Sept 29, 2025 | Vol. 29 No. 9 | Archives
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- Government Shutdown Likely Wednesday
- State Pressure Grows Under OBBBA
- Turn Out and Speak Up! No Kings Rallies!
- CDC Chaos Continued
- Criminalizing Homelessness: Utah Pushes Mega-Prison
- Immigrant Health and Safety
- Big (Temporary) Wins in Recent Court Cases
- What (Else) We’re Reading
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Government Shutdown Likely Wednesday |
A federal shutdown is looking increasingly likely as current funding is set to expire tomorrow, September 30. President Trump cancelled a meeting with Democratic leadership last week but is scheduled to meet today to discuss a path forward. Lawmakers have two options: pass a continuing resolution (CR) to temporarily extend funding or let the government shut down.
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Continuing Resolution: President Trump is pushing Republicans to pass a “clean” extension to buy more time for full-year funding negotiations. House Republicans narrowly passed a seven-week stop gap bill to extend hospital and telehealth funding, but not ACA premiums subsidies. The Senate rejected that measure, along with a Democratic alternative CR that would have reversed health care cuts from HR 1, making a CR now seem dead in the water.
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- Government Shutdown: With no CR advancing and Congress out on recess for the week, only two legislative days remain before funding runs out. Lawmakers on both sides don’t seem willing to budge, making a shutdown increasingly likely.
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What will happen?: There are still a lot of unknowns and additional information is forthcoming. Importantly, HRSA leaders indicated on the BPHC update last week that health centers should still be able to draw down funds. However, given the unprecedented nature of this Administration, the reality that a shutdown gives the Administration MORE spending power, a threat to fire many federal workers, and the lack of agency instructions from the Administration, it is unclear what will actually happen. What other government services will continue is also TBD. Stay tuned for more information.
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"“This isn’t a battle I can fight alone. If I didn’t have the help, I wouldn’t be here — I would be homeless again.”
- Michelle Cates, Baltimore HCH client and Medicaid recipient
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State Pressure Grows Under OBBBA |
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The One Big Beautiful Bill Act (OBBBA) is already reshaping health care across the country as states unprepared to implement HR 1 face tough budget decisions. Examples:
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New York began unwinding expanded state coverage for people making up to 250% of the federal poverty level.
- Minnesota is bracing for $160 million a year in Medicaid administrative burdens.
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North Carolina’s Medicaid agency announced it will cut Medicaid provider payments.
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As it becomes clear that voters will feel the impact of cuts before the midterm elections, the Trump administration is scrambling to rebrand HR 1 as the ‘Working Families Tax Cut Bill’ or the ‘Working Families Tax Plan.’
Medicaid is already under severe strain. In 2024, the uninsured rates rose in 18 states and D.C as pandemic-era continuous coverage ended. At the same time, providers across the country have struggled with increased administrative burdens and limited resources, resulting in physician burnout levels not seen since the height of the pandemic. In Georgia, work requirements have only deepened the issue, from FY 2021-2025 the state spent more on bureaucracy than on care for patients ($54.2 million vs $26.2 million). These pressures threaten access to essential services, especially in rural areas where doctors at health centers describe practicing under “disaster medicine” conditions.
Rural Health Transformation Fund launched. CMS recently opened applications for the five year, $50 billion Rural Health Transformation Fund intending to soften the impact of Medicaid cuts. Experts are concerned that the rushed timeline and potential for political interference will limit its effectiveness while others argue the fund is simply not large enough to offset the cuts.
Focus on Montana: In its application to CMS to implement work requirements, Montana is asking to include people experiencing homelessness in its definition of “a short-term hardship/good cause exemption.” Every state should do this!
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Turn Out and Speak Up! No Kings Rallies! |
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Take Action: On October 18th communities across the country will gather for another No Kings protest, to stand up against tyranny and the attacks on our communities. Find a protest near you, show up, lean in, and be loud in solidarity with your neighbors. Together, we must make it clear: our communities are strong, and we will not stay silent in the face of injustice.
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The turmoil at HHS and the Centers for Disease Control has intensified resulting in waning public confidence as less than half of Americans believe the agency can carry out its core functions:
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CDC leaders resign: One month into the job, Trump appointed CDC Director Susan Monarez was fired after rejecting political pressure that conflicted with scientific guidance. In protest, four other top officials stepped down, with one saying “I only see harm coming."
- Staff pushback: More than 1,000 current and former HHS employees demanded RFK Jr. resign, stating his leadership risks the health of all Americans.
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Senate hearings: Congress heard testimony from both RFK Jr. and former CDC Director Monarez. RFK Jr. faced bipartisan criticism, and fact checkers flagged all of his false claims. Monarez testified she was removed for refusing to pre-approve vaccine recommendations that she had not yet seen and for rejecting pressure to fire career scientists.
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New MAHA report: The Make America Healthy Again Commission announced its Make Our Children Healthy Again report aimed at lowering chronic illness among children. The report identifies four drivers behind rising rates of chronic disease: poor diet, chemical exposure, lack of physical activity and chronic stress, as well as "overmedicalization." The report drew criticism for overlooking key causes of childhood deaths as well as lacking accountability measures.
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Vaccines in Turmoil: These leadership disruptions are more than bureaucratic drama, they represent a threat to public health and lifesaving vaccines. After replacing all 17 members of the Advisory Committee for Immunization Practices (ACIP) panel with 7 hand-picked members back in June, HHS added five new members ahead of last week’s ACIP meeting. The new panel decided not to recommend COVID shots, even for high-risk individuals, and delayed a vote on changing hep B vaccines for newborns. Together, the changes at CDC and the ACIP recommendations are creating very different vaccination realities across the country:
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- West Coast Alliance: California, Oregon, and Washington are forming a public health alliance to maintain credible vaccine recommendations in the face of federal uncertainty.
- Northeast Public Health Collaborative: Seven northeastern states formed their own coalition to share resources and ensure trust in public health, including around vaccines.
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School Vaccines Mandate Ended: Florida’s Surgeon General ended school vaccine mandates (equating vaccines to slavery), with Dr. Oz publicly backing the move.
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Criminalizing Homelessness: Utah Pushes Mega-Prison |
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In response to Trump’s Civil Commitment Executive Order encouraging states to enforce involuntary commitment laws, officials in Utah proposed a new 16-acre “homeless campus” which includes 1,300 beds, 300-400 of which are set aside for involuntary civil commitments.
Despite the state’s claim that this approach emphasizes accountability and public safety, forced treatment does not solve homelessness, but rather pushes people away from care and contributes to overdose deaths and premature mortality. We’re already seeing the failure of punitive policies across the country, including in Maine, where the closure of syringe services programs and the clearing of encampments has led to the largest HIV outbreak in the state’s history.
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At its core, this is about criminalization, not care. |
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Displacement worsens health outcomes and undermines human rights. Yet public opinion often overlooks these realities, a new AP-NORC poll finds that many Americans still attribute poverty and homelessness to individual choices, even as most believe the government has a responsibility to address these issues. For the HCH community, it is clear: affordable housing and access to care are the needed solutions, not criminalization.
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Immigrant Health and Safety
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Non-citizens continue to be targeted for harassment and deportation, which directly impacts their health and safety.
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Access to care: The Trump administration has launched investigations into state Medicaid spending for immigrants in several blue states, while ICE has begun showing up in California hospitals – deterring many people from seeking care.
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Deportation raids: The Supreme Court lifted restrictions on ICE raids in Los Angeles which were paused after advocates accused ICE of targeting people based on ethnicity. In Chicago, Trump threatened to unleash the newly renamed “Department of War” ahead of increased ICE activity, escalating his attacks on blue cities.
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Big (Temporary) Wins in Recent Court Cases |
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Housing Grants Protected (for now): Huge win! The National Alliance to End Homelessness partnered with Democracy Forward and filed a lawsuit challenging the new funding restrictions on the CoC Builds notice of funding opportunity. A federal judge granted a temporary restraining order preventing the Trump administration’s unlawful attempt to restrict HUD housing grants. This is only temporary until another hearing can occur that aims to release the grant funds without the new requirements. Stay tuned for more information.
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Immigrant Access Upheld: Another huge win! A federal judge granted a preliminary injunction on the Administration’s restriction on federal public benefits for certain non-citizens. The National HCH Council strongly opposed the attempt to limit health center services. The preliminary injunction prevents enforcement in the 22 states involved in the litigation and DC. Meanwhile, the Trump Administration has paused implementation of this policy across all states. This means there is NO CHANGE for health centers and other programs—we will continue seeing all residents of our service areas.
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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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| 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 © 2025 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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