This past week, a federal judge ruled that the U.S. Immigration and Customs Enforcement had improperly accessed protected health information of millions of Medicaid enrollees, including U.S. citizens.
ICE's access to that medical data has raised concerns that individuals may avoid seeking necessary care out of fear their private information would be shared – compromising public health and potentially increasing states' healthcare costs.
That prompted a multistate lawsuit, which has led to the Department of Homeland Security being precluded from using the Center for Medicaid & Medicare Services' data obtained for immigration enforcement purposes.
That includes data already acquired, until the termination of this litigation or 14 days after DHS and the Department of Health and Human Services complete "a reasoned decisionmaking process," according to the judge's ruling.
WHY IT MATTERS
In the complaint brought against President Donald Trump’s administration last month in Northern California federal court, attorney generals from 20 states – California, Arizona, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont and Washington – sought to bar use of Medicaid data for immigration enforcement and deportation purposes.
The attorneys general argued that the administration "abruptly changed, without notice, opportunity for public input, or reasoned decision-making" its policy of keeping state Medicaid agencies’ healthcare records confidential in their lawsuit filed July 1.
Because ICE had a policy against using Medicaid data for immigration enforcement purposes, which had been publicized to states, medical providers and Medicaid patients since 2013, U.S. District Judge Vince Chhabria said he would grant them a partial preliminary injunction.
Medicaid data from several states, which could include Children’s Health Insurance Program data, was shared with ICE officials, according to the complaint.
That action, they argued, would compromise the health of individuals experiencing emergencies and leave states and their safety net hospitals footing the bill for federally mandated emergency healthcare services.
"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," the attorneys general said.
"Congress itself extended coverage and federal funds for emergency Medicaid to all individuals residing in the United States, even those who lack satisfactory immigration status," they noted.
They also asked for immediate relief to protect state data and "to bar the federal government from reneging on the terms of the longstanding State/federal Medicaid partnership," and the judge agreed the attorneys proved their claims that the federal decision to share the PII was arbitrary and capricious.
"It appears that ICE is primarily focused on obtaining current address information for people who are in the country unlawfully," Chhabria wrote. "But CMS appears to have granted ICE unfettered access to all information about all Medicaid patients in the United States, whether citizens or noncitizens."
However, Chhabria denied the plaintiffs' request to require the federal agencies to undertake notice-and-comment rulemaking before deciding whether to change their policies because "several federal statutes appear to permit, and sometimes even require, agencies to provide such information to DHS upon request."
THE LARGER TREND
As part of Trump's executive order, Ending Taxpayer Subsidization of Open Borders, CMS said in May that it would crack down on Medicaid funding for immigrants and act "decisively" to ensure funds are used for eligible individuals only.
Then in June, federal health agency staff were asked to release personally identifiable information for Medicaid enrollees in seven states – California, New York, Washington, Oregon, Illinois, Minnesota and Colorado – that permit non-U.S. citizens to enroll.
All U.S. states are required to offer temporary emergency Medicaid coverage that pays just for lifesaving services in emergency rooms to anyone, including non-U.S. citizens, who are lawfully present or not.
But ICE was provided access to the personal data of the 79 million Medicaid enrollees to help track down immigrants who may not be living legally in the United States, according to a data-sharing agreement between CMS and DHS reportedly obtained by The Associated Press in mid-July.
That agreement allowed ICE to access the data between 9 a.m. and 5 p.m., Monday through Friday, through Sept. 9.
"It’s unthinkable that CMS would violate the trust of Medicaid enrollees in this way," Hannah Katch, a former CMS adviser, had told the AP.
ON THE RECORD
"Everyone should be able to seek medical care without fear of what the federal government may do with that information," said Nick Brown, attorney general of Washington state, in a statement following the injunction.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
