The Trump administration is pressuring Utah and more than a dozen other states to end health insurance programs that cover immigrant children without permanent legal status, warning of stricter federal financial oversight and potential funding clawbacks.
In a letter sent this week, the Centers for Medicare & Medicaid Services (CMS) cited President Trump’s February executive order, “Ending Taxpayer Subsidization of Open Borders,” and pledged to audit states offering coverage to undocumented children. CMS stated that any “improper spending” would be subject to recoupment of federal funds.
“Medicaid is not, and cannot be, a backdoor pathway to subsidize open borders,” said Mehmet Oz, Trump’s appointee to oversee CMS. “We are putting [states] on notice.”
Impact on Utah
1,312 children are currently enrolled under Utah’s program, with capacity for up to 2,000.
Utah is the only Republican-led state to offer this coverage, which began after legislation passed in 2023.
The program, primarily state-funded, also receives some federal funds, placing it in CMS’s crosshairs.
Legislative Fallout
CMS’s warning coincides with Congress’s debate over the “One Big Beautiful Bill”, which would slash federal Medicaid contributions to states that support such programs.
Gov. Spencer Cox has not responded to requests for comment on a potential special legislative session to repeal the program.
Lawmakers like Sen. Luz Escamilla (D-Salt Lake City) and Rep. Steve Eliason (R-Sandy) are exploring the broader implications, especially given Utah’s Medicaid trigger law, which could eliminate coverage for many adults if federal support drops.
“The lack of comprehensive preventive care not only costs more in the end, but also impacts the education and social outcomes of these kiddos,” Escamilla said during a committee hearing.
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