An order from President Donald Trump to temporarily block the disbursement of most federal grants and loans could have a massive impact on health programs ranging from those addressing HIV and AIDS to maternal health and services for older Americans.
The announcement, which created exceptions for direct-aid programs such as Medicare and Social Security, sent shock waves through Washington and state governments Tuesday, with stakeholders scrambling to understand the impact of the freeze on programs like the Children’s Health Insurance Program, nutrition programs for seniors, public health programs and much more.
The uncertainty is amplified by a communications pause the Trump administration put on federal agencies, leaving even state governments in the dark.
“A pause on grant funding can be very disruptive for all health programs,” even if temporary, said Richard Hughes IV, a health lawyer at Epstein Becker Green. “It’s an all-of-government directive that puts everything into a lurch for states and grantees.”
[Trump White House orders freeze on federal grants, loans]
Health care providers, advocates, patient organizations, state and local governments, public health departments and many others receive billions of dollars in grants through the Health and Human Services Department to provide health care services, train health care providers, research health threats and much more.
Much of that funding flows to states, which then award subgrants to local governments, health care providers and community organizations.
The pause, announced Monday evening by the Office of Management and Budget, is intended to ensure programs are complying with Trump’s executive orders related to gender ideology, diversity, equity and inclusion programs, abortion and energy, according to an OMB official.
A spreadsheet obtained by CQ Roll Call lists hundreds of programs under review, including CHIP, a block grant to states to cover health care for low-income children, and some Medicaid funding.
But a senior administration official said the freeze does not impact programs that provide direct benefits to Americans nor does it apply to mandatory programs like Medicaid. The official also indicated the freeze would not apply to CHIP.
[White House sends aid freeze questionnaire to federal agencies]
Still, Medicaid officials reported being locked out of accounts that are used to draw down federal funds, said Joan Alker, executive director and co-founder of the Center for Children and Families, which works with Medicaid programs.
“This is already causing panic,” Alker said. “This is grossly irresponsible. If Medicaid is exempt, that should have been made very clear in the memo to begin with.”
A group of organizations including the American Public Health Association filed a motion for a temporary restraining order in the U.S. District Court for the District of Columbia Tuesday in hopes of blocking the move, with Georges Benjamin, executive director of the association, saying the decision “threatens to stall essential public health and prevention programs and research.”
“Halting these funds stymies progress and is a matter of life and death,” Benjamin said.
The freeze could also apply to hundreds of other programs funded by HHS, which is the largest grantmaking agency in the federal government, making up a large portion of the more than $1 trillion the federal government spends every year on grants.
Programs affected
Several programs impacted by the freeze are under the law known as the Older Americans Act, which funds services for aging Americans, including nutrition services.
“If in fact this order includes the Older Americans Act, this would presumably halt service to millions of vulnerable seniors who have no other means of purchasing or preparing meals,” said a Meals on Wheels America spokesperson, Jenny Young.
“And the uncertainty right now is creating chaos for local Meals on Wheels providers not knowing whether they should be serving meals today.”
The spreadsheet also lists dozens of programs funding services for HIV/AIDS.
“People with HIV/AIDS depend on medications, health care and support services for the rest of their lives and we have to take steps to prevent HIV every day, we just can’t stop funding these programs,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.
Questions remain about how Trump’s executive orders on gender and transgender people will impact HIV programs. Many HIV prevention and treatment programs provide services to people who are transgender. Those people are disproportionately more likely to have or contract HIV than the general population, often because of care access issues, according to data from both the Centers for Disease Control and Prevention and the World Health Organization.
“These lifesaving programs serve a wide array of different populations, and HIV is an infectious disease with serious health consequences if not properly addressed —we can’t overlook any community and must serve everyone,” Schmid said.
The senior administration official added that programs not implicated by Trump’s executive orders are not subject to the pause.
A pause could be as short as a day, the official said, and some programs have already been approved. If agencies are concerned a program may defy an executive order, they should consult OMB to begin unwinding objectionable policies, the official said.
[White House seeks to tamp down concerns over funding directive]
Speaking during the White House press briefing Tuesday, White House press secretary Karoline Leavitt said the pause would be “temporary,” adding that “the Office of Management and Budget is reviewing the federal funding that has been going out the door.”
She said the memo “requires federal agencies to identify and review all federal financial assistance programs consistent with the President’s policies and requirements.”
“It means no more funding for transgenderism and wokeness across our federal bureaucracy and agencies,” she said.
OMB directed agencies to complete the spreadsheet by Feb. 7 with specific information about hundreds of listed grant programs.
The information requested includes whether the program supports or provides services to “illegal aliens,” provides diversity, equity, inclusion and accessibility mandates, policies, programs, preferences and activities, promotes “gender ideology,” or supports abortion.
Democratic senators expressed alarm about the potential sweeping impact of the cuts.
“It’s very troubling, the programs that are going to be affected for constituents,” said Sen. Ron Wyden of Oregon, the ranking Democrat on the Senate Finance Committee.
Sen. Bernie Sanders, I-Vt., the ranking member of the Senate Health, Education, Labor and Pensions Committee, wondered in a statement about the move’s impact on community health centers, Head Start and pregnant mothers who receive help through WIC, a supplemental nutrition program.
“Let’s be clear,” he said. “The Trump Administration’s action last night to suspend all federal grants and loans will have a devastating impact on the health and well-being of millions of children, seniors on fixed incomes, and the most vulnerable people in our country.”
Aidan Quigley contributed to this report.
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