Spending cuts, immigration, and Medicaid are at the top of the Washington agenda. That climate provides fertile ground for misinformation and myths to multiply on social networks. Some of the most common are those surrounding immigrants, Latinos, and Medicaid.

These claims include assertions that Latinos who use Medicaid, the federal-state program for low-income people and those with disabilities, “do not work” and exaggerations of the percentage of people with Medicaid who are Latinos.

The U.S. House voted narrowly on Feb. 25 in favor of a budget blueprint that could lead to Medicaid cuts of up to $880 billion over a decade.

Medicaid and the Children’s Health Insurance Program are part of the national safety net, covering about 80 million people. Medicaid enrollment grew under the Affordable Care Act and after the start of the covid-19 pandemic but then started falling during the final two years of the Biden administration.

Immigrants’ impact on the nation’s health care system can be overstated in heated political rhetoric. Now-Vice President JD Vance said on the campaign trail last year that “we’re bankrupting a lot of hospitals by forcing these hospitals to provide care for people who don’t have the legal right to be in our country.” PolitiFact rated that statement “False.”

KFF Health News, in partnership with Factchequeado, compiled five myths circulating on social media and analyzed them with experts in the field.

1. Do Latinos who receive Medicaid work?

Most do. A KFF analysis of Medicaid data found that almost 67% of Latinos on Medicaid work, “which is a higher share of Medicaid adults who are working compared to other racial and ethnic groups,” said Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured. KFF is a health information nonprofit that includes KFF Health News.

“For many low-income people, the myth is that they are not working, even though we know from a lot of data that many people work but don’t have access to affordable employer-sponsored insurance,” said Timothy McBride, co-director at the Center for Advancing Health Services, Policy and Economics Research, part of the Institute for Public Health at Washington University in St. Louis.

Neither the Department of Health and Human Services Office of Minority Health nor the Centers for Medicare & Medicaid Services responded to requests for comment.

2. Are Latinos the largest group enrolled in Medicaid?

No. White people who are not Hispanic represent the biggest demographic group in Medicaid and CHIP. The programs’ enrollment is 42% non-Hispanic white, 28% Latinos, and 18% non-Hispanic Black, with small percentages of other minorities, according to a CMS document.

Latinos’ share of total Medicaid enrollment “has remained fairly stable for many years — hovering between 26 and 30% since at least 2008,” said Gideon Lukens, research and data analysis director on the health policy team at the left-leaning Center on Budget and Policy Priorities, a research organization.

In a Feb. 18 blog post, Alex Nowrasteh and Jerome Famularo of the libertarian Cato Institute wrote: “The biggest myth in the debate over immigrant welfare use is that noncitizens — which includes illegal immigrants and those lawfully present on various temporary visas and green cards — disproportionately consume welfare. That is not the case.” They included Medicaid in the term “welfare.”

Although Latinos are not the biggest group in Medicaid, they are the demographic group with the greatest percentage of people receiving Medicaid. There are about 65.2 million Hispanics in the country, representing 19.5% of the total U.S. population.

Approximately 31% of the Latino population is enrolled in Medicaid, in part because employed Latinos often have jobs that do not offer affordable insurance.

Eligibility for Medicaid is based on factors such as income, age, and pregnancy or disability status, and it varies from state to state, said Kelly Whitener, associate professor of practice at the Center for Children and Families at Georgetown University’s McCourt School of Public Policy.

“Medicaid eligibility is not based on race or ethnicity,” Whitener said.

3. Do most Latinos living in the country without legal permission use Medicaid?

No. Under federal law, immigrants lacking legal status are not eligible for federal Medicaid benefits.

As of January, 14 states and the District of Columbia had used their own funds to expand coverage to children in the country without regard to immigration status. Of those, seven states and D.C. expanded coverage to some adults regardless of immigration status.

The cost of providing health care to these beneficiaries is covered entirely by the states. The federal government does not put up a penny.

The federal government does pay for Emergency Medicaid, which reimburses hospitals for medical emergencies for people who, because of their immigration status or other factors, do not normally qualify for the program.

Emergency Medicaid began in 1986 under the Emergency Medical Treatment and Labor Act, signed by President Ronald Reagan, a Republican.

In 2023, Emergency Medicaid accounted for 0.4% of total Medicaid spending.

Some conservative lawmakers say immigrants in the country illegally should not get any Medicaid benefits.

“Medicaid is meant for American citizens who need it most — seniors, children, pregnant women, and the disabled,” Rep. Dan Crenshaw (R-Texas) said on social media. “But liberal states are finding ways to game the system and make taxpayers cover healthcare for illegal immigrants.”

4. Do Latinos stay on Medicaid for decades?

Experts say there is no analysis by race or ethnicity of the length of time people use the program.

“The people who stay on Medicaid the longest are people who have Medicaid due to a disability and who live with a medical situation that does not change,” Tolbert said.

People who use long-term Medicaid support services represent 6% of the total number of people in the program.

Many beneficiaries are in the program temporarily, McBride said.

“Some studies indicate that as many as half of the people on Medicaid churn off of Medicaid within a short period of time,” he said, such as within a year.

5. Are Latinos on Medicaid the group that uses medical services the most?

Latinos do not use significantly more Medicaid services than others, experts say. Latinos receive preventive services (such as mammograms, pap smears, and colonoscopies), primary care and mental health care less than other groups, according to documents from CMS and the Medicaid and CHIP Payment and Access Commission, a nonpartisan organization that provides policy and data analysis.

Latinos do account for a disproportionate share of Medicaid labor and delivery services. Latino families and white families each represent about 35% of Medicaid births, although white people make up a bigger share of the overall population.

While Latinos represent 28% of all Medicaid and CHIP enrollees, they account for 37% of beneficiaries with limited benefits that cover only specific services.

“They actually use health care services less than other groups, because of systemic barriers such as limited English proficiency and difficulty navigating the system,” said Arturo Vargas Bustamante, a professor at UCLA’s Fielding School of Public Health and the faculty research director at the university’s Latino Policy and Politics Institute.

Latino people also avoid using services out of fear of the “public charge” rule and other policies, Vargas Bustamante said. President Donald Trump expanded the public charge policy and strongly enforced it during his first term, though it was softened under President Joe Biden. The policy was intended to make it harder for immigrants who use Medicaid or welfare programs to obtain green cards or become U.S. citizens.

“The chilling effect of public charge persists, but recent orders such as mass deportation or the elimination of birthright citizenship have generated their own chilling effects,” Vargas Bustamante added.

When patients walked into Planned Parenthood clinics, a consumer data company sold their precise locations to anti-abortion groups for targeted ads.

When patients picked up prescriptions for testosterone replacement therapy, law enforcement retrieved their names and addresses without a warrant.

And when a father was arrested by immigration authorities, agents allegedly accessed his personal information from a medical clinic where he received diabetes treatment.

Progressive California lawmakers have proposed a number of bills aimed at bolstering privacy protections for women, transgender people, and immigrants in response to such intrusions by anti-abortion groups, conservative states, and federal law enforcement agencies as President Donald Trump declares the nation “will be woke no longer” and flexes his executive power to roll back rights.

Democrats have supermajorities in the state legislature, but even if they pass the proposals, they may first need to lobby one of their own: Gov. Gavin Newsom, who has noticeably tempered his once harsh criticism of Trump.

Last month, the Democratic governor issued a rare veto threat against a bill that would expand the state’s sanctuary law to limit cooperation between state prisons and federal immigration agents. And Newsom recently called transgender athletes’ participation in women’s sports “deeply unfair” on his new podcast with guest Charlie Kirk, a founder of the conservative group Turning Point USA. Newsom went on to tell Kirk that he had a “hard time with” the way the right talks about transgender people.

Billions of dollars are also on the line for California. Newsom visited the White House last month seeking unconditional aid for wildfire victims in Los Angeles, and the state relies on Washington for over 60% of its Medicaid budget, which is vulnerable to significant cuts under the GOP’s budget blueprint.

“California’s leaders have not been as aggressive, out of recognition that there are many things that the state needs federal cooperation on,” said Thad Kousser, a political science professor at the University of California-San Diego.

A Newsom spokesperson declined to comment on pending legislation. He has a track record of supporting abortion, transgender, and immigrant rights.

Since taking office, Trump has granted the Elon Musk-controlled Department of Government Efficiency — created through a Trump executive order — access to previously restricted data, including medical information, raising concerns that sensitive information could be exposed without proper safeguards. 

The White House did not respond to requests for comment.

While most Americans are familiar with the Health Insurance Portability and Accountability Act, known as HIPAA, it offers only narrow protection for patients in health care settings. There’s no comprehensive federal law protecting data privacy.

Health care information has increasingly become a tool of surveillance and enforcement, and in states that have banned certain medical treatments or toughened immigration laws, vulnerable populations are at greater risk, said Suzanne Bernstein, a health privacy rights expert with the Electronic Privacy Information Center.

Progressive Democrats are concerned that personal information and people’s medical decisions could be used to monitor or criminalize patients, facilitate arrests in or near health care facilities, or jeopardize access to health care services.

They and health privacy advocates say now is the time to shore up protections for the nearly 2 million immigrants living in California without authorization, the more than 200,000 transgender adults in the state, and thousands of people — living in the state or out of state — in need of abortion care in California each year. Some of these laws could take effect immediately if signed.

“This is about making sure that people are able to access critical health care in California and to take the politics out of our hospitals and health clinics,” said state Sen. Jesse Arreguín, who hopes the governor would sign his bill to protect immigrants.

The bills are expected to be debated in Sacramento in the coming months.

Since the Supreme Court overturned the constitutional right to abortion, anti-abortion groups have purchased location information from consumer data companies to target people seeking abortion care with anti-abortion ads. And authorities in states with abortion bans have used cellphone data to enforce laws beyond their borders.

A bill introduced by state Assembly member Rebecca Bauer-Kahan, AB 45, would make geofencing, the collection of phone location by data brokers, illegal around health care facilities that provide in-person services. It would also prevent reproductive health information collected during research from being disclosed in response to out-of-state requests.

Conservative organizations said the proposal would single them out by restricting their ability to inform women about alternatives to abortion, including services offered by crisis pregnancy centers.

“I think that could very well be a First Amendment violation,” said Jonathan Keller, president of the California Family Council, a statewide anti-abortion nonprofit. “It doesn’t seem like the bill would be prohibiting or putting any restrictions on a group like Planned Parenthood if they wanted to market or target to a local high school or college.”

So far this year, lawmakers in 49 states have introduced more than 700 anti-transgender bills, seeking to ban gender-affirming care, prohibit gender identity education in schools, or restrict transgender students from participating in sports, according to the Trans Legislation Tracker, a national research organization tracking bills affecting transgender people. Transgender adults represent less than 1% of the U.S. population.

And some states with bans or restrictions on gender-affirming care have been targeting health care data. In 2023, Republican Gov. Ron DeSantis requested that Florida universities release data on the number of individuals who have been diagnosed with gender dysphoria or received treatment at campus clinics. That same year, Missouri’s Republican attorney general, Andrew Bailey, submitted 54 requests to one hospital seeking information about gender-affirming care procedures.

Trump has issued a series of executive orders to ban access to gender-affirming care for minors. Federal judges have temporarily blocked some portions of his orders.

To guard against other states that criminalize or ban gender-affirming care, California state Sen. Scott Wiener wants to expand current protections for minors to include adults.

His bill, SB 497, would require law enforcement to obtain a warrant to access state databases on gender-affirming care and make it a misdemeanor to release the data to unauthorized parties. It would also prohibit health care providers, employers, and insurers from releasing information about a person who seeks or obtains gender-affirming physical and mental health care to an agency or individual from another state.

“We want to make sure that we are as comprehensively as possible shielding trans people from hate emanating from the federal government, other states, and private parties,” Wiener said.

Keller countered that authorities in states with bans on abortion or gender-affirming care should have access to medical information as they investigate providers who could harm patients or coerce them into procedures against their will. He cited a lawsuit against Kaiser Permanente over a teenager who detransitioned after undergoing gender-affirming care. A 2015 survey found it was uncommon for people undergoing gender-affirming care to decide to permanently detransition.

“The only way that you’re able to uncover that level of widespread malpractice and malfeasance is if these health care records are able to be accessed,” Keller said.

The California Family Council plans to oppose both bills.

Earlier this year, Trump rescinded a long-standing policy of not making immigration arrests near hospitals, schools, or churches. The decision has providers fearful that Immigration and Customs Enforcement agents will disrupt their work at health facilities and prompt immigrants to skip medical care — for themselves or, of particular concern, their children.

Anticipating the move, California’s Democratic attorney general, Rob Bonta, issued guidance in December advising health care providers how best to respond if ICE comes to their doorstep. But while private entities are encouraged to follow these policies, only state-run facilities are required to adopt them.

“Some health care providers have implemented them, but not everyone has,” Arreguín said.

Arreguín’s SB 81 would require all health care facilities, including hospitals and community-based clinics, to follow state guidance to limit cooperation with immigration authorities. It would also prohibit providers from granting access to private areas or places where a patient is actively receiving treatment or care, unless there’s a warrant.

Another immigration bill, AB 421, would limit the sharing of local law enforcement information if agents plan to make an arrest within a one-mile radius of a hospital or medical office, a child care or day care facility, a religious institution, or a place of worship. California law enforcement has some discretion to share information with immigration agents when an individual has been convicted of a serious crime or felony.

Kousser said immigration is more complicated for California politicians than health privacy. Although a February poll by the Public Policy Institute of California found that 7 in 10 Californians think immigrants are a benefit to the state, Kousser said that lawmakers, especially those who won by narrow margins in contested districts, still have to make tough political choices.

Senate Republican leader Brian Jones, who represents a predominantly Democratic district in San Diego, is proposing to change California’s sanctuary policies to require law enforcement to share information with ICE when a person has been convicted of a serious crime.

“When these violent felons are released from local custody, they go right back into the communities that they came from to re-victimize those same immigrant communities,” Jones said.

But Jones acknowledged the need for nuance when it comes to health privacy.

“Look, the bottom line for me on this immigration reform in America is it needs to be humanitarian and it needs to make sense,” Jones said. “And so, if there are areas that we need to protect folks, it might make sense.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

California’s Medicaid program has borrowed $3.4 billion from the state’s general fund — and will likely need even more — to cover ballooning health expenses for 15 million residents with low incomes and disabilities.

The state Department of Finance disclosed the loan to lawmakers in a letter late Wednesday, noting funds were needed to make critical payments to health care providers in Medi-Cal, the state’s version of Medicaid. In recent months, Gov. Gavin Newsom’s administration has warned of skyrocketing health care costs, including higher prescription drug prices and increased enrollment by newly eligible seniors and immigrants without legal status.

Finance spokesperson H.D. Palmer said the loan will cover Medi-Cal obligations through the end of the month. He declined to specify the total of the program’s potential shortfall. However, a document circulated by state Senate leaders warns that additional funding may be needed to cover expenses through June 30, the end of the fiscal year.

The cost overrun adds a new layer of difficulty for Democrats who control the legislature and are already grappling with congressional budget plans that could slash Medicaid funding, which accounts for 60% of Medi-Cal’s $174.6 billion budget. President Donald Trump and Republican lawmakers have also criticized California Democrats for covering residents regardless of their immigration status.

Newsom spokesperson Izzy Gardon downplayed the loan. “Rising Medicaid costs are a national challenge, affecting both red and blue states alike,” Gardon said. “This is not unique to California.”

Health officials last year said the state would spend roughly $6.4 billion in the 2024-25 fiscal year to cover immigrants without legal status, which the Democratic governor has hailed as a key step toward his goal of providing “universal coverage” for Californians. In recent testimony, however, finance staff told legislators that health benefits extended to all income-eligible immigrants without legal status are projected to cost roughly $9.5 billion, of which $8.4 billion will come from the general fund.

Republicans called for fresh scrutiny of the state’s decision to cover residents without legal status. “This program is out of control,” Senate Minority Leader Brian Jones posted on the social platform X. “We are demanding a full hearing and a full cost analysis so the public knows exactly where their tax dollars are going.”

Patient advocates objected to Republicans singling out the expansion for immigrants.

“Health care costs are influenced by many factors including prescription drugs, hospital costs, and more,” said Rachel Linn Gish, a spokesperson for Health Access California, a consumer health advocacy group.

According to a fall update from the Department of Health Care Services, Medi-Cal spending grew due to higher-than-expected enrollment of seniors, fewer Californians losing Medi-Cal coverage than anticipated, and increased pharmaceutical spending, as well as expanding coverage of immigrants. For instance, the state is spending $1.1 billion more on residents who were expected to lose coverage after the covid-19 pandemic, and an additional $2.7 billion more than anticipated to cover unauthorized residents.

Assembly Speaker Robert Rivas said he’s committed to maintaining the state’s expansions of Medi-Cal services.

“There are tough choices ahead, and Assembly Democrats will closely examine any proposal from the Governor,” he said in a statement. “But let’s be clear: We will not roll over and leave our immigrants behind.”

Senate leaders said they were looking closely at the state’s estimated costs and caseloads and would recommend cost containment measures as part of their budget proposal in the coming weeks.

Scott Graves, budget director at the California Budget & Policy Center, said it’s not unusual for the state government to make adjustments when spending doesn’t line up with projections.

Last year, for instance, the state borrowed $1.75 billion against its general fund when revenues from a state provider tax were delayed. Prior to that, Department of Finance officials said, California took out a similar loan in 2018 for $830 million.

“The reality is all of these are just estimates, especially with a very complicated program like Medi-Cal,” Graves said, noting that $3.4 billion is roughly 2% of the state’s overall Medi-Cal budget. “It seems like we’re on the verge of making a mountain out of a molehill.”

Mike Genest, who served as finance director under Republican Gov. Arnold Schwarzenegger, agreed that adjustments can be routine. But he said the magnitude of Medi-Cal’s current overrun was not.

“For this to happen in the middle of the year — we’re only in March — I mean, that’s pretty astounding,” Genest said.

California Democrats continue to characterize Trump and congressional Republicans as the biggest threat, pointing to the House budget plan to shrink Medicaid spending by as much as $880 billion. They say cuts of that magnitude would leave millions of residents uninsured, reducing access to preventive care and driving up costlier emergency room services.

They cautioned that some short-term cost increases could be driven by newly eligible residents seeking long-delayed care, which could level off in coming years. However, some acknowledge difficult decisions ahead.

“We definitely have to ensure that those who are our most vulnerable — our kids, those with chronic conditions — continue to have some sort of coverage,” said Democratic Sen. Akilah Weber Pierson, a San Diego County physician. “The question is, what will that look like? To be quite honest with you, at this point, I don’t know.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.