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The Centers for Medicare and Medicaid Services (CMS) is doubling down on an effort to link public health insurance programs to immigration enforcement systems nationwide, announcing a sweeping new action this week to remove ineligible immigrants from Medicaid and the Children’s Health Insurance Program (CHIP).

CMS officials said Tuesday the agency will begin sending monthly enrollment reports to states listing all Medicaid and CHIP enrollees whose immigration and citizenship status cannot be verified in federal databases. Databases that will be cross-checked for eligibility include those at the Social Security Administration and the Department of Homeland Security’s SAVE system.

States will receive the reports throughout each month and must review each unverified case before reporting the results back to CMS. According to the agency, the first reports were sent on Tuesday. Confirmation from states will be used to verify eligibility for the two programs.

“Our focus is on protecting taxpayer dollars and making sure benefits go to those who are eligible and to whom Congress has given those benefits,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement. “We’re tightening enrollment oversight to guarantee these critical programs are available only to those who meet the eligibility criteria as required by law.”

CMS Administrator Dr. Mehmet Oz said the new verification system was a critical step in ensuring the integrity of Medicaid and CHIP. “Taxpayer dollars are intended to serve eligible, vulnerable Americans, not those ineligible to participate in these programs. Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid and CHIP benefits,” Oz said. “This action underscores HHS’s and CMS’s continued commitment to program integrity, safeguarding taxpayer dollars, and ensuring these benefits are available only to those eligible under the law.”

CMS officials said Tuesday that the decision to verify enrollment came directly from President Donald Trump, the administration’s continued focus on curbing illegal immigration, and its insistence on program integrity. In one of Trump’s first executive orders of his second term, in February, the president directed agencies to review all federal benefit programs and identify all actions that could be taken to protect those programs against fraud and abuse. Eligibility verifications were included in the directive, with an emphasis on ensuring only U.S. citizens and legal immigrants were benefiting from the programs.

A month later, HHS expanded its own definition of public benefits, increasing the number of programs that are used to verify enrollment and immigration status from 31 to 44. The move tied into an initiative by several states to use a form of Medicaid to supply premium subsidies to Obamacare insurance shoppers, despite clear statements from HHS officials that federal funds would not be made available.

A legal fight is now brewing between CMS and the White House on one side and the states on the other, with some Democrats claiming the move is designed to hurt immigrant communities and has no basis in law. Last month, a federal judge ordered HHS to stop sharing data with ICE, after a court filing by the White House said the agency was legally required to assist in immigration enforcement and deportation efforts. In addition to sharing information about immigrants’ use of Medicaid and CHIP, HHS passed similar data about food stamps, housing vouchers, and other programs.

That same month, states also saw a change in the number of times eligibility checks must be conducted on Medicaid enrollees. Signed into law last month as part of a Republican spending bill, the provision will require states to review eligibility at least twice a year, double the previous requirement.

Democratic attorneys general have already said they will challenge the move in court. A group of 21 states, led by New York’s Letitia James, sued HHS earlier this month over rules the department passed requiring states to verify the immigration status of all potential beneficiaries of federally funded programs. James argued in a press release that the new rule would harm her state’s inclusive approach to safety-net services.

“For decades, states like New York have built health, education, and family support systems that serve anyone in need,” James said. “These programs work because they are open, accessible, and grounded in compassion. Now the federal government is pulling that foundation out from under us overnight, jeopardizing cancer screenings, early childhood education, primary care, and so much more. This is a baseless attack on some of our country’s most effective and inclusive public programs, and we will not let it stand.”

Republicans in Washington, on the other hand, are pressing for more aggressive immigration enforcement in tandem with public benefit programs, arguing it is only natural that illegal immigrants should not be able to access programs intended for vulnerable Americans. “I support President Trump’s strong stance on this issue, and this commonsense requirement will help reduce fraud and abuse in Medicaid and other federal safety net programs,” CMS Administrator Dr. Oz said of the recent rule change, echoing similar statements from HHS officials.

CMS has said the report program will continue to expand, and states can expect to see regular monthly enrollment reports. However, the agency does not have a fixed end date for the current verification effort, meaning CMS reports could continue for the duration of the Trump administration, and perhaps beyond.