BROOKLYN, N.Y. — On a recent weekday evening, Avram Kline kicked a soccer ball to his son on the bright green pitch in Brooklyn Bridge Park, where the skyscrapers of Manhattan loom just across the East River.

Kline is a self-described soccer superfan who founded the Newcomers Football Club, a mutual aid group to support asylee and refugee players from all over the world — Chad, Morocco, Senegal, South Sudan, Syria and other nations — who found their footing in the United States by gathering to cook food, teach each other their languages and, most of all, to play soccer.

“People who play together, even on a casual basis, without even knowing each other, are already friends, and they already have a bond of trust, because the game is based on trust,” said Kline, 56.

The 2026 FIFA World Cup, which begins on Thursday, is expected to draw between 5 million and 7 million soccer fans to the 11 U.S. host cities. New York City, which is hosting games in partnership with East Rutherford, New Jersey, is expecting 1.2 million fans. But as the games begin, Kline and many others say the Trump administration’s immigration crackdown and the planned presence of Immigration and Customs Enforcement agents is casting a pall over an event that is supposed to bring the world together.

“To say that you might get racially profiled, you might get interviewed, or you might be pulled aside. Yeah, that’s incredibly embarrassing,” Kline said.

This week, White House border czar Tom Homan told CBS News that ICE officers will provide security during the games, but that they will focus primarily on public safety, not immigration enforcement.

But many soccer fans, stadium workers, civil rights groups and some city officials are skeptical. They say the presence of immigration agents at World Cup games is more likely to cause disturbances than prevent them, citing recent altercations between protesters and ICE agents at detention facilities, including in Newark, New Jersey.

“Can anyone really trust ICE or this administration when they say they will not be engaging in immigration enforcement at stadiums or around fan clubs or fan festivals or watch parties?” said Jamil Dakwar, director of the human rights program at the American Civil Liberties Union.

“I don’t think anyone really can take their word for it, given the record of the last year and a half.”

In April, the ACLU and more than 120 other groups issued a travel advisory warning soccer fans, journalists and players that they could be arbitrarily denied entry to the country, be arrested or detained, or be subjected to surveillance or racial profiling as part of the Trump administration’s immigration crackdown.

Earlier this week, Omar Abdulkadir Artan, who was set to be the first Somali to referee a World Cup tournament, was denied entry into the U.S. at Miami International Airport. U.S. Immigration officials told Stateline that Artan was “inadmissible due to vetting concerns.” At the end of last year, the Trump administration included Somalia on a list of 39 countries whose nationals are subject to enhanced travel restrictions.

World Cup participants Côte d’Ivoire, Haiti, Iran and Senegal are also on the list. On June 6, Aymen Hussein, a striker for the Iraqi team, was also reportedly detained and questioned for nearly seven hours at Chicago O’Hare International airport. While Hussein was let into the country, the team’s photographer was denied entry.

Lauren Bis, acting assistant secretary for public affairs at the U.S. Department of Homeland Security, said in a statement to Stateline, “International visitors who legally come to the United States for the World Cup have nothing to worry about.” Bis also said that only someone’s status living in the country illegally would make them a target for immigration enforcement and added, “Speculation to the contrary is ill-informed.”

Grassroots and local efforts 

Oscar Morales and Melinda Fox have protested ICE enforcement activity in neighborhoods in Atlanta, which is also hosting World Cup games. When they discovered they lived in the same Old Fourth Ward neighborhood, which is hosting a massive watch party this week, they were determined to spread the word that federal immigration officers might show up.

During the past few weekends, Fox and Morales and several other volunteers knocked on doors and conducted public training sessions to inform people of their right to decline to speak to immigration agents who don’t have a warrant. They’ve also encouraged local businesses to post signs saying ICE would not be welcome.

“People were very scared of what happened in Minneapolis, like they are just seeing how ICE agents are escalating things,” Morales said.

Georgia Republican Gov. Brian Kemp signed a law in 2024 that tightened the state’s ban on so-called sanctuary policies, threatening localities with a loss of funding and misdemeanor charges for failing to cooperate.

Georgia’s stance has put Atlanta in a tough spot, Democratic city councilmember Kelsea Bond told Stateline.

In April, Bond helped push through two resolutions expressing the city council’s opposition to ICE facilities inside the city limits and requesting that the Atlanta Police Department chief establish policies under which employees would document any suspected misconduct from ICE agents when they are present during police activities.

“I was getting emails and questions from my own constituents and supporters,” Bond said. “I was very deliberate about working with immigrants’ rights organizations to build support for this initiative, and we had dozens of community members come out to city hall to speak in the public safety committee meeting and ensure that both of these ICE-related resolutions got passed.”

In California, Cesar Zamaro works as a bartender at SoFi Stadium in the Los Angeles suburb of Inglewood, another World Cup site. Zamaro is a member of UNITE HERE Local 11, a union representing more than 2,000 bartenders, cashiers, dishwashers, cooks and other food workers at SoFi Stadium. On Wednesday, the union approved a contract that, along with wage increases, includes language giving workers the right to strike if ICE “threatens worker safety during the World Cup,” according to a news release.

“It takes away your desire to get to work when you know that you might be harassed or you might be detained for no reason,” Zamaro said.

Zamaro and other organizers say they are seeking a commitment from FIFA that they will be protected. Stateline reached out to FIFA but did not receive a response.

Not the right place for ICE?

Logan Kennedy, an assistant professor of criminal justice at East Carolina University, said that in the past, ICE has helped provide security for large sporting events. However, Kennedy noted that under the Trump administration, the agency has become much more aggressive in its immigration enforcement.

“We’ve seen an increase in collateral arrests. There’s a lot of discretion in those situations, and it can be seen as overly authoritative in a lot of ways,” Kennedy said. “And it really damages public perceptions of not only ICE in general, obviously, but also that has a widespread impact on every type of police agency in the United States.”

Kennedy said it would undermine ICE’s legitimacy to target World Cup participants or fans.

“This would just make us look horrible, number one, from an international perspective, and two, really reduce our legitimacy from a policing standpoint.”

In Kansas City, Missouri, Democratic Mayor Quinton Lucas said the city will cooperate with law enforcement but will not participate in “immigration acquisition.”

“Are we going to get into a civil war with ICE? I certainly hope that’s not necessary, but the best group that can control that is ICE itself and the Trump administration itself,” Lucas told Stateline.

Back on the pitch at Brooklyn Bridge Park, Kline reflected on all the ways club members became a part of his family and role models to his son. Kline said soccer fans are likely to fight back if one of their own is targeted.

“At any party that takes place in the public area with other soccer fans, citizens like me, there’s no way in hell that ICE would be able to do their thing,” Kline said.

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

In at least four states, migrants detained in ICE facilities have launched hunger strikes in recent weeks to protest the conditions in which they are being held.

An ongoing hunger and labor strike at the 1,000-bed Delaney Hall facility in Newark, New Jersey, reportedly involves roughly 300 people and has sparked daily protests outside the jail, which is owned and operated by the GEO Group, a private security company that provides security, maintenance, food and medical care under a 15-year contract with U.S. Immigration and Customs Enforcement (ICE).

Earlier this month, it was reported that at least 20 detainees at the 750-bed Desert View Annex in Adelanto, California, had launched a hunger strike to call attention to what they allege are substandard conditions at that facility, including a lack of medical care, unsafe drinking water, and mold.

And last month, hunger strikes reportedly erupted at the 1,800-bed North Lake Processing Center in Baldwin, Michigan, and at the Moshannon Valley Processing Center in Clearfield County, Pennsylvania, which has a capacity of nearly 1,900. North Lake is the largest facility in the Midwest, and Moshannon Valley is the largest in the Northeast.

The GEO Group operates all of the facilities where the hunger strikes have taken place.

Families of migrants detained at Delaney Hall say their relatives  are being tear gassed and beaten by guards. Outside the facility, ICE agents have countered protesters with pepper spray, the New Jersey Monitor reported.

In a statement on Thursday, New Jersey Democratic Gov. Mikie Sherill said the New Jersey Department of Health tried to conduct a health inspection of Delaney Hall, but was denied access to all but a limited portion of the facility. Sherill said Delaney Hall should be shut down.

“Refusing to provide full access raises serious questions about what ICE is trying to hide from public view,” she said in the statement. “I am calling for ICE to immediately de-escalate the situation as I continue working to keep New Jersey residents safe.”

ICE issued a statement dismissing the accusations of substandard conditions at the facilities as a “hoax.”

“All detainees are provided with 3 meals a day, clean water, clothing, bedding, showers, soap, and toiletries. Illegal aliens also have access to phones to communicate with their family members and lawyers,” the statement says. “Certified dietitians evaluate meals. In fact, ICE has higher detention standards than most U.S. prisons that hold actual U.S. citizens.”

In a statement, the GEO Group asserted that its support services “are monitored by ICE, including by on-site agency personnel, and other organizations within the Department of Homeland Security to ensure compliance with ICE’s detention standards and contract requirements regarding the treatment and services ICE detainees receive.”

For the last few days, Gabriela Fuentes, 35, has protested outside Delaney Hall.  She said her husband, who came to the U.S. from Guatemala on a work visa, told her recently that the guards had beaten and tear gassed him and other detainees.

“We’re all human, we’re all people, just because we’re Hispanic does not mean that we need to be treated like this,” Fuentes said.

Haddy Gassama, senior counsel at the American Civil Liberties Union, described the hunger strikes as “the natural consequence of a detention system that’s really falling apart at its seams.”

“Hunger strikes are a tool that people use when they are most desperate, where they feel that they have no other options,” Gassama said. “It’s really the natural consequence of what happens when you supersize a detention system that’s already rife with abuse so fast, with so much money, with so little accountability.”

Jasmine Rivera, executive director of the immigrant rights group Pennsylvania Immigration Coalition, said it’s hard to get a handle on the scope of the hunger strikes in Pennsylvania and elsewhere.

“Upon the hunger strike, the detention center stopped communication lines to that particular unit, so it’s hard for us and for family members to stay up-to-date on what was happening,” Rivera said.

In Michigan, Ruby Robinson, an attorney at the Michigan Immigrant Rights Center, called for more state oversight of ICE detention facilities.

“It’s our understanding that they do not really have the means to adequately provide the oversight that’s needed, and outside of that, we don’t really see any other oversight, besides visits from members of Congress,” Robinson said.

“Because many immigrants are being detained in county jails, not just private detention facilities, there’s an opportunity to ensure that state law is followed. And if state law is insufficient, then it needs to be updated to basically reflect reality.”

This story was updated to include a statement from the GEO Group.

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

In its latest effort to narrow pathways to immigration to the United States, the Trump administration says it will crack down on attorneys who file fraudulent asylum claims for their clients.

The U.S. has long granted asylum to people who are unable or unwilling to return to their home countries because they have been persecuted, or fear persecution, based on their race, religion, nationality, social group or political opinions.

In a directive it issued on Tuesday, the U.S. Department of Homeland Security instructed U.S. Immigration and Customs Enforcement to develop anti-fraud policies and to take action against immigration attorneys who file false asylum claims in an immigration court.

James Percival, Homeland Security’s general counsel, said “it is standard practice for immigration attorneys representing illegal aliens to assert that virtually every illegal alien is going to be persecuted or tortured in his or her home country.”

“Historically, ICE has depended on the discipline of immigration judges and the enforcement of criminal fraud laws to deter this conduct, but ICE has its own tools,” Percival said in a statement. “Now, thanks to this directive, ICE attorneys have greater authority to enforce the law and stop the abuse of our asylum system by illegal aliens and attorneys.”

The limited available data suggests that asylum fraud is extremely rare. A 2015 report by the Government Accountability Office found that as asylum applications increased during the early 2010s, the terminations of asylum status due to discovered fraud declined, from 103 in 2010 to 34 in 2014.

U.S. Citizenship and Immigration Services granted asylum to a total of 76,122 people during that period and terminated asylum status for 374 of them because of fraud.

The administration’s new anti-fraud directive comes one month after a federal appeals court struck down an executive order by President Donald Trump that sought to close the U.S. border to asylum-seekers.

A panel of the District of Columbia U.S. Circuit Court of Appeals ruled that Trump’s executive order, which he issued on the first day of his second term, and subsequent administration guidance to turn back asylum-seekers without a court hearing were “unlawful” and “cast aside federal laws affording individuals the right to apply and be considered for asylum.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Budget constraints are forcing liberal-leaning states that spend their own money on healthcare for noncitizens to scale back that aid, as they grapple with federal Medicaid cuts and the expiration of federal subsidies that helped people buy Obamacare plans.

Under federal law, immigrants who are in the country illegally are not eligible for federally funded health coverage.

But as of last month, six states — California, Colorado, Illinois, New York, Oregon and Washington — plus the District of Columbia were spending state dollars to cover some income-eligible noncitizen adults regardless of their immigration status. A total of 14 states plus the district provide state-funded coverage to noncitizen children whether they are here legally or not. And three states — Colorado, New Jersey and Vermont — cover pregnant women regardless of their immigration status.

In addition, 40 states have taken up options in Medicaid and the Children’s Health Insurance Program, known as CHIP, to provide coverage to lawfully present children and/or pregnant women who are not citizens.

But the sweeping tax and spending bill President Donald Trump signed into law last summer cuts federal spending on Medicaid, the joint federal-state health insurance program for low-income people. It also places new eligibility restrictions on lawfully present immigrants, including refugees and asylees, who are enrolled in a variety of government-subsidized health programs, including Medicaid, CHIP, Medicare and plans available on the insurance marketplaces created under the Affordable Care Act, better known as Obamacare.

And Congress at the end of last year failed to renew federal subsidies that helped people buy Obamacare plans.

With less federal money to provide health benefits, at least five states (California, Colorado, Illinois, Minnesota and Washington) plus the District of Columbia have already scaled back or announced plans to scale back state-funded health benefits for immigrants. Other states also may have to pull back as budget pressures continue.

“The federal government shifted much more of the financial burden of providing those services to states. And so states are taking a holistic view at their healthcare budgets and trying to figure out where they can cut,” said Medha Makhlouf, a law professor and the founding director of the Medical-Legal Partnership Clinic at Penn State Dickinson Law, who studies immigrants’ access to healthcare.

“Historically and currently, as we’re seeing, immigrants are going to be the first to be cut, for a variety of reasons. They don’t have political power in the same way citizens do.”

Drishti Pillai, director of immigrant health policy at KFF, a health policy research group, warned that the state cuts, combined with the federal changes, “will likely increase uninsured rates and reduce access to care among immigrants and their children, most of whom are U.S. citizens.

“Over the long-term, these changes could lead to worse health outcomes that could be more complex and expensive to treat,” Pillai said.

But Cooper Smith, director of homeland security and immigration at the America First Policy Institute, a conservative think tank that has worked on policy development with the current Trump administration, said that when budgets tighten, policymakers should prioritize U.S. citizens.

“Taxpayers pay into a system,” Smith said. “I think it’s reasonable to expect that those who have paid into the system should be the primary beneficiaries of public benefit.”

California has traditionally provided some of the most generous benefits. But last June, Democratic Gov. Gavin Newsom signed a state budget that barred immigrants who are here illegally from newly enrolling in the state’s Medicaid program, known as Medi-Cal. In addition, current enrollees between the ages of 19 and 59 will have to pay a new $30 monthly premium beginning in July 2027. And this July, the state will eliminate dental care for noncitizens.

Newsom’s budget plan for next year proposes scaling back Medi-Cal coverage for some immigrants living in the country lawfully, including an estimated 200,000 asylees, refugees, and others with certain immigration statuses.

California Democratic state Sen. María Elena Durazo is pushing legislation this session that would undo the enrollment freeze and restore access to full-scope Medi-Cal coverage for adults living in the U.S. illegally.

“California immigrants are not going to go away,” Durazo said. “We need them. They’re agricultural workers, they’re food workers, they’re construction workers.

“Are we going to not provide the minimal basic healthcare coverage and think that somehow it’s not going to come back to haunt us through emergency rooms and other counties and public hospitals?”

Hannah Orbach-Mandel, a policy analyst at the nonprofit California Budget and Policy Center, said the state should find alternatives to the cuts, such as raising corporate taxes. She said scaling back coverage puts immigrants “in a really vulnerable position that ultimately can result in people dying.”

Colorado made a similar choice.

Using state money, Colorado’s SilverEnhanced Savings program allows immigrants who are here illegally to buy Obamacare plans with zero premiums. But budget constraints prompted the state to lower the enrollment cap for the program to 6,700 from 12,000.

Now the state is poised to downsize another program. Last year, the state launched Cover All Coloradans to provide state-funded health coverage for low-income children and pregnant women who would be eligible for CHIP or Medicaid if not for their immigration status. But a bill the legislature sent last month to Democratic Gov. Jared Polis would scale back some of the benefits available under the program and cap enrollment to help close a roughly $1 billion state budget gap driven in part by ballooning Medicaid costs.

When the law creating the program was enacted in 2022, financial analysts estimated it would cost $14.7 million this fiscal year and cover almost 3,700 children and pregnant women. Instead, the program ended up serving almost 28,000 people at an estimated cost of $104.5 million.

Colorado Republican state Rep. Rick Taggart, a member of the Joint Budget Committee, called the changes to the program “a painful compromise.”

“It’s impossible to separate the human side from the financial side in this area,” Taggart said in a phone interview. “We are talking about children, and we’re talking about pregnant women, and they have very real needs … the children, in most cases, didn’t have anything to do with the decision about immigrating to the U.S. and to Colorado.”

But other Colorado lawmakers said providing services to children who are here illegally ends up depriving the children of legal residents.

“When we come up here compassionately talking about kids, let’s talk about all the kids in our state,” Republican state Rep. Brandi Bradley said during debate on the House floor last month. “There’s plenty of kids whose parents are working a ton of jobs to just keep up with inflation and the price of groceries in the state, while we continue to grow programs like this.”

According to a 2001 court ruling, the New York Constitution bars the state from distinguishing between citizens and legal immigrants in providing Medicaid. Legal immigrants include people who have temporary and humanitarian status or might be here under the Deferred Action for Childhood Arrivals program, known as DACA, and would be income-eligible for Medicaid.

But even New York has had to make changes. Because of federal funding cuts, the state says, it is narrowing the income eligibility rules for its state-run Essential Plan, which provides zero-premium coverage for people who are here legally but do not qualify for Medicaid.

Beginning in July, the program will no longer cover households making between 200% and 250% of the federal poverty level. The change will end coverage for an estimated 450,000 New Yorkers.

“Our priority continues to be protecting coverage for as many New Yorkers as possible and ensuring people have information and assistance during this transition,” said Danielle De Souza, a spokesperson for the New York State Department of Health.

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org

Health officials from the U.S. cities hosting the 2026 FIFA World Cup say they are preparing to deal with infectious diseases, heat-related illness, and an array of other health threats when millions of fans, many of them from overseas, come to watch the games.

The World Cup is expected to draw between 5 million and 7 million soccer fans to the 11 U.S. host cities, which are Atlanta, Boston, Dallas, Houston, Kansas City, Los Angeles, Miami, New York City (in partnership with East Rutherford, New Jersey), Philadelphia, the San Francisco Bay Area and Seattle.

The newly formed Big Cities Health Coalition, a consortium of health officials from 36 of the nation’s largest health departments, says it has been formulating a strategy to mitigate any negative health impacts from such a large influx of people entering the country at once.

At a news briefing on Wednesday, health officials from Atlanta, Dallas, New York City, Philadelphia, and San Jose said they are preparing for disease monitoring and contact tracing during the weeks of soccer matches, which begin on June 11.

The officials said they aren’t concerned about the hantavirus, which is very rare. However, they are worried about the spread of measles after recent outbreaks around the country.

“Somebody might be here for a game in Atlanta and be exposed to something — let’s say measles, since that’s been so prevalent lately,” said Marcus Plescia, district health director at the Fulton County Board of Health, which includes the Atlanta region, “But by the time we realize that and start to look at who might be at risk, that fan might have traveled to Dallas to see their team playing there.”

“Something that happens here may actually have its impact somewhere else, and we’re going to have to think about how we handle that and hand off information.”

Alister Martin, commissioner of New York City’s health and mental hygiene department, said health officials also are concerned about extreme heat, alcohol and drug use, and sexually transmitted diseases.

“Relevant teams from disease control to mental health have been preparing to work in new capacities for months, and most recently, we tested our emergency capacity at our healthcare facilities,” Martin said.

At the briefing, the health officials said they are strapped for resources as a result of the expiration of COVID-19-era public health funding, and that host cities have gotten federal dollars for security and infrastructure needs but not for public health.

“In Atlanta, at least, there’s been some significant investment in infrastructure improvements, and those are very important things,” Plescia said. “We’ve not received a lot of direct funding for specific public health services.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

An increasing number of conservative states are mandating that state and local social service providers verify and report the immigration status of the people they serve — in some cases threatening stiff penalties for public employees who fail to comply.

Under federal law, immigrants who are in the United States illegally are generally barred from receiving public benefits such as nonemergency health care, food aid and housing help, though a handful of left-leaning states use their own money to provide such benefits.

Supporters of the new verification and reporting laws say they will help curb illegal immigration by making it more difficult for people who aren’t eligible for public aid to receive it.

Government-funded health care, housing aid and the right to have a driver’s license are a “pull factor that encourages illegal immigration,” said Cooper Smith, director of homeland security and immigration at the America First Policy Institute, a conservative think tank that has worked on policy development with the current Trump administration.

Government benefits, Smith said, are “an incentive for (immigrants) to come here and cross the border and make this their home, and we don’t want to see that.”

In Tennessee, legislators this week sent a bill to Republican Gov. Bill Lee that would require all state and local agencies to verify the immigration status of people who apply for federal, state or local government benefits, and to report those who are here illegally to the legislature and the state’s new immigration enforcement agency.

The measure, which the governor is expected to sign, authorizes the state attorney general to investigate possible violations, and threatens jail time or a loss of state funding for workers or agencies that fail to comply.

The potential penalties in Tennessee’s law are especially strict, but this year Indiana, Utah, and Wyoming also enacted laws requiring state and local agencies to verify the immigration status of people applying for certain benefits. In Indiana and Wyoming, agencies also must report immigrants who are here illegally to federal authorities. Louisiana enacted a similar verification and reporting law last year.

The Indiana and Wyoming laws go beyond the specific individuals applying for aid.

In considering an application for the Supplemental Nutrition Assistance Program (SNAP), the Indiana law requires agencies to notify federal authorities if they cannot verify the immigration status of any member of an applicant’s household. Similarly, the Wyoming law requires the state health department and the state department of family services to notify federal immigration authorities if they determine that anyone applying for public benefits resides in a household that includes a person who is here illegally.

Critics say the new state laws will dissuade many people who are eligible for benefits — especially those with family members who are here illegally — from getting help they are entitled to, and force state and local officials to perform an immigration enforcement role for which they are ill equipped.

“They have to do this verification process for everybody that walks in the door. This is something that slows down services for every Tennessean in the name of collecting data and trying to make assessments that folks are not trained to make,” Democratic state Sen. Jeff Yarbro said last month during the floor debate on the bill.

“There’s probably no one who understands enough of the rules to make that determination,” he said. “But we are forcing that decision upon every single government office in the state of Tennessee — it’s just a little bit insane.”

Tanya Broder, an attorney at the National Immigration Law Center, which advocates for immigrants, said the new laws represent an escalation of state anti-immigration efforts. She said the measures demonstrate that conservative states are moving in lockstep with the Trump administration.

“There are many, many states that impose restrictions on access to public to state and local public benefits, but some of these reporting requirements that states are proposing now likely do violate the law,” Broder said. “I think they are sowing a campaign of fear and misinformation.”

Broder added that the fear of penalties might prompt agency workers in Tennessee to overreport and potentially engage in racial profiling.

The Tennessee bill is part of a sweeping package of immigration enforcement measures the state legislature approved this year. Tennessee’s broad immigration agenda was crafted in coordination with the White House, specifically with Deputy Chief of Staff Stephen Miller, the architect of the Trump administration’s crackdown on illegal immigration.

Earlier this month, Lee signed a measure that requires state judges to cooperate with federal immigration authorities. And last month, the governor signed a bill that makes it a crime under Tennessee law for an adult to refuse or fail to leave the state within 90 days of a final order of removal. The law also makes it a crime for immigrants to try to enter the state if they have an outstanding deportation order.

Other bills that would require local sheriffs to cooperate with federal immigration agents and make it illegal for people who are living in the U.S. illegally to operate a commercial vehicle or truck in the state are on Lee’s desk awaiting his signature.

Smith, of the America First Policy Institute, said Tennessee is “serving as a model for other states to follow.”

Republicans struggled this year to secure funding for the Department of Homeland Security, Smith noted, “so they know that their ability to get meaningful legal immigration reform, through both houses of Congress and signed by the president, is very, very unlikely,” he said. “So the next step is to do as much as you can at the state level.”

Julia Gelatt, an associate director at the Migration Policy Institute, a Washington-based think tank, agreed with Smith’s assessment of the political situation.

“There are things that the federal government can’t control, or that may be harder to achieve at the federal level, particularly with a Congress that isn’t passing bills,” Gelatt said.

“We know that Stephen Miller advised Tennessee on their immigration bills, and I think that his philosophy is that the federal government and state governments should make life in the United States so hard for people who don’t have legal status that they decide to go home.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Massachusetts and Rhode Island are considering dropping GLP-1 drugs for obesity treatment from their Medicaid programs, continuing a trend of states that have stopped coverage of these expensive medications. 

Thirteen state Medicaid programs are covering GLP-1 drugs for the treatment of obesity this year, down from 16 last year. 

Medicaid programs in California, New Hampshire, Pennsylvania and South Carolina have eliminated coverage of the drugs for weight loss, because the expense strained state budgets. 

In Massachusetts, the governor’s proposed fiscal 2028 budget would not fund the state’s Medicaid program, MassHealth, to cover GLP-1 medications for weight loss alone, though the state would continue covering the drugs for diabetes and other conditions. The legislature is still debating the state budget. 

Rhode Island’s governor also has proposed removing GLP-1 coverage from the state’s Medicaid program for weight loss treatment. 

North Carolina reinstated such coverage in mid-December after having dropped it in October. 

Medicaid programs in Delaware, Kansas, Michigan, Minnesota, Mississippi, Missouri, Tennessee, Utah, Virginia and Wisconsin also cover the drugs for obesity treatment, according to KFF, a health policy research group. 

But some states, such as Michigan, have restricted eligibility for these medications to morbidly obesity patients rather than those who are overweight or obese. The move is expected to save the state an estimated $240 million. 

Meanwhile, lawmakers in Louisiana are debating whether to allow Medicaid to cover GLP-1s for obesity treatment if enrollees have another chronic condition, or comorbidity, such as prediabetes, hypertension or cardiovascular disease.  

The medications generally have been too expensive for people without insurance. In February, one of the largest producers of these drugs, Novo Nordisk, announced it would reduce their list prices to $675 per month in 2027. 

Gross spending on Medicaid prescriptions for GLP-1s — for diabetes as well as for weight loss — has increased from around $1 billion in 2019 to almost $9 billion in 2024 as demand for these drugs has risen, according to KFF. 

At the same time almost 40% of adults and a quarter of children with Medicaid have obesity and may benefit from having access to the drugs, according to KFF. 

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

In the eight states that expanded Medicaid after 2018, the number of people receiving prescriptions for the opioid addiction treatment medication buprenorphine increased dramatically, according to a paper that researchers will present next month.

The states that expanded Medicaid before that period also saw gains, but they were generally smaller. That’s because other changes, aside from Medicaid expansion, made buprenorphine easier to get after 2018.

The researchers found that among all patients — those covered by Medicaid, other insurers and the uninsured — the number of buprenorphine prescriptions increased in the eight most recent Medicaid expansion states (Idaho, Maine, Missouri, North Carolina, Oklahoma, South Dakota, Utah and Virginia) by more than 21% between 2019 and 2023. Maine, Oklahoma and Virginia saw the most dramatic increases.

Among the states that expanded Medicaid in 2018 or before, Kentucky, Vermont and West Virginia experienced the largest boosts. The study, published in February in JAMA Network Open, was conducted by researchers from Rutgers University and Indiana University, based on pharmacy claims data from retailers across the country.

Stephen Crystal, director of the Center for Health Services Research at Rutgers University and one of the authors, explained that buprenorphine became more accessible after 2018 as the federal government loosened various prescribing rules, including allowing prescribing via telehealth.

“Longer-term tracking shows that expansion, whether early or later, provides essential financial access and supports the growth of a provider network that improves population-level treatment rates,” Crystal told Stateline.

Experts warn that looming Medicaid cuts could cut off buprenorphine access to thousands of patients. The broad tax and spending law President Donald Trump signed last summer is projected to cut federal Medicaid spending by an estimated $886.8 billion over the next decade, largely because new work requirements will push people off the rolls, according to estimates by the Congressional Budget Office. CBO estimates that it could increase the number of people without health insurance by 7.5 million in 2034.

Opioid overdose deaths in the U.S. peaked during the COVID-19 pandemic, reaching a high of 81,806 deaths in 2022. They’ve fallen sharply since then, to 79,358 in 2023 and 54,045 in 2024.

Medicaid is  the largest payer of opioid use disorder treatment, and in 2023 it covered nearly half of all non-elderly adults in the U.S. with opioid use disorder in 2023, said Robin Rudowitz, a senior vice president at KFF, a health policy research group.

“Having health insurance is the main way for people to have consistent access to health care services, and also particularly for Medicaid, as most people are low income, and it provides protections against financial burdens,” Rudowitz said.

“And for (opioid use disorder) specifically, research shows that when people discontinue treatment, mortality risk increases. And for discontinuation of Medicaid, specifically, when coverage lapses, mortality rate increases.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.