Since our nation’s founding, federalism has been rooted in American values, ideas and structure. Federalism was a key principle of the adoption of the Constitution and preservation of our democracy — yet, today, inefficiencies and barriers undermine our republic.

In 1965, former President Lyndon B. Johnson signed the Social Security Amendments to create basic healthcare access to Americans who were not currently insured. Overseen and run by the Center for Medicare & Medicaid Services, Medicare provides Americans aged 65 or older with insurance, while Medicaid provides lower-income Americans with insurance coverage. 

In the turmoil following the 2024 presidential election, leaders of the Republican party have led accusations that undocumented immigrants are leeching off Medicaid resources and argue for logical action to be taken to eliminate this aspect of Medicaid fraud — by cutting the program’s budget by over $1 trillion. 

The baseline behind “Medicaid exploitation” is entirely false, based on one factor: Undocumented migrants are not and have never been eligible for Medicaid. You must be a U.S. citizen to be eligible for the program and any type of benefits. Undocumented migrants are not U.S. citizens. 

If the issue is Medicaid emergency reimbursements, where some of America’s most vulnerable are “taking advantage of the system” and the only viable solution is to cut funding to eliminate said fraud and waste, then I have one response. Almost half of Medicaid emergency funds are used to give birth to U.S. citizens. These reimbursements are given to the hospital after having provided emergency care to patients, required under federal law. 

Reimbursements are only given to non U.S. citizens who meet the same criteria as American citizens already eligible for Medicaid in the status quo. In fiscal year 2023, less than 1% of Medicaid spending went towards emergency Medicaid funds.

The Trump administration has brought up riveting arguments to slash budgets at all costs, and while I rarely agree with the Trump administration’s policies, there is a key layer in the inefficiencies of the federal funding of Medicaid disappearing behind state-run programs and oversight.

On July 4, the U.S. Congress passed President Donald Trump’s “One Big Beautiful Bill Act.” A key and controversial aspect of this legislation was the removal of over $1.02 trillion to Medicaid budgets over the next decade, under the critical guise of “removing and eliminating discrepancies in funding allocation and efficiency.” 

A center point of political debate between all three branches of government has been the allocation of federal funding to state programs and evidence of misuse of funds by state programs. 

Despite varying perspectives, one constant remains a focal point of current debates: Immigrants have been increasingly blamed for accessing Medicaid benefits. In reality, the true waste and fraud stem from a lack of collaboration between both levels of government, creating gaps that result in funding discrepancies.

The true cause of fraud, waste and abuse that the administration is so concerned about stems from the structure of the program: federalism. What the CMS looks for to determine funding efficiency is through improper payments, which are “payments that do not meet CMS program requirements,” as the CMS shares. 

The reality of improper payments found in Medicaid stems from administrative errors at the state level of oversight. Medicaid, as a large healthcare program, provides nearly 80 million people with healthcare access; human errors are bound to be made. Seventy-four percent of improper payments to the program are due to insufficient documentation, as Georgetown reports in 2025. 

Programs such as Medicaid follow loosely based federal guidelines and are implemented independently across 50 States, five territories and the District of Columbia. Administration and oversight errors are expected when the federal government provides no specific and standardized regulations on proper payments, documentation and simple enforcement to mitigate eligibility inefficiencies. 

Each state and territory is responsible for running the respective Medicaid program in its state under a loose set of federal guidelines, initially set up to support a federalist system. The issue with this is simply that states have nothing to work with — there is no unison across 56 different programs and the federal government struggles to “check” 56 independently run Medicaid programs, creating huge holes for the efficient funding usage Republicans want to see.

In the status quo, it’s not fraud or abuse that is dragging down federal funds. Rather, it is the consequences of the federal government’s own lack of accountability in enforcing proper guidelines to mitigate technical and system-based reports. 

The basic solution to eliminating the fraud and waste the Trump administration is so concerned about derives simply from reducing a layer of federalism, increasing federal oversight and implementing proper guidelines to proactively address the loss of federal funding.    

The current political climate of the U.S. has led to the scapegoating and further marginalization of immigrants who are not eligible for Medicaid nor responsible for funding discrepancies. America has taken the easy way out and placed careless blame.

Samantha is a freshman in LAS.

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