Oct. 30, 2025 | Vol. 29 No. 10 | Archives
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- Shutdown Stalemate
- Medicaid and the States – Costly Inefficiencies
- HUD: Leaked Changes threaten Housing Assistance
- Escalating ICE Enforcement
- Cuts to SOAR and CDC Undermine Health
- What (Else) We’re Reading
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Shutdown Stalemate Stretches Into Second Month, Nearing 2019 Record |
Today marks Day 30 of the government shutdown, five days short of the 35-day record set in 2019. The Senate has now failed 12 times to pass the House’s short term funding bill, which would only keep the government funded through Nov. 21. With the Senate deadlocked and the House out of session since Sept. 12, the stalemate shows no sign of breaking.
The sticking point? Health care, specifically the Affordable Care Act’s Advance Premium Tax Credits (APTCs) which are set to expire at the end of the year. Democrats are insisting that any deal include an extension of the APTCs, but most Republicans, except for 13 House Republicans who requested an extension only after the government re-opens, are opposed. If Congress fails to act, premiums are expected to more than double next year, pushing an estimated 4 million people off of coverage, even if Congress acts today, states will still face major disruptions.
As Congress remains in a stalemate, people across the country are growing increasingly impacted by the effects of the shutdown:
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Food assistance at risk: SNAP benefits are expected to run out by Nov. 1, impacting 40 million people, with 25 states warning they will be unable to deliver payments on time. USDA has announced they will not use contingency funds to prevent disruptions, despite their ability to do so, resulting in 25 states and DC filing a lawsuit against the agency. Across the country, food banks are bracing to help people keep food on the table as they face impossible choices between food and rent, increasing the risk of homelessness.
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Federal worker fallout: Over 4 million federal employees have gone a full month without pay, leaving many dependent on food banks. The Trump administration has also taken the shut down as an opportunity to fire thousands of federal employees, including and1300 at CDC (700 of who were quickly reinstated after receiving wrongful termination notices). The move was quickly challenged in court and a federal judge has indefinitely barred the administration from further layoffs during the shutdown.
- Deepening health impacts: Furloughs at HHS and CDC are disrupting some health services, including the suspension of CDC responses to public health emergencies, experimental treatments for NIH patients, overdose and controlled substance research, and FDA operations like food safety inspections.
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Medicaid and the States: Costly Inefficiencies |
State legislative sessions begin in January, leaving lawmakers with just two months to prepare responses to the deep budget cuts from HR 1. Many states are scrambling to submit applications for the $50 billion Rural Transformation Fund which, rather than supporting rural health, is requesting application that “rebuild and reshape” health care. The true expense and inefficiency of these policies continue to grow clearer:
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Georgia’s costly experiment: A Government Accountability Office report found Georgia’s Medicaid work requirement program spent twice as much on administrative costs as it did on actual health care, with the federal government covering 90% of the administrative costs. Despite this, the Trump administration extended the program through December 2026.
- Failed pilot in Louisiana: In preparation for new Medicaid work requirements, Louisiana tested a communication system that highlights just how difficult implementation will be. The state sent 13,000 enrollees a text message with a link to verify their incomes, the response rate was lower than 7%.
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Medicaid contractors under scrutiny: Lawmakers are pressing Medicaid contractors over system errors that have wrongly terminated coverage for thousands of individuals, concerned about what these errors could result in as many states will rely on these same contractors to implement HR 1 provisions.
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While HR 1 is law, states have choices in how they implement a number of these provisions. Use the Council’s state level advocacy brief to engage with your state officials and advocate for the least harmful policies by reducing barriers and preserving access to care. for the least harmful policies.
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HUD: Leaked Changes Threaten Housing Assistance |
There is still no word on when HUD will release the FY2025 Continuum of Care Notice of Funding Opportunity (NOFO), but new reporting suggests it could include major policy changes that severely restrict access to housing assistance.
Of particular concern is a proposed 30% cap on permanent housing, down from the current 87% — a shift that could force 170,000 people back into homelessness and has drawn bipartisan concern, including from 22 House Republicans.
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Time limits and work requirements: Local housing authorities and landlords could impose work requirements of up to 40 hours per week and limit assistance to as little as two years.
- Exclusion of mixed status families: Households with noncitizen members would be ineligible for housing assistance, and US citizens would need to prove their citizenship to qualify.
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These proposals are not yet finalized, which is why we need to act now. Urge Congress to hold HUD accountable and protect critical housing programs using the National Alliance to End Homelessness action alert.
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| Escalating ICE Enforcement |
Deportation efforts continue to target cities, recently escalating to target service providers, including an incident in Chicago where four individuals were detained outside a homeless shelter, leaving residents and staff traumatized.
These actions not only endanger communities but chill access to health care. A new report highlights the growing health dangers for pregnant immigrants and their babies who are avoiding prenatal care due to fear of being detained. Advocates warn that these mass deportation efforts endanger lives, disrupt access to services, and destabilize the health care workforce.
Related Reading:
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Cuts to SOAR and CDC Undermine Health |
The SAMHSA SOAR Technical Assistance Center officially closed in August after the administration cut its funding. SOAR provided critical training to thousands of caseworkers, teaching them how to help people experiencing homelessness navigate the complex disability application process. The SOAR website, including online courses and the resource library, are no longer available, leaving a gap in support for individuals:
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"SOAR has been instrumental in helping thousands of vulnerable individuals access the disability benefits they need to stabilize their lives, and while the TA Center has closed, the need for training and technical assistance to support caseworkers serving people experiencing homelessness with disabilities remains as critical as ever."
— Kristin Lupfer, former Project Director of the SAMHSA SOAR TA Center
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The loss of SOAR is part of a broader pattern of deep cuts in HHS. Nearly a quarter of CDC staff have been laid off since the Trump administration took office, prompting warnings from former CDC leaders that the agency is deeply unprepared to protect the country’s health and safety. Former Surgeons Generals have accused Secretary RFK Jr of “endangering the health of the nation.” To fill the void in federal leadership, 15 states have formed a new public health alliance to share best practices, coordinate disease surveillance, and publish health guidelines.
Related Reading:
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What (Else) We're Reading |
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| Laura Brennan
Senior Policy Manager
National Health Care for the Homeless Council
lbrennan@nhchc.org
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Copyright © 2025 National Health Care for the Homeless Council, Inc.
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