- Congress Moves to Gut Medicaid – with Deadly Results
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Leaked HHS Budget Reveals Cuts and a Massive Reorganization
- DOGE Watch
- Six Executive Actions
- Three Administrative Announcements
- Three Nominations
- What (Else) We’re Reading
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Coming Up on A Closer Look
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Medicaid Cuts Are DEADLY
Congress is considering deep cuts to Medicaid that could result in tens of thousands of unnecessary deaths each year. In next week’s Closer Look blog, we’ll break down the specific proposals coming from the House Energy and Commerce committee and steps you can take to advocate against these harmful cuts.
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Congress Moves to Gut Medicaid – With Deadly Results |
Before leaving for a two-week recess, Congress passed a revised budget resolution instructing the Energy and Commerce Committee to cut $880 billion over the next 10 years, largely from Medicaid. This first step in the reconciliation process serves as a blueprint for legislative text that will force lawmakers to take a clear stance on Medicaid cuts – despite promises to protect the program and only address fraud.
The reconciliation timeline is ambitious. The House Energy and Commerce committee is expected to mark up their portion of the bill by May 7th, with the goal of sending a complete package to the Senate before Memorial Day. The cuts they’re proposing threaten coverage and the health of the 1 in 5 people who depend on Medicaid. And, in the face of public opposition, including from Trump voters, 13 Republican Representatives sent a letter to House leadership opposing Medicaid cuts.
A Deadly Decision: Cutting Medicaid will leave millions uninsured – and cost people their lives. One recent analysis estimates that federal Medicaid work requirements would lead to 15,400 deaths annually and staffing cuts would result in 34,000 more deaths each year. This isn’t about waste, fraud, and abuse—it’s about ensuring people have access to life-saving care. The reality: Medicaid is cost-efficient and provides critical economic benefits to states, including boosting revenue and employment.
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What's the connection between homelessness and Medicaid?
- How does Medicaid promote stability for people experiencing homelessness?
- Why is Medicaid important for the health care safety net?
- How would work requirements impact unhoused people and their providers?
- What happens if Medicaid is taken away from people experiencing homelessness?
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📢 Take Action on Medicaid 📢 |
The actions continue to be the same because the threats are the same — we cannot emphasize more strongly how important it is to be engaged with your Members of Congress on this issue right now:
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Leaked HHS Budget Reveals Cuts and a Massive Reorganization |
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At HRSA, the Office of Health Center Investment Oversight and the Office of Strategic Business Operations were eliminated and the majority of staff working on technology upgrades for CHCs were let go, delaying the launch of systems that would have helped the government better evaluate the impacts of federal investments in CHCs.
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The Low Income Home Energy Assistance Program (LIHEAP), which helps low income households pay for heating and utility bills.
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The Office of the Assistant Secretary for Planning and Evaluation (ASPE), responsible for setting the federal poverty guidelines that determine eligibility for programs like Medicaid, food assistance, and housing aid.
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The loss of these programs will have a significant impact on individuals who rely on the supports from these programs. Remaining HHS staff are scrambling to keep essential functions afloat.
In late March, HHS abruptly canceled $11 billion in COVID funding from local health departments. Twenty-three (23) states and DC immediately sued the government and a federal judge has temporarily blocked the cuts. However, many organizations are still left reeling, unable to rely on the funding during a time when there’s a surge in measles and vaccine hesitancy.
On April 16, a leaked draft of the President’s budget shows how the Administration plans to recast HHS into the Administration for a Healthy America (AHA), eliminating HRSA and SAMHSA (and other agencies) and consolidating the Department into eight areas: policy/research, Surgeon General, primary care, maternal/child health, mental health, environmental health, HIV/AIDS, and health workforce. This consolidation is expected to have a severe impact on addiction treatment and mental health services. The leaked budget also showed:
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- A 30% funding cut to HHS overall - approximately $40B in cuts.
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Mandatory funding levels for health centers (Section 330) to be maintained at FY25 levels ($4.26B), while discretionary funding is being cut by 9% ($157M), likely through canceling HIV-related grant work.
- The elimination of services like the LGBTQ+ line of the national suicide prevention hotline.
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Proposed policy changes to HRSA, including a new process for determining medically underserved area/medically underserved populations and revised terms for 340B (pharmacy assistance) participation.
- Some of the HRSA programs to be eliminated: Scholarships for Disadvantaged Students, Primary Care Training and Enhancement, Nursing Workforce Diversity, Medical School Education, Ryan White Ending HIV Epidemic, among others.
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Some of the SAMHSA programs to be eliminated: Homeless Prevention Programs; Assertive Community Treatment for Individuals with SMI; Minority AIDS Initiative; Improving Access to Overdose Treatment; Overdose Prevention (naloxone); Screening, Brief Intervention, and Referral to Treatment (SBIRT); Treatment Systems for Homeless; among others.
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Take Action TODAY - May 1 |
This May Day we are fighting back. We are demanding a country that puts our families over their fortunes—public schools over private profits, health care over hedge funds, prosperity over free-market politics.
Find a May Day National Day of Action event near you to speak out against these cuts to our communities
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Executive Order: Protecting American Communities from Criminal Aliens – Requires the Department of Homeland Security to develop a list of “sanctuary cities” and identify federal funds to those jurisdictions for termination/suspension. Further, the EO orders the federal government to compel compliance with federal law and develop rules to ensure no “alien” receives federal benefits in any local jurisdiction (this will include Medicaid).
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Executive Order: Strengthening and Unleashing America’s Law Enforcement to Pursue Criminals and Protect Innocent Citizens – Identifies federal resources to defend and protect local/state police officers facing misconduct charges, create new practices for aggressive policing in local communities, expands funding for prisons, seeks to end all current consent decrees, increase military present in local jurisdictions, and otherwise take strong measures against state/local jurisdictions who continue to “impede federal actions.”
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Impact to the HCH Community of both these EOs: Should these directives move forward, expect to see sharp increases in federal police presence and aggressive policing tactics and enforcement. Expect to see greater arrests of unhoused people, risks for violence, and negative law enforcement encounters. Local jurisdictions will likely lose a wide range of federal funding on currently covered services (e.g, Medicaid), jeopardizing the likelihood they can continue. The greatest impact of these orders is likely to fall on Black and Brown people, as well as anyone suspected of not being a U.S. citizen.
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Executive Order: Lowering Drug Prices by Once Again Putting Americans First – Requires health centers who receive funding under section 330(e) of the Public Health Service Act to provide insulin and injectable epinephrine at or below the 340B price to low income individuals who have a high cost-sharing requirement, high unmet deductible, or no health insurance.
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Impact to HCH Community: The EO only applies to future grants, but it’s unclear how “future” is defined or when these provisions go into effect. This mirrors a 2020 Trump-era EO which BPHC finalized a regulation detailing implementation but it was rescinded before it could go into effect.
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Impact to HCH Community: This raises serious privacy concerns, particularly on data related to immigration status, sexual orientation, and gender identity. We’re waiting for further information, but the implications for patient data security are significant.
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White House Office of National Drug Control Policy (ONDCP): Statement of Drug Policy Priorities – ONDCP outlined the administration’s drug policy goals which combine border enforcement rhetoric with harm reduction strategies. It calls for disrupting the supply chain, holding other countries accountable and encourages states to increase availability of drug test strips and access to MOUD, as well as “improving the integration of mental health treatment with clinical and recovery support services.”
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Three Administrative Announcements |
New DEI Rules for all HHS Grants: HHS placed new DEI requirements in an updated Grants Policy Statement for any grantee who accepts funding via a NOA dated April 16, 2025 or later. The new language can be found on page 18/19 and requires all recipients to comply that they will not engage in any DEI activities. Read more about this update here.
End of Medicaid waivers covering social determinants of health: CMS will no longer approve (or extend) state 1115 waivers to use Medicaid funding for “programs that are not directly related to health care.” These waivers target designated state health programs (DSHPs) and designated state investment programs (DSIPs)—but importantly—these are not the 1115 waivers commonly used for medical respite care and tenancy supports in supportive housing. (CMS issued a warning in March that those waivers would be reviewed on a case-by-case basis.) However, this signals the shift away from addressing social determinants of health and the broader move to restrict Medicaid.
Medicaid blocks gender affirming care for youth: A new CMS memo urges states not to use Medicaid funds for hormone treatment or surgeries for youth (although youth has not been defined). It’s unclear if this is legally binding or will stand up in court, especially given the courts have paused Trump’s Executive Order on GAC. Adding to the concern, the U.S. Justice Department has directed prosecutors to investigate GAC surgeries, though no details have been made public.
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Centers for Medicare and Medicaid Services (CMS): After being confirmed in the Senate, Dr. Oz was sworn in as administrator of CMS earlier this month and as noted above has already been issuing memos and guidance from CMS.
Director of the Office of National Drug Control Policy (ONDCP): Trump nominated Sara Carter, a conservative journalist and Fox News contributor, to serve as the nation’s drug czar. Carter has no experience in drug policy, public health, or law enforcement. She will need Senate confirmation, but the date has not been set yet.
Deputy Assistant Secretary of SAMSHA: A former Trump official, Art Kleinschmidt, was named to leadership at SAMSHA. Kleinschmidt contributed to Project 2025 and previously served as the Deputy Director of ONDCP.
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What (Else) We're Reading (and Watching) |
There is SO MUCH going on that it’s hard to include it all. Below are a dozen more articles we found relevant this month:
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| Laura Brennan
Senior Policy Manager
National Health Care for the Homeless Council
lbrennan@nhchc.org
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| Your support is crucial!
All our advocacy work — including this newsletter! — is funded by dues from NHCHC's members and private donations. Consider joining the Council or donating to support this work!
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Copyright © 2025 National Health Care for the Homeless Council, Inc.
www.nhchc.org | (615) 226-2292
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