The Centers for Medicare & Medicaid Services (CMS) announced in a State Medicaid Director letter increased federal oversight in regard to state use of federal Medicaid dollars to cover health care for individuals who are in the country illegally. Under federal law, federal Medicaid funding is generally only available for emergency medical services for noncitizens with unsatisfactory immigration status who would otherwise be Medicaid-eligible. To ensure appropriate usage of federal healthcare funding for individuals with an unsatisfactory immigration status in a manner contrary to federal law, CMS is increasing financial oversight activities of state federal revenue claiming in this area and will recoup any improper spending. CMS activities are expected to include focused reviews of Medicaid expenditures reported by states on the quarterly CMS-64 and in-depth financial management reviews (FMRs).