Supreme Court Upholds Birthright Citizenship: What The Decision Means For Medicaid And Newborn Coverage

On June 30, 2026, the Supreme Court of the United States in Trump v. Barbara¹ ruled on the constitutionality of President Trump’s Executive Order 14160, “Protecting the Meaning and Value of American Citizenship” (“EO 14160”), which had directed federal agencies to limit recognition of citizenship at birth in certain cases where a child’s parents lack permanent legal status. In its ruling, the Supreme Court affirmed the lower court’s preliminary injunction against EO 14160, leaving the order enjoined and unenforceable. The decision leaves intact the longstanding interpretation that, subject to narrow, longstanding exceptions (e.g., children of accredited foreign diplomats), children born in the United States are citizens at birth regardless of their parents’ immigration status.

In reaching that decision, five Justices concluded that the Fourteenth Amendment guarantees birthright citizenship, while Justice Kavanaugh provided the sixth vote on statutory rather than constitutional grounds. Although Justice Kavanaugh agreed with the Court’s judgment, he did not join the majority’s conclusion that EO 14160 violated the Fourteenth Amendment. Instead, he reasoned that EO 14160 was invalid on statutory grounds because it conflicted with the Immigration and Nationality Act’s provisions governing citizenship at birth.² Justice Kavanaugh also indicated that, in his view, if Congress amends the Immigration and Nationality Act or enacts a new statute creating new exceptions along the lines of EO 14160 for children born to foreign citizens unlawfully or temporarily in the country, such a statute “would pass constitutional muster.” Justice Kavanaugh’s concurrence leaves open the possibility that Congress could pursue similar policy objectives through legislation. Because five Justices grounded the ruling in the Fourteenth Amendment, however, any statute adopting EO 14160‑like exceptions would likely still confront a constitutional challenge under the majority’s reasoning.

Medicaid and Newborn Eligibility

The Supreme Court’s decision has important implications for the Medicaid program. Medicaid finances approximately 41% of all births in the U.S.³, making any potential changes affecting birthright citizenship particularly relevant for maternal and infant health coverage.

As discussed in our blog post last year, since 1984, federal law⁴ has guaranteed that infants born to mothers enrolled in Medicaid at delivery are automatically eligible for Medicaid coverage through their first year of life. The “deemed newborn” rule does not require a separate Medicaid eligibility determination for a newborn at enrollment; instead, eligibility is based on the mother’s Medicaid enrollment status at the time of delivery and generally continues through the first year of life. Had EO 14160 taken effect, state Medicaid agencies might have needed to reassess Medicaid eligibility workflows, documentation requirements for determining parental immigration status, and enrollment systems to reflect changes in the legal framework governing citizenship at birth.

Looking Ahead

Although EO 14160 has been invalidated, the broader policy debate over the relationship between immigration status and access to healthcare is likely to continue. Future policy changes addressing immigration status and healthcare eligibility could arise through legislative, regulatory, or administrative mechanisms.

For example, in 2025 the Department of Homeland Security rescinded guidance⁵ limiting immigration enforcement actions in certain sensitive locations, including hospitals.⁶ In addition, beginning October 1, 2026, Section 71109 of the Working Families Tax Cut legislation⁷ will restrict^[8] federal Medicaid and Children’s Health Insurance Program (CHIP) matching funds for certain categories of noncitizens who previously qualified for federally matched coverage. States that choose to continue coverage for affected populations without federal matching funds may need to assume a greater share of the costs. These changes could place additional fiscal and administrative pressure on states that have expanded healthcare coverage for certain noncitizen populations, particularly pregnant women and children.

Although President Trump has indicated that he intends to seek a rehearing of the decision, the Supreme Court’s ruling provides near-term clarity regarding Medicaid’s “deemed newborn” rule and related newborn coverage processes. The broader landscape, however, remains unsettled, as the intersection of immigration policy and healthcare access continues to evolve through legislative, regulatory, and administrative actions.

Footnotes

1. Trump v. Barbara, 609 U.S. _ (2026).

2. 8 U.S.C. § 1401(a), https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title8-section1401&num=0&edition=prelim.

3. See Medicaid.gov, Maternal & Infant Health Care Quality, https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality#:~:text=Related%20Resources&text=More%20than%20one%20out%20of,births%20in%20the%20United%20States.

4. 42 U.S.C. § 1396a(e)(4), https://uscode.house.gov/view.xhtml?req=(title:42%20section:1396a%20edition:prelim).

5. See Department of Homeland Security, Statement from a DHS Spokesperson on Directives Expanding Law Enforcement and Ending the Abuse of Humanitarian Parole (January 21, 2025), https://www.dhs.gov/news/2025/01/21/statement-dhs-spokesperson-directives-expanding-law-enforcement-and-ending-abuse.

6. See U.S. Immigration and Customs Enforcement, Common Sense Enforcement Actions in or Near Protected Areas Memorandum (January 31, 2025),ice-memo-common-sense-enforcement-actions-in-or-near-protected-areas.pdf.

7. See H.R. Con. Res. 14, 119th Cong. (2025) (enacted), https://www.congress.gov/bill/119th-congress/house-bill/1/text.

8. See Department of Health & Human Services Centers for Medicare & Medicaid Services, Letter SHO #26-001 Re: Implementation of Section 71109 “Alien Medicaid Eligibility” of the Working Families Tax Cut Legislation (Public Law 119-21) (April 8, 2026), https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf.