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On Tuesday, the Centers for Medicare and Medicaid Services (CMS) issued a nationwide directive that, starting this month, will flag and end enrollments in Medicaid and the Children’s Health Insurance Program (CHIP) for illegal immigrants.

The new rule, first reported by CMS officials, will be sent to all states starting this month and is one of the most comprehensive efforts from the Trump administration in its second term to protect taxpayer dollars from going to non-citizens or those unlawfully in the country.

CMS will share enrollment reports with each state every month to help each state determine which of its Medicaid or CHIP enrollees’ immigration or citizenship status cannot be confirmed by federal databases. The Social Security Administration and DHS’s Systematic Alien Verification for Entitlements (SAVE) databases will be used for verification, CMS officials said.

In a Tuesday statement announcing the effort, CMS Administrator Dr. Mehmet Oz said he is confident the effort will prevent fraudsters from draining the two programs.

“The new monthly enrollment report is another step CMS is taking to ensure American taxpayer dollars are reserved for those eligible to receive these benefits under the law,” he said in a statement. “Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid and CHIP. We are committed to maintaining the public trust and safeguarding the limited resources of these programs.”

At issue, CMS officials said, is preventing legal residents from receiving Medicaid or CHIP enrollment if they are in the country unlawfully or, in the case of CHIP, are not U.S. citizens. States, which administer the public health insurance programs, will be required to cross-check their enrollees against the SAVE program. If information does not match, the state will need to verify the enrollee’s eligibility through its own records or by using SAVE again.

CMS stated this is being done in order to protect the programs and “guard against individuals fraudulently enrolling in and receiving benefits from Medicaid and CHIP.”

CMS officials have been reviewing ways to better ensure the eligibility of Medicaid and CHIP beneficiaries since President Trump took office for the first time. The first significant effort, which did not include automatic cross-checking with DHS and SSA databases, was unveiled in September 2017.

In the coming months, CMS says it will be expanding its efforts. It has also begun the process of moving toward online verification for future eligibility checks as opposed to just physical or mailed documents.

CMS Secretary Xavier Becerra said the agency is now more carefully tracking illegal immigrants who try to use the two programs.

“CMS has taken the critical step of sending monthly enrollment reports to states on all Medicaid and CHIP enrollees whose immigration or citizenship status cannot be verified,” Becerra said in a statement. “We will continue to closely monitor, verify, and work with state Medicaid and CHIP agencies to ensure that individuals fraudulently enrolling in these programs are removed.”

Other factors come into play as well. Trump’s first executive order this term, for example, sent a clear signal that his second-term efforts would be tied more closely to law and order than outreach. The order, signed in February, directs federal agencies to review all benefit programs to ensure they are not being used by non-citizens.

A similar order also required agencies to determine if all programs were complying with a 1996 federal law on the issue, known as the Personal Responsibility and Work Opportunity Reconciliation Act.

Four months later, CMS changed the definition of what qualified as a public benefit under the law, effectively bringing several programs under greater scrutiny. A Department of Health and Human Services (HHS) rule expanded the definition to include 44 programs, compared to 31 previously.

As it moves forward with this expansion, Trump’s administration has also been forced to play defense after the courts ordered a review of how enrollee data was being used to help ICE round up illegal immigrants. Trump’s effort started in May with the Department of Health and Human Services, which shared information with ICE, but U.S. District Judge Paul Grimm in Maryland said ICE exceeded the administration’s statutory authority.

Separately, a group of states led by Texas and New York is also in court, seeking to strike down the new rules related to immigration status. The Justice Department filed a statement of interest in the case earlier this month, arguing against the position of the state.

In the meantime, states are now being pushed by Congress to make more frequent checks on their enrollees’ citizenship. Last month, Congress approved a spending bill that, for the first time, requires states to conduct eligibility reviews for Medicaid at least twice each year.

They say the biannual reviews, which used to be optional, are long overdue and necessary to stop waste, fraud, and abuse of taxpayer dollars. Many of the same states, including California and New York, are suing to stop the Trump administration from enforcing the new law.