The intersection between birthright citizenship and access to healthcare has become increasingly complex following recent legal and policy developments. On January 20, 2025, President Trump issued Executive Order 14160, “Protecting the Meaning and Value of American Citizenship” (“EO 14160”), directing federal agencies to limit recognition of citizenship at birth in certain cases where the child’s parents lack permanent legal status.
Litigation Over EO 14160
Several states and individuals filed lawsuits seeking to enjoin the implementation of EO 14160 on the grounds that it violates the Fourteenth Amendment. By spring 2025, three separate federal district courts—in Washington, Maryland, and New York—had issued “nationwide” preliminary injunctions halting its enforcement against anyone nationwide (i.e., not just the plaintiffs named in the lawsuit). The injunctions were appealed to the Supreme Court, and in Trump v. CASA, Inc. (June 2025), a consolidation of the three cases, the Supreme Court determined that the courts lacked authority to issue these broad, nationwide injunctions and that the lower courts needed to limit the injunctions so that they were no broader than what was necessary to provide complete relief to each plaintiff. The Supreme Court left unresolved the constitutional question of whether the Fourteenth Amendment guarantees citizenship to all children born in the United States.
On July 23, 2025, the Ninth Circuit upheld the District Court for the Western District of Washington’s grant of a nationwide injunction in State of Washington v. Trump, finding that EO 14160 was likely unconstitutional and that a nationwide injunction was necessary to provide complete relief to the state plaintiffs. The Ninth Circuit reasoned that because residents of plaintiff states may give birth in non-party states and families often move across state lines, limiting the injunction geographically would still expose the states to administrative burdens and inconsistent outcomes. On that basis, the Ninth Circuit upheld the national scope of the injunction, a decision that may yet invite further review by the Supreme Court. If this nationwide injunction is narrowed or vacated on appeal, it raises the question of whether birthright citizenship would apply in some states but not others depending on the state’s enforcement of EO 14160, which, as discussed below, would have immediate implications for Medicaid and newborn coverage.
Medicaid and Newborn Eligibility
Since 1984, federal law[1] has guaranteed that infants born to mothers enrolled in Medicaid at delivery are automatically eligible for Medicaid coverage through their first year of life. This “deemed newborn” rule does not require proof of a mother’s U.S. citizenship or permanent legal status at the time of enrollment. Instead, coverage is treated as effective at birth based on the mother’s Medicaid enrollment status at delivery. States may later verify documentation as to immigration status, but the newborns are legally entitled to coverage throughout their first year regardless of subsequent questions about parental immigration status.
Enrollment of “deemed newborns” is typically supported by the Social Security Administration’s (“SSA”) Enumeration at Birth (“EAB”) program, which links hospital birth records to the SSA for the issuance of a Social Security number (“SSN”) and transmits this data to state Medicaid agencies. Many state Medicaid systems depend on the SSA assigning SSNs to newborns to activate “deemed newborn” Medicaid eligibility. EO 14160 has complicated this enrollment process. Under the “deemed newborn” rule, eligibility is based on the mother’s Medicaid enrollment at delivery without reference to the father’s status. By contrast, SSA guidance implementing EO 14160 permits delays in SSN issuance if either parent’s status cannot be verified, raising the possibility that newborn enrollment could be disrupted even when the mother herself is eligible.[2]
Some states, including California, Illinois, and New York, have extended state-funded Medicaid-like coverage to undocumented residents, including pregnant women. In those jurisdictions, infants may also receive coverage under state rules regardless of parental status. Yet even in states with supplemental coverage programs, operational enrollment often relies on the same administrative infrastructure as Medicaid, including the EAB process. Because these systems are often integrated, delays in the federal EAB process can still cause bottlenecks in enrollment and reimbursement, even where state law provides coverage without an SSN.
EMTALA and Emergency Care
Obligations under the Emergency Medical Treatment and Active Labor Act (“EMTALA”) and Emergency Medicaid[3] remain largely unchanged, but the scope of these existing laws is limited. Hospitals must provide emergency screening and stabilizing treatment to mothers in active labor and to newborns in need of immediate care during their first year of life, regardless of their immigration status or insurance.[4] Similarly, states are required to cover labor and delivery for otherwise ineligible noncitizens under Medicaid’s emergency provisions.[5] Neither EMTALA nor Emergency Medicaid, however, extends to routine postpartum care for mothers or preventative care for infants beyond emergencies. Some states have supplemented federal law with state-funded programs that extend full-scope Medicaid-like coverage to undocumented children, ensuring access to well-baby visits and preventative services. Elsewhere, however, coverage beyond emergencies remains contingent on successful enrollment in Medicaid through the “deemed newborn” rule.
Birthright Citizenship in the Broader Health Policy Environment
Executive action is increasingly shaping eligibility for federal health programs through immigration- and status-based directives. On August 19, 2025, the Centers for Medicare & Medicaid Services (“CMS”) issued a press release announcing new oversight measures to ensure that enrollees in Medicaid and the Children’s Health Insurance Program (“CHIP”) meet statutory immigration requirements. Similarly, on July 10, 2025, U.S. Department of Health and Human Services (“HHS”) issued a press release stating that it has rescinded a previous policy that had extended Title X family planning funds to undocumented immigrants, thereby limiting access to federally supported planning services for patients without lawful immigration status. These measures illustrate how questions of legal status are increasingly intertwined with maternal health policy.
Conclusion
Litigation surrounding EO 14160 has drawn birthright citizenship into direct tension with federal health programs, particularly Medicaid’s “deemed newborn” rule. At the same time, related policy shifts from federal agencies reflect a broader redefinition of eligibility for maternal health services.
Taken together, these developments underscore the evolving relationship between immigration status and access to federally supported health services. As policy continues to adapt to new and complex questions surrounding eligibility, stakeholders will need to stay attentive to further changes and the implications for patients and providers alike.
FOOTNOTES
[1] 42 U.S.C. § 1396a(e)(4).
[2] See Social Security Administration, Guidance on Protecting the Meaning and Value of American Citizenship (Executive Order 14160) for Verification Requirements under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (July 2025), https://www.ssa.gov/sites/g/files/npxnvu131/files/2025-07/SSA%20Guidance%20Document%20-%20EO%2014160.pdf.
[3] 42 U.S.C. § 1396b(v)).
[4] 42 U.S.C. § 1395dd.
[5] 42 U.S.C. § 1396b(v)(2).