May 28, 2026  |  Vol. 30 No. 7 |  Archives

In This Issue

218 days, or 31 weeks, until Medicaid work reporting requirements go into effect and states are still waiting on official guidance from CMS, which is statutorily required by June 1. That gives states just seven months to implement massive changes, an inadequate amount of time for systems so complex. Many states have begun moving forward without guidance, working on definitions and implementation plans based on informal guidance from CMS. According to a new survey of Medicaid officials, several Republican led states are adding more barriers than required in the law while other states are preparing state employees for the confusion.

Some states launched early. Nebraska became the first state to implement the work reporting requirements despite the lack of official guidance from CMS. Advocates warned the early rollout puts thousands of people at risk of losing coverage and raised skepticism about the state’s ability to successfully launch the program.

“The onus will be on us as the provider to do everything we can to try and determine eligibility for our patients.” 

-Kenny McMorris, CEO, Charles Drew Health Center, Omaha, NE

The Rural Health Transformation Fund will do little to help providers with the financial burden because most of the money is expected to go to big corporations focused on health system technology and cybersecurity. To address the financial fallout on providers, three states are considering establishing distressed hospital loan funds to keep clinics and hospitals open.

CMS also released new rules that limit how states can fund their Medicaid programs, which will put more financial pressure on states to cut services from their programs. In what the agency says is an effort to save $775 billion over the next decade, the proposed rules target state-directed payments, tie payment limits to Medicare rates, and impose limits on certain fee-for-service payments. 

Continue working with your state lawmakers and Medicaid officials to craft work requirement rules that soften the impact on people experiencing homelessness. Use our letter to states to advance 8 ways H.R.1 can be implemented better.

The fraud, waste, and abuse witch hunt continues. This month the Administration announced they are withholding $1.3 billion of Medicaid funding from California after claiming that many blue states have “not taken fraud very seriously.” CMS also deferred an additional $91 million from Minnesota, bringing the total amount of Medicaid funding withheld from the state this year to almost $300 million. Then, late last week, the Administration homed in further on Minnesota, announcing “the largest autism fraud bust in American history”  with 15 people indicted for over $90 million in Medicaid fraud.

To assist these efforts, HHS announced a new agency wide AI initiative, Audit Enforcement and Risk Oversight (AERO), that will scan five years of audit histories for all 50 states to identify and crack down on fraud.

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Medicaid isn’t a waste, it’s a lifeline. We need to hear from patients and providers about why Medicaid matters to you and your community so we can push back against these harmful narratives. Whether Medicaid helped you access critical care, supports your ability to work, or has allowed your patients to get the services they need, we want to hear it.

Tell us your story or share a few details and we’ll follow up with you directly. We’ll use these stories to show lawmakers the importance of Medicaid.

The White House released the 2026 National Drug Control Strategy, outlining a range of priorities including primary prevention, accessing comprehensive treatment (to include medications), and engaging in recovery. It also proposes a national wastewater testing system to monitor drug use, the use of AI to examine electronic health records, and heavily promotes faith-based recovery options.

The Administration states it should be easier to access treatment than to access drugs, a claim that is highly inconsistent with their own actions. Instead, cuts to Medicaid, harm reduction, and behavioral health care will make it harder to access care, impacting recent progress made reducing overdose deaths.

The strategy also identifies fentanyl test strips as an important tool, directly contradicting one of two SAMHSA Dear Colleague letters issued the week prior which prohibits federal funding for test strips:

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The Trump Administration issued a new proposed rule that will weaken the 2016 Equal Access Rule, that allowed transgender (and other gender non-conforming people) to access shelters, housing and other HUD-funded services without discrimination. If finalized, the rule will eliminate critical protections that ensure transgender and gender nonconforming individuals can access shelter and housing that aligns with their gender identity.

This rule is fundamentally about dignity, respect, and importantly, safety. One in four transgender people experiencing homelessness reported avoiding staying in a shelter due to fear of being mistreated and 70% of those who stayed in a shelter reported high rates of mistreatment. Rescinding the Equal Access Rule will only increase discrimination and harassment, forcing more people into unsheltered homelessness.

Submit a public comment before the June 29th deadline, sharing why equal access to housing for transgender and gender non-conforming people is important! Comments can be submitted directly on the federal register or through Advocates for Trans Equality comment portal.

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The appropriations process for fiscal year 2027 has begun. Community Health Center and HCH program funding, included in the Labor, Health and Human Services bill, is not out yet. That legislative text is expected before the House committee markup on June 5. The Transportation, Housing, and Urban Development legislative text was released last week and includes an 8% cut to HUD from FY26 levels.

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Call your members of Congress at 202-224-3121 and urge them to provide the highest possible funding for key programs including the Community Health Center Program and HUD housing programs! Describe why this funding is important to your local community and why cuts to these programs will only harm vulnerable people without solving any of our health and housing problems.

Increased ICE activity continues to take a massive toll on immigrant communities. New data from Los Angeles found a rise in mental health conditions, with half of the patients screened having anxiety, three quarters experiencing depression, and more than one in eight reporting suicidal thoughts. This comes as immigrant communities face massive health coverage losses due to Medicaid and ACA changes, along with fear that Medicaid data will be used to find and deport individuals.

The not finalized/not in effect proposed mixed status rule from HUD already wreaked havoc in one small Texas town. The Housing Authority falsely sent notices that mixed-status families were no longer eligible for public housing assistance. The notices, rescinded three weeks later, dropped the public housing occupancy rate from 91% in January to 43% in May, a peak at what’s to come if the rule takes effect.

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Make a statement. Support the movement.

Laura Brennan
Senior Policy Manager
National Health Care for the Homeless Council

lbrennan@nhchc.org

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