North Carolina Joins Republican States in Using Health Agencies to Report Suspected Undocumented Immigrants

Several Republican-led states have aligned with President Trump's deportation efforts by directing their public health agencies to report Medicaid recipients whose legal status is uncertain to the U.S. Department of Homeland Security.

North Carolina joined the effort in late April. It now requires its public health agency to flag such recipients to federal immigration authorities. At least four other states—Indiana, Louisiana, Montana, and Wyoming—have enacted similar laws. Lawmakers in Oklahoma and Tennessee are considering measures. Republicans control both legislative chambers and the governor's office in all six states.

"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 enroll in Medicaid, the federal-state program for low-income and disabled individuals, and its related Children's Health Insurance Program for those under 19. Undocumented immigrants cannot receive Medicaid benefits, but green-card holders, asylees and refugees qualify. A quarter of U.S. children, most citizens, live with an immigrant.

The new state reporting laws increase risks for immigrants seeking U.S. healthcare. White House mandates have used Medicaid data to identify and deport people.

North Carolina's law targets only health agencies. Tennessee's bill, awaiting Gov. Bill Lee's signature, would require all state agencies to report suspected undocumented individuals. The seven state measures exceed federal requirements, which limit cooperation to providing personal information when enforcement officers request it.

In Louisiana, families with mixed immigration statuses say the state's 2023 law discourages Medicaid applications for their U.S.-citizen children.

"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 Republicans added the health department mandate to a bill restoring $319 million in Medicaid funds cut during last year's budget impasse. Starting in October, state employees will ask noncitizens on Medicaid for proof of immigration status and report those lacking "satisfactory" 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," said Republican state Rep. Donny Lambeth during House debate.

A Cato Institute analysis found immigrants use less welfare than U.S.-born individuals and commit less fraud. State health agencies already verify applicants' immigration status for Medicaid eligibility.

Several Republican bill sponsors did not respond to comment requests. North Carolina Department of Health and Human Services spokesperson Hannah Jones said the agency is assessing the law's impact.

A 2025 KFF-New York Times survey showed half of adults who likely lack legal status said a family member avoided medical care over immigration enforcement fears.

Anabel Rosa, a North Carolina discrimination attorney, said immigrants awaiting legal authorization already avoid government aid. "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,"

Such policies leave U.S.-citizen children without coverage or 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,"

States have tried other tactics. Florida's 2023 law requires hospitals to ask patients' immigration status, leading noncitizens to avoid care, separate families and suffer distress, per a 2024 University of South Florida study. Texas Gov. Greg Abbott issued a similar order in 2024.

Twenty-one Democratic-led states joined California's 2024 lawsuit to block DHS from using Medicaid data for deportations. A federal judge allowed sharing identities but not medical information. The case continues.

DHS declined to comment.

After signing the bill, Democratic Gov. Josh Stein urged protection for Medicaid coverage of nearly 27,000 lawfully present pregnant women and children. He did not address the reporting provision.

Polanco-Galdamez said the laws erode trust in healthcare among underserved families. "At the end of the day, public health systems function best when people feel safe seeking medical care," she said. "Policies that blur the line between healthcare access and immigration enforcement risk pushing vulnerable families further into the shadows."