Jan. 30, 2025  |  Vol. 29 No. 1  |  Archives

In this issue:

Photo by Gage Skidmore, via Flickr Creative Commons license

The White House’s Office of Management and Budget (OMB) issued a memo on Monday evening that froze federal funding for all grants—which includes HRSA-funded health centers. After nationwide confusion resulted from this vague directive, OMB issued a clarification memo, which did little to help. Non-profit organizations and State Attorneys General quickly filed a lawsuit, which was heard Tuesday evening, where the judge halted the order until Monday when another hearing will be held. Yesterday, the White House rescinded the original memo.

The intent is to create chaos and confusion. However, the collective nationwide outrage that occurred was helpful in getting fast legal assistance. Anticipate more of these events in the near future.

The Trump Administration released many Executive Orders (EOs) shortly after Inauguration. These EOs cover a wide range of issues, impact nearly every aspect of public service, and direct federal actions that will be extremely harmful to vulnerable people. Due to space limitations, we are focusing this Mobilizer content on three issues that most directly impact the HCH Community: immigration, DEI, and gender.

Executive Order: Protecting the American People Against Invasion:

Executive Order: Protecting the Meaning and Value of American Citizenship: Challenges birthright citizenship under the 14th Amendment when neither parent is a U.S. citizen or permanent resident (this applies to those undocumented as well as those who are legally present visa holders). NOTE: Lawsuits have been filed challenging this order. The President does not have the authority to undo a Constitutional right.

Additional: The Trump Administration also rescinded prior “sensitive location” guidance that prohibited immigration enforcement in health care settings, homeless shelters, and other spaces.

Likely impact to the HCH Community: Added trauma and fear among patients and staff, decreased access to care and willingness to apply for benefits. Possible immigration enforcement at health center and/or medical respite care locations.

Resources from Immigration partners: 

Executive Order: Ending Illegal Discrimination and Restoring Merit-Based Opportunity:

Executive Order: Ending Radical and Wasteful Government DEI Programs and Preferencing:  

Additional: Federal agencies were instructed to shut down DEI programs, put all DEI federal employees on paid leave, and remove any DEI related materials from websites and social media.

Likely Impact on the HCH Community: Federal funding for all DEI work will end, and at this time it is unclear what the lookback review will mean.

Executive Order: Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government:

Executive Order: Protecting Children from Chemical and Surgical Mutilation: Restricts access to gender affirming care (GAC) for youth under the age of 19, this includes puberty blockers, hormone therapy and surgery. Prohibits federal funding from covering such care, restricts research and education grants to medical schools and hospitals, and directs HHS to issue regulations that end GAC for minors.

Executive Order: Initial Rescissions of Harmful Executive Orders and Actions: Repeals Biden administration nondiscrimination protections for LGBTQI+ individuals.

Likely Impact on the HCH Community: Transgender individuals will no longer have anti-discrimination protections in employment, health care, prisons/jails, or homeless shelters. Health center data collection on gender identity is likely to be impacted, but there are no further details at this time. The EO says federal funds cannot support promoting gender ideology and this may eventually prohibit HCH programs from providing gender affirming care for adults. The order restricting GAC directs HHS to issue regulations to end care for youth and directs federal agencies to take steps toward withholding funds from providers who provide such care. Providers can still provide GAC to people under the age of 19 until those regulations are issued. Until HRSA informs otherwise, current policy remains in effect.

Related Reading: 

What a GOP-Controlled Congress Means for Trans People | 19th News

Background on Trump Executive Order Targeting Health Care for Transgender People Under 19 | Human Rights Campaign

The burst of Executive Orders the last nine days is a deliberate effort to overwhelm the opposition to any single part of this President’s agenda. It is important to remain focused on our mission and goals and the individuals we serve. Here are some immediate ways to take action:

Communicate with your elected officials and policymakers: Write letters or emails, make phone calls, attend town halls and public meetings. Help your elected leaders understand the potential impact even a temporary pause in federal funding would have on the individuals you serve. Focus on real stories and real people. (Find your federal representatives here.)
Engage in social media campaigns: Social media platforms can be a powerful tool for organizing, sharing information, and mobilizing people. Posting personal stories, data, and information about the impact of funding cuts can increase awareness. Use hashtags, engage with advocacy organizations online, or start a grassroots hashtag campaign to raise visibility.
Raise Public Awareness: Consider writing an opinion piece for local newspapers or online publications to help spread the message to a broader audience. Organizing or attending local rallies and protests can show visible public opposition to funding cuts, drawing more attention to the cause.
Mobilize your own network: Identify strategic allies and partners and encourage them to contact elected officials on your behalf. Arm them with information and simple, clear talking points.

Bipartisan funding negotiations began last week with House appropriators hoping to reach a topline agreement to fund the government before the continuing resolution (CR) expires on March 14th. The ongoing debates on whether House Republicans will do one or two budget bills remains to be decided. Given the small Republican majority in the House (Republicans have 219 seats and need 218 votes to pass bills) Speaker Johnson wants to do one reconciliation bill and hopes to bring it to the floor by April. This places House Republicans on a tight timeline as one bill requires more time to pass and involvement from a greater number of committees. Speaker Johnson aimed to have a blueprint for their package decided at the Republican retreat this week, but lawmakers left late Wednesday frustrated with a general outline and no final numbers. 

Included in that blueprint and in an effort to provide tax breaks to their new billionaire friends, House Republicans are considering hundreds of budget options which could add up to $2-3 trillion in spending cuts. These cuts would be used to pay for the tax cuts and immigration enforcement that Republicans are prioritizing over the health and welfare of millions of people. These include cuts to Medicaid (see below), cuts and changes to eligibility for food assistance programs like SNAP and TANF, and reinstatement of public charge, among others, and will disproportionately impact our most vulnerable communities, including people experiencing homelessness, individuals with disabilities, and immigrants.

As mentioned above and in last month’s Mobilizer, the return of the Trump Administration puts deep cuts to Medicaid back on the table putting millions of people at risk. This fear was reaffirmed after a leaked Republican budget document showed a slew of proposals to cut Medicaid and threaten coverage. Included in the laundry list of budget options are:

These are only the largest cuts being proposed to Medicaid. If all of the Medicaid changes being proposed were implemented, it would result in a $2.3 trillion cut to the program – most of that coming from the per capita cap, reducing the expansion match rate, and lowering reimbursements to states. It’s unlikely Republicans will pursue all of these cuts, but it is abundantly clear that some of the harmful proposals will likely make it into the final budget package. A dozen moderate House Republicans in competitive districts spoke against cuts to the Affordable Care Act and Medicaid in a closed door meeting last week, citing concerns about their ability to win reelection in 2026. This is likely due to the fact that voters overwhelming oppose cuts to Medicaid and generally favor the program.

States will also look to advance measures to cut Medicaid after the first Trump administration approved more than a dozen waivers allowing state Medicaid work requirements. A court ruling prevented most from being implemented, but Georgia’s remained in place. And, after being implemented for just one year, the Georgia program data shows low rates of coverage, administrative burdens, and higher costs on the system.  The programs costs have been so alarming that three Democratic senators requested the Government Accountability Office investigate the costs to the federal and state government to better understand the cost burden and the obstruction to accessing care. Despite the program’s high costs and low coverage, states across the country will likely pursue similar policies. Earlier this month, Arkansas Governor Huckabee stated her intention to implement a broader work requirement than the one blocked by the courts after the first Trump administration. 

Related Reading:

 

THANK YOU TO PROVIDERS AND ADVOCATES: Thank you to the 118 organizations and more than 600 individuals who signed on to our letter urging Congress to protect Medicaid!

The Senate is focused on President Trump’s cabinet nominations, and holding hearings and votes to get it staffed quickly. So far 3 nominees have been confirmed, but dozens more are going through the process. Here’s what we know about nominees relevant to the HCH Community (for a refresher on the nominees, check out last month’s Closer Look blog):

Related Readings:

New Street Medicine Resources from HRSA

In very clear terms, HRSA has said health centers can engage in street medicine. Newly released compliance language outlines how to ensure street medicine activities should be documented in your scope of project. This encouragement complements CMS’s additional ‘place of service’ code for street medicine back in July 2023.

Resources:

Related Readings:

Finalized Regulations

During his final days in office, former President Biden issued two final regulations relevant to the HCH community. It is possible for President Trump to rescind these regulations, however at this point they remain in place.

Partner Resources:

Federal Resources:

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

lbrennan@nhchc.org

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