were not authorized by the statute,” Lockwood wrote in his order.

At the same time, states are also now under new statutory requirements as part of a Republican spending package passed last month. The law, which required states to perform eligibility checks for Medicaid enrollees at least twice a year, was billed by supporters as an anti-fraud measure but was opposed by Democrats and advocates who claimed it was excessive.

CMS did not immediately respond to inquiries about the pending lawsuit, which is not expected to go to trial until at least the summer. It remains unclear how aggressively the agency will move on its own against immigrants who, while they may still legally qualify for some benefits under the law, can’t immediately produce all the necessary documents to prove that status.

CMS has said that those immigrants would still be eligible to retain their benefits while the verification process plays out, though specific timeframes for that process and how often that happens have not been announced.

The controversy is another example of the tension between Washington Republicans and many states with Democratic leadership over immigration policy and the role of safety-net programs. Advocates for the CMS policy say it is necessary to ensure that taxpayer money is used for those who are legally entitled to it. Opponents say the measures make it more difficult for the most vulnerable families to receive care and attempt to bar immigrants from accessing services.