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The Centers for Medicare and Medicaid Services (CMS) announced on Tuesday a major new effort to monitor public health programs and ensure that illegal immigrants are not enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The new measures, first reported by agency officials, are some of the most expansive measures taken by the Trump administration in his second term to crack down on taxpayer-funded benefits being distributed to non-citizens.

CMS will begin issuing monthly enrollment reports to states, the officials said. Each report will include a list of Medicaid and CHIP enrollees whose citizenship or immigration status can’t be verified with federal data. The list will include data from several other federal databases, including the Social Security Administration and the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program.

The agency released the first such report on Tuesday. The monthly reports, the officials said, will go out to each state throughout the month, with states then required to check each case and respond to CMS with the results of their own determinations.

CMS has said the push is part of a new effort to tighten access to Medicaid and CHIP. “We are strengthening enrollment safeguards to protect taxpayer dollars and ensure that these critical programs are only serving those who are eligible by law,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement.

CMS Administrator Dr. Mehmet Oz said the move was about maintaining the integrity of the nation’s safety-net health programs. “Every dollar misspent is a dollar that has been taken away from an eligible, vulnerable person in need of Medicaid and CHIP,” he said. “CMS’s action today sends a strong message that this administration will continue to have zero tolerance for fraud or abuse and will always protect the integrity of our programs.”

The move is the latest in a series of steps by the Trump administration to restrict eligibility for federal benefit programs to citizens and legal immigrants. One of Trump’s first executive orders, on Inauguration Day, was a push to identify illegal immigrants and prevent them from accessing federal programs. That order followed up on a similar move Trump made on his first day in office four years ago.

In February, he followed through on that mandate, instructing federal agencies to review every benefit program they operate to ensure non-citizens were not receiving public benefits in contravention of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act. The move was one of several administrative actions from the White House in the past year on a host of issues that include immigration, regulatory reform, and social welfare.

The Department of Health and Human Services (HHS) later that month took another step to tighten benefit access, instructing states to expand their own definitions of “public benefits” programs for purposes of enforcing verification rules. The list, as a result, expanded from 31 programs to 44, the HHS official said.

Growing Legal Fight

The new CMS reporting requirements come at a moment of heightened political debate over the reach of federal immigration enforcement in the administration of public benefits programs. Last month, a federal judge ordered the Health and Human Services Department to stop handing over information about enrollees to immigration authorities.

The administration has been passing such information to Immigration and Customs Enforcement (ICE) in an effort to identify individuals who could be deported. The judge’s decision last month, however, found the practice went beyond the administration’s legal authority. At the same time, state governments are now subject to new statutory requirements as part of Republican spending legislation enacted last month. The package of aid funding required states to conduct eligibility verification on Medicaid enrollees at least twice a year, a major step-up from prior practices.

Supporters of the change say it is necessary to crack down on fraud and abuse. The change, opponents say, creates unnecessary red tape for families. More than 20 Democratic state attorneys general have already filed a lawsuit challenging the verification rules. Led by New York Attorney General Letitia James, the coalition argues the new mandate, which would require states to verify immigration status for enrollment in federally funded programs, could block access to benefits for millions of people.

“States like New York have long stood up health, education, and family support systems that are open to anyone in need,” James said last month. “These programs work because they are accessible and inclusive – because they are built on compassion. The federal government is pulling the foundation out from under us overnight, threatening everything from cancer screenings to early childhood education, primary care to food assistance, housing supports to job training. This is an attack on some of our most effective and inclusive public programs, and we will not let it stand.”

The lawsuit is one of a series of ongoing legal challenges that the new CMS report requirements will likely face. CMS’s move this week has also come as new Republican-sponsored verification rules have been going into effect in some states, as the federal government has required states to check eligibility for Medicaid at least twice a year, as opposed to once.