States and the nation’s well being business have been thrown into disarray after the Trump administration ordered Monday that the federal government freeze practically all federal grants at 5 p.m. ET Tuesday, a sweeping directive that at the very least initially appeared to incorporate funding for Medicaid, the state-federal medical health insurance program that covers greater than 70 million Individuals.
By midmorning Tuesday, state officers across the nation reported they’d been shut out of a important on-line portal that enables states to entry federal Medicaid funding.
Sen. Ron Wyden of Oregon, the highest Democrat on the Senate Finance Committee, mentioned on the social media website Bluesky that the portals have been down in all 50 states following the Trump administration’s order.
“It is a blatant try to tear away well being care from thousands and thousands of Individuals in a single day and can get individuals killed,” he wrote.
Round noon Tuesday, as state well being officers pressed the federal authorities for readability, the White Home Workplace of Administration and Price range — which issued the Monday memo — put out new steerage clarifying that “obligatory applications like Medicaid” weren’t included within the freeze.
Karoline Leavitt, the White Home press secretary, declined to substantiate that Medicaid was exempt when pressed by reporters throughout an early afternoon briefing.
However she later mentioned in a publish on the social platform X that “no funds have been affected” by what she described as a “portal outage.”
The chance that federal Medicaid funding could be shut off in a single day spooked advocates already on edge about this system’s future. President Donald Trump vowed on the marketing campaign path to not search cuts for Medicare or Social Safety, the nation’s main entitlement applications serving largely retired individuals. However he didn’t make the identical promise about Medicaid, which pays for well being look after primarily low-income and disabled individuals — roughly 1 in 5 Individuals.
Separate from the freeze, congressional Republicans are discussing slicing the practically $900 billion program, arguing prices have ballooned with enrollment, notably together with this system’s enlargement to cowl extra low-income adults. Lawmakers are additionally eyeing methods to save cash for Trump’s different legislative priorities — particularly, extending the tax cuts from his first time period that expire on the finish of this 12 months.
The federal authorities pays most prices for Medicaid, which is operated by states. Medicaid pays for many long-term look after Individuals and for about 40% of all U.S. births, and along with the associated Kids’s Well being Insurance coverage Program covers about 38 million youngsters.
Federal funding for Medicaid doesn’t go on to particular person enrollees however to the states, which then distribute it to suppliers, well being plans, and different entities that serve Medicaid enrollees.
State officers can entry that funding by way of web portals.
Joan Alker, who’s government director of the Heart for Kids and Households on the Georgetown McCourt Faculty of Public Coverage, mentioned on X Tuesday that the portal lockout is “a significant disaster.”
She identified that many states entry their federal funding on the finish of the month — “i.e. this week,” she wrote.
The unique freeze order got here within the type of a vaguely worded two-page memo from the Workplace of Administration and Price range to all federal companies directing them to “briefly pause all actions associated to obligation or disbursement of all Federal monetary help.”
“This short-term pause will present the Administration time to assessment company applications and decide the most effective makes use of of the funding for these applications per the legislation and the President’s priorities,” the memo mentioned. The one applications explicitly famous as exceptions have been Medicare and Social Safety, which left it unclear how states would proceed to pay medical doctors, hospitals, nursing properties, and personal well being plans to handle Medicaid.
Across the nation, well being officers scrambled to make sense of the order, which was scheduled to take impact at 5 p.m. ET Tuesday. A federal decide halted the freeze shortly earlier than its implementation, blocking the change till subsequent week.
Whilst OMB clarified that Medicaid was not included, the speedy impacts to different important well being applications have been changing into clear, particularly for neighborhood well being facilities and medical analysis facilities.
Democrats in Congress expressed outrage on the Trump administration for pausing federal funding not solely to Medicaid but in addition to quite a few different applications, together with the Supplemental Vitamin Help Program, also called meals stamps, the WIC diet program for pregnant and postpartum ladies and infants, and faculty meal applications for low-income college students.
“The Trump Administration’s motion final evening to droop all federal grants and loans could have a devastating impression on the well being and well-being of thousands and thousands of kids, seniors on fastened incomes, and essentially the most weak individuals in our nation,” Sen. Bernie Sanders (I-Vt.) mentioned in a press release Tuesday. “It’s a harmful transfer in direction of authoritarianism and it’s blatantly unconstitutional.”
The Nationwide Affiliation of Medicaid Administrators and the most important nursing dwelling associations have been amongst these looking for clarification from the White Home on Tuesday in regards to the order’s impression on Medicaid funding.
Quite a few state officers and teams mentioned they have been contemplating or had already filed litigation difficult the order. One lawsuit was filed Tuesday in opposition to OMB in federal court docket in Washington, D.C., by the Nationwide Council of Nonprofits and the American Public Well being Affiliation, looking for a brief restraining order to “preserve the established order till the Court docket has a possibility to extra totally contemplate the illegality of OMB’s actions.”
Attorneys normal in California, New York, and 4 different states introduced Tuesday afternoon a joint lawsuit in opposition to the Trump administration over the order, which they mentioned had already frozen programs for Medicaid, Head Begin, and even youngster assist enforcement throughout a number of states.
“There isn’t a query this coverage is reckless, harmful, unlawful, and unconstitutional,” mentioned New York Lawyer Normal Letitia James. She added that she and different Democratic attorneys normal would search a brief restraining order to halt the OMB coverage from going into impact.
Leavitt defended the freeze throughout her White Home briefing — the primary of the brand new administration — saying it was important to making sure that federal funding was getting used appropriately.
“It is a very accountable measure,” she mentioned.
Reporting contributed by Bram Sable-Smith, Jordan Rau, Renuka Rayasam, Brett Kelman, and Christine Mai-Duc.
pgalewitz@kff.org,
@philgalewitz
