AS A PHYSICIAN, I never imagined that Medicaid — our nation’s cornerstone public health insurance program — could turn into a tool for immigration enforcement. But this month that’s precisely what happened. That should alarm every American who believes in the sanctity of health care privacy, the protection of the vulnerable, and the Hippocratic oath doctors swear to uphold.
According to an internal memo obtained by the Associated Press, the Trump administration directed the Centers for Medicare and Medicaid Services (CMS) to hand over personal health data, including the immigration status of millions of Medicaid enrollees, to the Department of Homeland Security (DHS). This transfer occurred despite objections from CMS officials and appears to violate multiple federal privacy laws, including the Social Security Act and Health Insurance Portability and Accountability Act (HIPAA).
This is no small matter. Over 78 million people, nearly 1 in 4 Americans, are enrolled in Medicaid. It’s the primary payer for reproductive health: Medicaid covers 42% of all births nationwide, with higher percentages in some states. For many, it’s the route to perinatal care, mental health and substance use services, and chronic disease management.
Using private medical data to facilitate deportation is a profound infringement on patient confidentiality and betrayal of core medical ethics. When patients no longer trust health care, they avoid help, worsening illness and unraveling confidence in health systems. I’ve seen the repercussions firsthand. One woman delayed treatment, fearing Immigration and Customs Enforcement (ICE). By the time she was seen, her condition had progressed beyond what we could easily reverse.
This handoff comes amid ICE raids in cities like Los Angeles, where even those obeying court orders are being targeted. The retrieved data specifically concerns states like California, Illinois, Washington State, and the District of Columbia, jurisdictions that legally used state-only funds to extend Medicaid benefits to undocumented residents. These states followed the rules, deliberately excluding federal reimbursements. Now, the federal government is breaking its end of the deal.
Weaponizing health care
This isn’t just a breach of ethics. It’s the weaponization of health care and a violation of constitutional privacy guarantees. Federal law mandates universal availability to emergency Medicaid regardless of immigration status. Further, privacy laws like HIPAA and 42 CFR Part 2 strictly limit disclosure of personal health or enrollment information without proper authorization. The administration’s actions subvert the spirit, if not the letter, of these protections.
We urgently need congressional oversight and legal intervention. Lawmakers must investigate the basis for this data transfer, demand transparency from CMS and DHS, and explicitly prohibit the sharing of health data for immigration enforcement purposes. If this precedent stands, it permits broader misuse, not just against immigrants, but against anyone whose care the government deems politically inconvenient.
Some states expanded Medicaid to address long-standing health disparities. Within a year of California opening Medi-Cal eligibility to all low-income residents, regardless of immigration status, 1.6 million undocumented people gained access to comprehensive care. For pregnant women in particular, this has been lifesaving.
If this precedent stands, it permits broader misuse, not just against immigrants, but against anyone whose care the government deems politically inconvenient.
These expansions matter because the stakes are life and death. Pregnancy-related deaths have more than doubled in two decades, with Black and Indigenous women disproportionately affected. Families of color and immigrant households are more likely to live at or below the poverty line and face barriers to care, from geographic isolation to systemic biases. Medicaid is often their only option.
This move also undermines public health. Research shows that worry of deportation reduces health care utilization, even among U.S. citizen children in immigrant families. According to a Kaiser Family Foundation report, roughly 1 in 5 immigrant families with children avoided programs like Medicaid and the Children’s Health Insurance Program (CHIP) due to fear of consequences. That effect will intensify.
Sacrificing health to fear
Over 123 million Americans live in areas with mental health provider shortages. For immigrants, especially the undocumented, threats of exposure deepen such barriers. If seeking care endangers families, they may forgo treatment altogether, putting both individual and public health at greater risk.
Many patients impacted by these policies have already fled trauma, poverty, or violence. They come to hospitals not for shelter, but to survive: to deliver safely, to treat cancer, to find psychological stability. They walk into clinics believing their information will not be used against them.
Health care should never be used as bait. Using Medicaid to locate and deport immigrants is a calculated betrayal.
As a physician, I took an oath to first do no harm and to serve without discrimination. As a citizen, I expect our institutions to uphold that same standard. And collectively, as a country, we are to safeguard the privacy and dignity of all people.
What we are witnessing instead is health care being used as a tool of punishment. And if we let our health systems participate in surveillance over healing, we only become complicit in harm over care.
About the author
Rachel Bervell, MD, MPH is a resident physician and a Public Voices Fellow with The OpEd Project, in partnership with the National Latina Institute for Reproductive Justice and Every Page Foundation. Her work centers on the intersection of reproductive and mental health, with a focus on health equity.