July 30, 2026 | Vol. 30 No. 10 | Archives
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- Hill Happenings (+ action!)
- Big Changes to Medicaid Work Reporting Requirements (+ action!)
- Medicaid: Beyond Work Requirements
- HCH Media Spotlights
- Immigration Public Charge Final Rule Released
- HUD FY26 CoC NOFO Faces Legal Challenge
- Additional Updates from the Administration
- What (Else) We’re Reading
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The House left for August recess after passing a $1.15 trillion annual defense bill and a budget resolution to set up a third reconciliation package which included $96 billion for the Pentagon, but no further cuts to Medicaid or other basic needs programs.
The House also tied parts of the Safeguard American Voter Eligibility (SAVE America) Act to the budget resolution. They included provisions that would require all voters to provide proof of citizenship when registering to vote and a photo ID when voting. Millions of people, especially individuals experiencing homelessness, lack access to these documents which will prevent them from voting. By attaching parts of SAVE to the budget resolution, House Republicans are hoping to increase pressure on the Senate which has been stalling on taking up the legislation.
See what else has been happening on the Hill:
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Passed: 21st Century ROAD to Housing Act – After receiving strong bipartisan support (and despite Trump’s refusal to sign the bill), ROAD passed into law and includes over 40 provisions intended to address the affordable housing shortage by encouraging homebuilding across the country. Whether and when this law will yield more affordable housing for extremely low-income people remains to be seen.
- Introduced: Two new bills this month that we are supporting
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Modernizing Opioid Treatment Access Act 2.0 - This bill would allow board-certified addiction physicians and psychiatrists to prescribe methadone for opioid use disorder and individuals to fill the prescription at their local pharmacy.
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Cure Hepatitis C Act - The bill would create a national hepatitis C elimination program to expand testing and treatment, especially for individuals who are low-income, incarcerated or uninsured.
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Ongoing: Medicare for All gaining momentum – Support for Medicare for All now includes more than half of the House Democratic caucus, and the proposal has gained attention from candidates running for office. The growing public concerns of health care affordability combined with Medicaid cuts are likely contributing to this uptick.
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BOLO: Lower Costs, More Transparency Act of 2026: Passed out of the Energy and Commerce Committee with full bipartisan support. The bill provides two new funding streams over the next two years for Community Health Centers, including $500 million to expand behavioral health services and $250 million for nutrition education and chronic disease prevention. The bill also permanently requires all CHCs to provide behavioral health services. This bill still has to go through two more House committees before it could get a full House vote, but keep your eye out!
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Big Changes to Medicaid Work Reporting Requirements |
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Our July Closer Look blog provided an update on CMS’s recent guidance on Medicaid work reporting requirements. The biggest takeaway? To qualify for the medical frailty exemption, individuals must prove both that they have a qualifying condition AND that the condition significantly impairs their ability to work. A change which has left doctors concerned about documenting someone’s ability to work and which will create significant challenges for individuals with disabilities, people with HIV, seasonal workers, and other vulnerable populations.
Lawsuit filed: Since this change goes beyond what’s included in the law, 25 states and DC sued CMS for the agency's overreach, seeking a temporary injunction by July 31. Unfortunately, today the District Court of Massachusetts declined to issue a Preliminary Injunction that would postpone implementation of the work requirements, meaning states, providers and patients must plan for the rule to go into effect. The judge agreed to expedite the case and hopefully issue a ruling before January 1, 2027, but states will still have to prepare for implementation.
State responses: States are seriously worried that the new requirements will lead to higher error rates and financial penalties. Many are already seeing the same situation in SNAP where new error rate penalties are expected to result in high costs for states. States are exploring new laws to address the financial difficulties, including by calling out businesses with a high percentage of employees on Medicaid and, in some cases, implementing financial penalties on those businesses.
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NEW RESOURCES!
We released four new resources to help you understand the CMS guidance on Medicaid work reporting requirements and prepare for implementation:
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State lawmakers need to hear from us! Send our letter to states to your Medicaid Director, Governor’s Office/Health Department leads, and state legislators. Our letter includes policy recommendations on how states can implement HR 1 while reducing harm to people experiencing homelessness.
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Medicaid: Beyond Work Requirements |
Waste, Fraud, and Abuse Narrative Continues: The Trump administration recently paused over $1 billion in Medicaid payments to California and Minnesota as part of the ongoing focus on waste, fraud and abuse. This is a continuation of ongoing fraud investigations which started in Minnesota and has resulted in huge losses for providers. The administration has also frozen funding for Medicaid fraud control units, most recently in New York arguing the state is not doing enough to address fraud.
1115 Waiver Changes: CMS recently issued a Letter to State Medicaid Directors that significantly changes the approval process for Section 1115 demonstrations – requiring the CMS Chief Actuary to certify the entire demonstration is budget neutral with a stricter methodology before it can be approved.
These changes will significantly limit states’ ability to expand Medicaid populations or services through section 1115 demonstrations, affecting both existing and new initiatives.
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Immigration Public Charge Final Rule Released |
The Trump administration published the public charge final rule. As a reminder, the public charge test is used to determine whether someone applying for a green card or seeking admission to the U.S. is likely to become dependent on the government for support.
Previously, immigration officials only considered cash assistance and long-term institutionalization as factors. Under the new rule, immigration officers can consider any public benefits. This change will create significant confusion and fear, and eligible immigrants and their families will likely avoid programs they are entitled to use, including health centers.
The rule has a 60-day implementation delay and will take effect on September 18, 2026. Until then, the current Biden-era public charge rule remains in effect.
Related Reading from our partners at Protecting Immigrant Families:
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HUD FY26 CoC NOFO Faces Legal Challenge |
Last month we shared information about HUD’s FY2026 Continuum of Care Notice of Funding Opportunity (CoC NOFO), which made major changes to homelessness policy. Since then, there have been two legal updates:
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A federal court vacated HUD’s FY25 CoC NOFO finding that the new restrictions were unlawful – this only applied to the FY25 CoC NOFO.
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A broad coalition filed a new complaint against HUD, challenging the FY26 CoC NOFO. Plaintiffs asked for an expedited briefing and arguments will be made by July 31, they are hoping for a final decision by August 10.
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Additional Updates from the Administration |
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DOJ Moves Towards Institutionalization: The Department of Justice (DOJ) issued a memo arguing that states do not have to offer home-or community-based care to individuals with disabilities, potentially lowering the barrier to institutionalize individuals. This is consistent with last year’s Executive Order that encouraged states to institutionalize people experiencing homelessness.
- HHS Admits Medicaid Data Shared with ICE: In a recent court filing, HHS admitted that they improperly shared information about millions of people with ICE back in January. ICE then shared that data with Palantir, which operates an app that ICE agents use to see the addresses of noncitizens.
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What (Else) We're Reading |
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The Council's Merch Shop is Open 24/7 |
Make a statement. Support the movement.
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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
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