2026年5月14日 / 美国东部时间上午5:00 / KFF健康新闻
多个州加入特朗普总统的驱逐行动，将联邦向移民当局的报告要求推进一步——将公共卫生机构作为执法臂膀。
北卡罗来纳州于4月底成为越来越多共和党领导州中的最新一员，要求其公共卫生机构向美国国土安全部报备那些法律身份存疑的医疗补助领取者。
健康政策研究人员预计，这一趋势将在那些急于与特朗普政府一道打击联邦层面医疗补助欺诈和非法移民的共和党控制州蔓延。目前至少已有印第安纳州、路易斯安那州、蒙大拿州和怀俄明州通过了类似法案，俄克拉荷马州和田纳西州等地的议员也正在审议相关议案。上述六个州均由共和党掌握“ trifecta”——即议会参众两院和州长办公室的控制权。
“这是当前政治关注度极高的议题，”哈佛大学法学院健康政策研究员卡梅尔·沙查尔说道。
全美共有超过7500万人参与医疗补助计划——这是由联邦和州共同运营的面向残疾人和低收入人群的公共卫生项目——及其相关的儿童健康保险计划，该计划为19岁以下人群提供低成本医保。无合法身份的移民无资格享受医疗补助福利，但包括绿卡持有者、避难者和难民在内的大量非公民群体符合申领条件。美国四分之一的儿童（其中大多数为公民）与移民家庭成员共同生活。
然而新的报告法案为在美国寻求医疗服务的移民增加了一层风险，白宫此前已出台指令，要求利用医疗补助数据识别并驱逐相关人员。
部分州的法律仅适用于卫生机构，北卡罗来纳州便是如此。但即将提交田纳西州州长比尔·李签署的法案则更为全面，要求所有州政府机构举报被怀疑非法滞留美国的人员。上述七项州级法案均超出了联邦要求的范围——联邦仅要求在执法官员提出请求时，提供领取者的个人信息以配合执法。
在路易斯安那州，有混合移民身份的家庭反映，该州去年生效的新法律阻止他们为拥有美国公民身份的子女申请医疗补助。
“我预计这项法律会让更多家庭纠结：寻求医疗服务是否安全，个人信息是否会被共享给移民当局，为孩子参保或接受治疗是否会让他们面临执法后果，”北卡罗来纳州移民律师耶塞尼亚·波兰科-加尔达梅斯说道。
北卡罗来纳州的共和党议员将要求州卫生部门报备的条款纳入了一项恢复3.19亿美元医疗补助资金的法案，该资金因州议会去年未能通过预算而被削减。
从10月起，州政府工作人员将向领取医疗补助的非美国公民索要移民身份证明，并将那些没有“令人满意”合法身份的人员上报给联邦当局。“这项法案不仅旨在为当前的关键需求提供资金，还将着手解决我们已知存在于体系中的欺诈和滥用问题，”共和党州众议员唐尼·兰贝思在众议院就该法案进行辩论时说道。
卡托研究所（一家自由意志主义智库）的分析显示，移民使用福利的比例远低于美国出生人群，该机构还发现非公民骗取福利的可能性比公民低得多。州卫生机构原本就被要求核实申请人的移民身份是否符合医疗补助申领资格。
负责该法案的几位共和党领导人未回应置评请求。北卡罗来纳州卫生与公众服务部发言人汉娜·琼斯表示，该机构仍在试图理解新法案的影响。
在2025年KFF与《纽约时报》联合开展的一项调查中，约一半“可能”缺乏合法身份的成年人表示，其家人因担心信息会引起移民执法部门注意而避开就医。
北卡罗来纳州歧视律师阿纳贝尔·罗萨表示，处于“申请流程中”或等待合法授权的移民通常已经不敢使用政府援助。
“多年来处理数千起案件的经验让我明白，大多数处于申请流程中的人都会自掏腰包支付医疗费用，”罗萨说道。
乔治敦大学儿童与家庭中心研究员莱昂纳多·奎略表示，此类政策实质上迫使身为美国公民的儿童无法获得医保或住院治疗。
“当你制定针对移民的政策时，可能以为只是针对家庭中的某个人，但这就像一枚精准度极差的炸弹，会波及整个家庭，”奎略说道。
利用州公共卫生机构寻找非法滞留移民并非各州采用的唯一策略。部分州已通过法案，要求医院收集并上报此类信息。南佛罗里达大学2024年的一项研究显示，2023年佛罗里达州出台的要求医院工作人员询问患者移民身份的法律，导致非公民不敢就医、家庭离散并造成心理创伤。共和党籍得克萨斯州州长格雷格·阿博特于2024年发布了一项与佛罗里达州法律类似的行政命令。
民主党州份已对特朗普政府挖掘私人医疗信息以 targeting 移民的政策发起反击，共有21个州加入去年加州提起的诉讼，试图阻止国土安全部利用医疗补助数据开展驱逐行动。一名联邦法官裁定，可以共享领取者的身份信息，但不得泄露医疗信息。诉讼仍在进行中。
国土安全部新闻办公室拒绝提供正式置评。
北卡罗来纳州民主党州长乔希·斯坦因签署该法案后发表声明，敦促共和党议员保护近2.7万名合法滞留美国的孕妇和儿童的医保覆盖范围。他未回应有关要求州政府上报非法移民条款的相关问题。
波兰科-加尔达梅斯表示，此类法律进一步削弱了弱势家庭对医疗体系的信任。
“归根结底，只有当人们放心寻求医疗服务时，公共卫生体系才能发挥最佳作用，”波兰科-加尔达梅斯说道。“模糊医疗服务获取与移民执法界限的政策，有可能将弱势家庭进一步推向阴影之中。”
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Trump demands Medicaid data for deportation. Some states go a step further.
May 14, 2026 / 5:00 AM EDT / KFF Health News
Several states have joined President Trump’s deportation efforts and are taking federal reporting requirements to immigration authorities a step further — by using their public health agencies as arms of enforcement.
North Carolina, in late April, became the latest member of a growing group of Republican-led states to require their public health agencies to flag recipients of Medicaid to the U.S. Department of Homeland Security if their legal status is in question.
It’s a trend health policy researchers expect to spread among GOP-controlled states eager to join Mr. Trump in the federal crackdown on Medicaid fraud and illegal immigration. Already, at least four states — Indiana, Louisiana, Montana, and Wyoming — have passed similar laws, and lawmakers in others, such as Oklahoma and Tennessee, are weighing measures. In those six states, Republicans hold a power trifecta — both chambers of the legislature and the governor’s office.
“This is an issue that is very much on the political radar right now,” said Carmel Shachar, a health policy researcher at Harvard Law School.
More than 75 million people are enrolled in Medicaid, the federal and state-run public health program for people with disabilities and low incomes, and its related Children’s Health Insurance Program, which provides low-cost coverage for people under 19. Immigrants without legal status are ineligible for Medicaid benefits, but a swath of noncitizens qualify, such as green-card holders, asylees, and refugees. A quarter of children in the U.S., most of them citizens, live with an immigrant.
Yet the new reporting laws add a layer of risk for immigrants seeking healthcare in the U.S., where mandates from the White House have used Medicaid data to help identify and deport people.
Some of the state laws apply only to health agencies, such as in North Carolina. But the bill headed to Tennessee Gov. Bill Lee’s desk would be comprehensive, requiring all state agencies to report people suspected of being in the U.S. without legal status. All seven state measures go beyond what’s federally required, which is to cooperate with enforcement officers by providing personal information of recipients when asked.
In Louisiana, families with mixed immigration statuses have reported that the state’s new law, enacted last year, deters them from applying for Medicaid for their kids with U.S. citizenship.
“I expect this law will lead to more families asking whether it is safe to seek healthcare, whether information can be shared with immigration authorities, and whether enrolling a child or seeking treatment could expose them to enforcement consequences,” said Yesenia Polanco-Galdamez, a North Carolina immigration attorney.
North Carolina Republican lawmakers inserted their mandate for the state’s health department as part of a bill that restored $319 million in Medicaid funds, which the legislature cut when it failed to pass a budget last year.
Starting in October, state employees will ask non-U.S. citizens receiving Medicaid for proof of their immigration standing and report those without “satisfactory” legal status to federal authorities. “This bill is designed not only to fund our critical needs today, but to begin looking at fraud, abuse issues we know exist within the system,” Republican state Rep. Donny Lambeth said during a House debate on the bill.
Immigrants use much less welfare than people born in the U.S., according to an analysis by the Cato Institute, a libertarian think tank, which also found noncitizens are much less likely to commit welfare fraud than citizens. State health agencies are already required to verify whether applicants’ immigration statuses qualify them for Medicaid.
Several Republican leaders responsible for the bill did not respond to requests for comment. North Carolina Department of Health and Human Services spokesperson Hannah Jones said the agency is still trying to understand the impact of the new law.
In a 2025 KFF-New York Times survey, about half of adults who “likely” lack legal status said someone in their family has avoided seeking medical care because they were concerned their information could draw the attention of immigration enforcement.
Anabel Rosa, a North Carolina discrimination attorney, said immigrants “in process,” or those waiting for legal authorization, generally already fear using government assistance for themselves.
“What I’ve learned from handling thousands of cases over the years is that most of the individuals who are in process pay for their own medical treatment out-of-pocket,” Rosa said.
Such policies essentially force children who are U.S. citizens to go without health coverage or hospital care, said Leonardo Cuello, a researcher at Georgetown University’s Center for Children and Families.
“When you do policies that target an immigrant, you may think that you are just targeting this one person in the family, but it’s a really imprecise bomb that takes out the whole household,” Cuello said.
The use of states’ public health agencies to find immigrants who lack legal status is not the only strategy states have deployed. Some have passed laws looking to hospitals to collect and report such information. A 2023 Florida law that requires hospital staff to ask about patients’ immigration status has made noncitizens hesitant to seek care, separated families, and caused psychological distress, according to a 2024 study by the University of South Florida. Texas Gov. Greg Abbott, a Republican, issued an executive order similar to Florida’s law in 2024.
Democratic states have pushed back against Trump administration policies that mine private medical information to target immigrants, with 21 signing on to a California lawsuit filed last year that attempts to prevent DHS from using Medicaid data for deportation efforts. A federal judge ruled recipients’ identities could be shared, but medical information could not. Litigation is ongoing.
DHS’ press office declined to provide a statement on the record.
After he signed the bill into law, North Carolina’s Democratic Gov. Josh Stein issued a statement urging Republican lawmakers to protect Medicaid coverage for nearly 27,000 pregnant women and children who are lawfully present in the country. He did not respond to questions about the provision that requires the state to report immigrants without legal status.
Polanco-Galdamez said such laws have further eroded trust in healthcare systems among underserved families.
“At the end of the day, public health systems function best when people feel safe seeking medical care,” Polanco-Galdamez said. “Policies that blur the line between healthcare access and immigration enforcement risk pushing vulnerable families further into the shadows.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
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