March 26, 2026 | Vol. 30 No. 5 | Archives
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New Threat to Medicaid – FRAUD (+ advocacy action!)
- Work Requirements Move Forward (+ advocacy action!)
- Get Involved! Join a meeting with your lawmakers?
- ICE Enforcement and Detention Harm Health, DHS Funding Fight Continues (+ advocacy action!)
- This Saturday: No Kings Protest!
- Proposed HUD Rules Threaten Housing Stability
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Expanding Use of Guardianship
- What (Else) We’re Reading
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New Threat to Medicaid – FRAUD |
Medicaid cuts have remained a top priority for the Trump administration and Congressional leaders who recently launched fraud investigations across multiple states. While framed as oversight for the misuse of funds, these efforts are attempting to destabilize Medicaid mostly in Democratic run states. What’s happening:
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The starting point: The investigations started in Minnesota, where the Trump administration attempted to withhold more than $250 million in funding, Minnesota pushed back, and the fight is tied up in litigation.
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Escalating number of state investigations: Centers for Medicare and Medicaid Services (CMS) launched a new initiative, expanding the investigation to California, Florida, Maine, and New York. House Energy and Commerce Committee leadership sent letters to ten states (CA, CO, MA, ME, NE, NY, OR, PA, VT, and WA) requesting information about Medicaid program integrity, threatening vital Home and Community Based Services (HCBS) like medical respite care.
- Additional federal action: DOGE publicly released provider-level spending data to identify potential fraud, raising concerns about patient privacy and the misuse of sensitive information.
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New Executive Order, new White House task force: The President issued a new executive order, “Establishing the Task Force to Eliminate Fraud,” ” which targets Medicaid and other safety net programs like housing, food, medical care, and cash assistance federal benefit programs.
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Work Requirements Move Forward |
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Three months into state legislative sessions and nine months out from implementation of the work requirement provisions in HR 1, states continue to grapple with these changes. Recent analysis found that state Medicaid budgets will lose $664 billion through 2034, and implementation costs (IT and additional staff) are expected to exceed $1 billion across 25 states.
Here’s the latest on state Medicaid decisions:
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- Arkansas will begin testing work requirements this summer, but will hold off enforcement until January 2027.
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Florida is pursuing Medicaid work requirements despite not expanding Medicaid and not being required to implement them.
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California anticipates thousands of people experiencing homelessness will lose Medicaid coverage. Safety net clinics in LA are pushing for a new 5-year, half-cent sales tax to fill funding gaps and continue providing care.
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GOOD News: Utah passed a state law codifying work requirements while explicitly exempting people experiencing homelessness.
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While implementation has not yet begun, data already shows a decline in Medicaid enrollment, a trend that could significantly impact key Medicaid populations including 2 in 5 births, 1 in 4 people with SUD or mental illness, and 3 in 5 nursing facility residents.
The changes will be felt across the country. Already 1 in 3 Americans report cutting basic expenses to pay for health care, a number that will grow as coverage losses increase.
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Take Action: Contact your state lawmakers and urge them to mitigate the harms of Medicaid cuts on people experiencing homelessness! Use Utah as an example of a state that has taken action to protect this population!
Use these resources to support your outreach:
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Photo credit: Stephanie Wroten, CEO, Duffy Health Center with Congressman Keating (February 2026)
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Get Involved! Meet With Your Lawmakers |
Want to meet with your elected officials—either in your work capacity or as a private citizen? Sign up to join virtual meetings by filling out this google form to indicate your interest. Laura Brennan, our Senior Policy Manager, will reach out as opportunities become available with your Representative and Senators.
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ICE Enforcement and Detention Harm Health, DHS Funding Fight Continues |
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Congress is no closer to ending the Department of Homeland Security partial government shutdown as negotiations between Democratic leadership and the White House have stalled. As discussions continue, the need for ICE and CBP reform remains clearer than ever with new reporting highlighting the health impacts across the country.
Reports from detention facilities show detainees receive inadequate medical care, particularly pregnant and postpartum individuals who report limited access to treatment, unsafe conditions, and a lack of follow up care. And, despite federal policy that says this group of individuals should only be detained under limited circumstances, ICE deported 363 pregnant, postpartum, and nursing immigrants between January 1, 2025 and February 16, 2026 – severing access to care and increasing trauma.
Across the country, fear of ICE continues to deter many people from accessing care, underlying the importance and need to continue advocating for sensitive locations. In communities with high ICE presence like Minneapolis, providers warn that enforcement actions pose a threat to the health care system and have gone as far as to set up a shadow medical system to help patients access care safely at home.
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Congress must keep hearing from us: NO DHS funding without restrictions on ICE. This includes clear protections that prohibit ICE enforcement at or near sensitive locations (clinics, hospitals, shelters, school, places of worship) so people can safely access care.
Call your elected officials today using the Capitol switchboard (202-225-3121) and urge them to oppose any DHS appropriations package that does not include these protections. Make it clear that access to care must be protected. Use our latest fact sheet to learn more about sensitive locations and why they’re critical.
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This Saturday: No Kings Protest! |
On Saturday, March 28, communities across the country will come together again for No Kings 3, a nationwide day of protest. As our communities remain under attack, costs push people out of housing and away from health care, we must stand with our neighbors and demand change.
Find a protest near you, make a sign, and have your voice be heard!
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Proposed HUD Rules Threaten Housing Stability |
The Department of Housing and Urban Development (HUD) published three proposed regulations that could significantly impact housing access and stability for tens of thousands of people:
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Restricting HUD assistance for “mixed status” families: This proposed rule would limit HUD housing assistance to only U.S. citizens and eligible noncitizens (generally legal permanent residents). It would require all people living in any Section 8 or public housing units (or other types of HUD-assisted housing) to verify their citizenship status. If finalized, this rule will displace many families who cannot verify their eligibility and will create significant administrative burdens for case managers.
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- Comments due: April 20. Note: Template language you can use to draft your own letter will be coming out shortly!
- Related Resources:
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Establishing an OPTIONfor work requirements and time limits in HUD housing: This proposed rule would give public housing agencies (PHAs) the option to implement work requirements up to 40 hours per week for “work-eligible” adults and allow PHAs to establish term limits of no less than 2 years for non-elderly, non-disabled families.
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- Comments due: May 1. Note: Template language you can use to draft your own letter will be coming out shortly!
- Related Resources:
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Revoking 30-day notice of eviction for nonpayment of rent: Currently, HUD-assisted tenants must receive at least 30 days’ notice before being evicted for nonpayment of rent. This rule would revert back to pre-2021 policies (which had been loosened due to COVID). Starting on March 30, 2026, public housing needs to give “at least 14 days’ notice,” while project-based Section 8 programs must comply with the provisions of the lease and State laws. Those living in Section 8 Rehab SROs, only 5 working days’ notice is required.
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- Comments due: April 27 - but note this will have already taken effect at that time.
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Expanding Use of Guardianship |
The Department of Veterans Affairs (VA), in partnership with the Department of Justice (DOJ), is launching a new initiative to expand the use of guardianship for veterans, specifically targeting those experiencing homelessness. Under guardianship, the government can assume control of where an individual lives, who they see, their assets, and what medical care they receive. A related but separate pilot, Project Safe Harbor, will test this model at five VA sites (Boston, Los Angeles, Tampa, San Antonio, and Hines).
These efforts come after staffing cuts at the VA eliminated thousands of medical positions and reduced access to therapists and other critical services. With this context, expanding access to guardianship rather than investing in critical, voluntary providers, raises series questions about the Department’s MO. The initiative also reflects a broader federal trend toward more coercive and punitive responses to homelessness and behavioral health, including:
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- DOJ’s FY25 Public Safety and Mental Health Initiative ($45 million): Requires civil commitment, prioritizes locations that criminalize homelessness, and prohibits any community that is friendly to immigrants from receiving funds.
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SAMHSA Assisted Outpatient Treatment (AOT) Program Grant - While not new, these grants existed under Biden and Trump previously, this grant requires awardees to be in a community that cooperates with ICE, punishes drug users, participates in encampment sweeps, and includes prohibitions on “anti-American activities” (TBD on what that means).
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Important note: Guardianship processes are governed at the state level. It is unclear whether the VA or DOJ have the legislative authority to advance this initiative.
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What (Else) We're Reading |
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We hope to see you in Orlando in June! |
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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 © 2026 National Health Care for the Homeless Council, Inc.
www.nhchc.org | (615) 226-2292
100 Powell Place #1558 | Nashville, TN 37204 US
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