Vaccine misinformation pushed by Secretary of Health and Human Services Robert F. Kennedy Jr. could put American lives at risk. (Eric Harkleroad/KFF Health News)

President Donald Trump’s administrations have been notorious for an array of “alternative facts” — ranging from the relatively minor (the size of inaugural crowds) to threats to U.S. democracy, such as who really won the 2020 election.

And over the past six months, the stakes have been life or death: Trump’s health officials have been endorsing alternative facts in science to impose policies that contradict modern medical knowledge.

It is an undeniable fact — true science — that vaccines have been miraculous in preventing terrible diseases from polio to tetanus to measles. Numerous studies have shown they do not cause autism. That is accepted by the scientific community.

Yet Secretary of Health and Human Services Robert F. Kennedy Jr., who has no medical background or scientific training, doesn’t believe all that. The consequences of such misinformation have already been deadly.

For decades, the vast majority Americans willingly got their shots — even if a significant slice of parents had misgivings. A 2015 survey found that 25% of parents believed that the measles, mumps, and rubella (MMR) vaccine could cause autism. (A 1998 study that suggested the connection has been thoroughly discredited.) Despite that concern, just 2% of children entering kindergarten were exempted from vaccinations for religious or philosophical objections. Kids got their shots.

But more recently, poor government science communication and online purveyors of misinformation have tilled the soil for alternative facts to grow like weeds. In the 2024-25 school year, rates of full vaccination for those entering kindergarten dropped to just over 92%. In more than a dozen states, the rate was under 90%, and in Idaho it was under 80%. And now we have a stream of measles cases, more than 1,300 from a disease declared extinct in the U.S. a quarter-century ago.

It’s easy to see how both push and pull factors led to the acceptance of bad science on vaccines.

The number of recommended vaccines has ballooned this century, overwhelming patients and parents. That is, in large part, because the clinical science of vaccinology has boomed (that’s good). And in part because vaccines, which historically sold for pennies, now often sell for hundreds of dollars, becoming a source of big profits for drugmakers.

In 1986, a typical child was recommended to receive 11 vaccine doses — seven injections and four oral. Today, that number has risen to between 50 and 54 doses by age 18.

The Advisory Committee on Immunization Practices, which renders judgments on vaccines, makes a scientific risk-benefit assessment: that the harm of getting the disease is greater than the risk of side effects. That does not mean that all vaccines are equally effective, and health officials have done a lackluster job of fostering public understanding of that fact.

Older vaccines — think polio and measles — are essentially 100% effective; diseases that parents dreaded were wiped off the map. Many newer vaccines, though recommended and useful (and often heavily advertised), don’t carry the same emotional or medical punch.

Parents of the current generation haven’t experienced how sick a child could be with measles or whooping cough, also called pertussis. Mothers didn’t really worry about hepatitis B, a virus generally transmitted through sex or intravenous drug use, infecting their child.

That lack of understanding spawned skeptics. For example, since 2010, the vaccine for influenza, which had been around for decades, has been recommended annually for all Americans at least 6 months old. In the 2024-25 season, the rate of flu vaccination was only between 36% and 54% in adults; in other years, it has been lower than that. “I got the flu vaccine, and I still got the flu” has been a common refrain of skeptics.

“Pre-covid, there were people who took everything but flu,” said Rupali Limaye, an associate professor at Johns Hopkins University’s Bloomberg School of Public Health, who studies vaccine demand and acceptance. “Then it became everything but covid. Now it’s everything — including MMR and polio.”

Even as the first Trump administration’s Operation Warp Speed helped develop covid vaccines, conservative media outlets created doubts that the shots were needed: doubts that mRNA technology had been sufficiently tested; doubts that covid-19 was bad enough to merit a shot; concerns that the vaccines could cause infertility or autism.

Trump did little to correct these dangerous misperceptions and got booed by supporters when he said that he’d been vaccinated. Once vaccine mandates came into play, Trump strongly opposed them, reframing belief in the vaccine as a question of personal liberty. And if the government couldn’t mandate the covid shot for school, it followed that officials shouldn’t — couldn’t — mandate others.

Thus 100 years of research proving the virtues of vaccination got dropped into a stew of alternative facts. You were either pro- or anti-vaccine, and that signaled your politics. Suddenly, the anti-vax crowd was not a small fringe of liberal parents, but a much larger group of conservative stalwarts who believed that being forced to vaccinate their kids to enter school violated their individual rights.

Even within the Trump administration, there have been some who (at least partly) decried the trend. While Marty Makary, the Food and Drug Administration commissioner, defended Kennedy’s decision to roll back the recommendation that all Americans get annual covid boosters — saying the benefits were unproven — he noted it should not be a signal to stop taking other shots.

As “public trust in vaccination in general has declined,” he wrote, the reluctance to vaccinate had harmed “vital immunization programs such as that for measles–mumps–rubella (MMR) vaccination, which has been clearly established as safe and highly effective.”

Nonetheless, Makary’s boss, Kennedy, continued to promote bad science about vaccines broadly, even as he sometimes grudgingly acknowledged their utility in cases like a measles outbreak. He has funded new research on the already disproven link between MMR shots and autism. He has halted $500 million in grants for developing vaccines using mRNA technology, the novel production method used for the first covid vaccines and a technique scientists believe holds great promise for preventing deaths from other infectious diseases.

In my 10 years practicing as a physician, I never saw a case of measles. Now there are cases in 40 states. More than 150 people have been hospitalized, and three, all unvaccinated, have died.

Alternative facts have formed what David Scales, a physician and sociologist at Weill Cornell Medical College who studies misinformation, calls “an unhealthy information system.” It is an alternative scientific universe in which too many Americans live. And some die.

This story can be republished for free (details).

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The U.S. Supreme Court on Oct. 29, 2024. (Photo by Jane Norman/States Newsroom)

WASHINGTON — The Supreme Court on Thursday set aside a lower court’s ruling, allowing the Trump administration to cancel hundreds of millions of dollars in National Institutes of Health grants that addressed diversity, equity and inclusion issues.

The 5-4 ruling narrowly divided the court, with Chief Justice John Roberts, Justice Sonia Sotomayor, Justice Elena Kagan and Justice Ketanji Brown Jackson dissenting from their colleagues.

The Trump administration originally requested the Supreme Court to intervene in the case in July, when Solicitor General D. John Sauer filed an application arguing “the district court lacked jurisdiction to order the government to pay out some $783 million in terminated grants.”

Sauer wrote the case was similar to one the Supreme Court had ruled on earlier this year, determining that a district court erred when it blocked “the Department of Education from terminating DEI-related grants.”

In that case, the Supreme Court ruled that “such claims likely belonged in the Court of Federal Claims, that the district court accordingly lacked jurisdiction.”

Sauer wrote in his application to the Supreme Court that the lower courts in the NIH grants case chose to ignore the justices’ prior ruling.

“The district court’s order directs the NIH to continue paying $783 million in federal grants that are undisputedly counter to the Administration’s priorities,” Sauer wrote. “This Court has already intervened to stay a materially identical order … and the same course is even more warranted here given the district court’s brazen refusal to follow controlling Supreme Court precedent.”

Democratic AGs weigh in

Democratic attorneys general for Arizona, California, Colorado, Delaware, Hawaii, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Washington and Wisconsin opposed the Trump administration’s request in a 49-page filing.

“The federal government’s application spins a tale of lower courts disregarding established legal guardrails to block routine agency decisions,” they wrote. “That narrative bears little resemblance to reality; indeed, it gets things exactly backward.”

The Trump administration’s decision to cancel the NIH grants, they wrote, came “without providing any meaningful explanation of their decisions.

“Defendants then executed the directives by, among other things, canceling hundreds of research grants to the plaintiff states’ public universities for projects investigating heart disease, HIV/AIDS, Alzheimer’s disease, alcohol and substance abuse, mental-health issues, and countless other health conditions.”

The American Public Health Association also opposed the Trump administration’s efforts to get the Supreme Court to throw out the lower court’s rulings.

The APHA wrote in its own filing that the Trump administration “failed to consider the reliance interests at stake—namely, the impact to researchers’ career progression, the risk to human life, and the damage to the overall scientific endeavor and the body of public health.”

Siding with Trump administration

Justices Clarence Thomas, Samuel Alito, Neil Gorsuch and Brett Kavanaugh disagreed, siding with the Trump administration and setting aside the lower court’s rulings in the case. Justice Amy Coney Barrett wrote a concurring opinion.

Gorsuch sharply rebuked the district and appeals courts in his opinion, in which Kavanaugh joined in part and dissented in part.

“Lower court judges may sometimes disagree with this Court’s decisions, but they are never free to defy them,” Gorsuch wrote. “In Department of Ed. v. California … this Court granted a stay because it found the government likely to prevail in showing that the district court lacked jurisdiction to order the government to pay grant obligations.”

Barrett appeared to agree, writing in her concurring opinion that “the District Court likely lacked jurisdiction to hear challenges to the grant terminations, which belong in the Court of Federal Claims.”

In a dissenting opinion, Jackson wrote that the justices did not take enough time to seriously consider the ramifications of their decision in the Education Department case when they spent “a mere nine days” deciding whether a federal district court or the Court of Federal Claims holds jurisdiction when the government terminates “federal grants en masse.”

“I viewed the Court’s intervention then—in an emergency stay posture, while racing against a fast-expiring temporary restraining order—as ‘equal parts unprincipled and unfortunate,’” Jackson wrote. “As it turns out, the Court’s decision was an even bigger mistake than I realized.”

Ariana Figueroa contributed to this report.

A mother holds her daughter while she gets a vaccine at a clinic in Texas in March. Children and adults who receive health insurance through Medicaid or the Children’s Health Insurance Program will now be subject to immigration or citizenship status checks, according to a new initiative announced this week by Robert F. Kennedy Jr., who oversees Medicaid as secretary of the U.S. Department of Health and Human Services. (Photo by Jan Sonnenmair/Getty Images)

This week, the Trump administration’s Centers for Medicare & Medicaid Services (CMS) announced an effort to check the immigration status of people who get their health insurance through Medicaid and the Children’s Health Insurance Program.

Medicaid is the public health insurance program for people with low incomes that’s jointly funded by states and the federal government. For families that earn too much to qualify for Medicaid but not enough to afford private insurance, CHIP is a public program that provides low-cost health coverage for their children.

The feds will begin sending states monthly enrollment reports that identify people with Medicaid or CHIP whose immigration or citizenship status can’t be confirmed through federal databases. States are then responsible for verifying the citizenship or immigration status of individuals in those reports. States are expected to take “appropriate actions when necessary, including adjusting coverage or enforcing non-citizen eligibility rules,” according to a CMS press release.

“We are tightening oversight of enrollment to safeguard taxpayer dollars and guarantee that these vital programs serve only those who are truly eligible under the law,” Robert F. Kennedy Jr., who oversees CMS as secretary of the U.S. Department of Health and Human Services, said in a press release announcing the new program.

As of April, roughly 71 million adults and children nationwide have Medicaid coverage, while another 7 million children have insurance through CHIP. Immigrants under age 65 are less likely to be covered by Medicaid than U.S.-born citizens, according to an analysis from health research organization KFF.

Immigrants who are in the country illegally aren’t eligible for federally funded Medicaid and CHIP. Only citizens and certain lawfully present immigrants — green card holders and refugees, for example — can qualify.

But some states have chosen to expand Medicaid coverage for immigrants with their own funds. Twenty-three states offer pregnancy-related care regardless of citizenship or immigration status, according to KFF. Fourteen states provide coverage for children in low-income families regardless of immigration status, while seven states offer coverage to some adults regardless of status.

The tax and spending package President Donald Trump last month cuts federal spending on Medicaid by more than $1 trillion, leaving states to either make up the difference with their own funds or reduce coverage. But the new law also includes restrictions on coverage for certain immigrants, including stripping eligibility from refugees and asylum-seekers.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

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Clinicians are providing medication abortion through telehealth services even to people in states where abortion is banned, thanks in part to shield laws in states where abortion is still legal. (Natalie Behring/Getty Images)

As conservative lawmakers work to restrict online access to abortion medication, a new report shows how popular it has become for women who live in states that have outlawed abortion.

Researchers from the University of Texas at Austin led a team that analyzed 15 months of prescription data from Aid Access, one of the largest online abortion telemedicine providers.

They found 84% of Aid Access’s more than 118,000 online prescriptions went to patients living in abortion-ban states.

The South and Midwest had the highest rates of patients accessing telemedicine abortion. Rates were also greater in high-poverty areas or where people would have to travel more than 100 miles to reach an abortion clinic, according to the report, which published this month.

Aid Access is able to mail abortion medications to residents in all 50 states — even those in states with abortion bans — thanks to shield laws in Democratic-led states. Shield laws are designed to minimize the legal risks for people who provide or access abortions across state lines.

Currently, 22 states and Washington, D.C., have reproductive care shield laws, either through legislation or by executive order, according to a report from University of California, Los Angeles School of Law.

Eight of those states — California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont and Washington — specifically protect telehealth abortion providers regardless of where their patient is located.

Shield laws, along with difficulty accessing in-person abortion services in abortion-ban states, have contributed to a rise in medication and telehealth abortions since the U.S. Supreme Court overturned the federal right to abortion in 2022, clearing the way for state bans. With telehealth abortion, patients have a virtual appointment with a clinician who can prescribe abortion medication, which is then filled by a licensed pharmacy and mailed to the patient.

Research has shown telehealth medication abortion is effective and safe, and comparable to in-person medication abortion.

Medication abortion accounted for nearly two-thirds of all clinician-provided abortions in states without bans in 2023, the most recent data available from the Guttmacher Institute, a research and policy organization focused on advancing reproductive rights.

But as abortion medication use rises, so have conservative efforts to ban it.

This year, more than a dozen states introduced bills to bar access to medication abortion by criminalizing its sale, purchase or distribution, according to Guttmacher.

One such bill in Texas, which could have been a blueprint for medication abortion restriction in other states, was specifically aimed at groups like Aid Access. It would have allowed private citizens to sue for at least $100,000 anyone who provided abortion pills in Texas. The bill passed the Texas Senate but died in the House in May.

Earlier this year, the state of Louisiana criminally charged a New York physician under its abortion ban law for allegedly providing abortion pills to a Louisiana teen via telehealth. New York, which passed a shield law in 2023, refused Louisiana’s request to extradite the doctor.

Last month marked the first federal test of shield laws, when a Texas man sued a California doctor for allegedly mailing abortion pills to his partner.

This week, a Texas woman filed a federal lawsuit against Aid Access and against a man who she said impregnated her, then spiked her drink with abortion pills. She is also suing the Dutch doctor who founded Aid Access, alleging Aid Access and its founder mailed abortion-inducing drugs in violation of Texas and federal law.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

In this photo illustration, a pharmacist holds a COVID-19 vaccine. States and clinicians are working on getting correct information on vaccines to vulnerable groups amid shifting federal guidance. (Photo illustration by Joe Raedle/Getty Images)

Heading into the respiratory illness season, states and clinicians are working to encourage pregnant patients to get COVID-19 vaccinations, even though the U.S. Department of Health and Human Services no longer recommends that they should.

Along with being older and having an underlying health condition, pregnancy itself is a risk factor. Pregnant women are more vulnerable to developing severe illness from COVID-19. They’re also at high risk for complications, including preterm labor and stillbirth. The vast majority of medical experts say getting the shot is safe and effective — much safer than having the illness.

But HHS Secretary Robert F. Kennedy Jr. announced in May that the agency would no longer recommend that pregnant women get the vaccine. Before testifying before Congress in June, Kennedy circulated a document on Capitol Hill claiming higher rates of fetal loss after vaccination. But the authors of those studies told Politico that their work had been misinterpreted.

Experts say the federal shift puts the onus on state health agencies to ramp up vaccine guidance and outreach. Clinicians and public health organizations are trying to dispel misinformation and make sure information reaches low-income people and people of color, who had higher maternal death rates during the pandemic. During the first two years of the pandemic, the virus contributed to a quarter of maternal deaths, according to federal data.

“We are severely disappointed,” said Dr. Neil Silverman, a professor of clinical obstetrics and gynecology at the University of California, Los Angeles David Geffen School of Medicine. He has studied vaccines and pregnancy for the past 15 years and specializes in high-risk pregnancies.

Silverman called the federal shift a “public health tragedy on a grand scale.”

RFK Jr. ends COVID vaccine recommendation for healthy children, pregnant people

Vaccinations against COVID-19 help prevent severe illness in pregnant people as well as their newborns, who are too young to get vaccinated, Silverman said. In what’s called passive immunity, vaccinated mothers pass on antibodies to their babies through the placenta and through breast milk.

“State public health agencies are probably going to have to implement vaccine guidance that differs from the federal recommendations. And that’s going to be an interesting can of worms,” said OB-GYN Dr. Mark Turrentine, a professor of obstetrics and gynecology at the Baylor College of Medicine in Texas.

Turrentine serves on a board of the American College of Obstetricians and Gynecologists that focuses on immunization and infectious diseases. He said his recent pregnant patients who had COVID-19 hadn’t gotten the vaccine.

“The change in guidance on the federal level just really makes a lot of confusion, and it makes it very challenging to try to explain to individuals why all of a sudden the difference,” Turrentine said.

A slew of public health organizations have been making a concerted effort to dispel vaccine myths. They include the Society for Maternal-Fetal Medicine, a Washington, D.C.-based nonprofit organization of maternal-fetal experts. At a news briefing the society held this month, clinicians stressed the safety and long-standing science behind COVID-19 vaccines, as well as the shots for RSV and the flu. Cases of RSV and the flu tend to peak in the winter months, while in recent years COVID-19 cases have spiked in the summer and the winter.

Dr. Brenna Hughes, an OB-GYN who chairs the organization’s infectious diseases and emerging threats committee, pointed to survey data from the federal Centers for Disease Control and Prevention showing that less than a third of eligible pregnant patients received COVID-19 shots, and only 38% received RSV shots for the 2023 to 2024 season. Less than half — 47% — received flu shots, and 59% received TDAP (whooping cough) vaccines.

CDC data shows that for last year’s and this year’s season, only between 12% and 14% of pregnant patients got the COVID-19 vaccine.

“The complications from the infection are so much greater than the complications and the very few and typically minor adverse events that might occur from the vaccine,” said microbiologist Sabra Klein, a professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health.

In June, the American College of Obstetricians and Gynecologists and 30 other professional health organizations signed a letter urging insurers to continue covering the COVID-19 shot for pregnant women, and have continued to urge coverage since then.

CVS Caremark, one of the nation’s three major pharmacy benefit managers, told Stateline it will continue covering the vaccine for pregnant women. The Arizona, California and North Carolina state Medicaid agencies also told Stateline they are still currently covering COVID-19 vaccines for pregnant women.

Doulas, midwives and lawmakers challenge erasure of Black women in maternal health care

Dr. Kimberly Fortner, president-elect of the Infectious Diseases Society for Obstetrics and Gynecology, said during the maternal-fetal medicine briefing that she hopes medical groups’ joint messaging will bolster insurers.

“Hopefully by us linking arms, that can then help develop consistency so that insurers will continue to pay for the vaccine,” she said.

Exacerbating disparities

Dr. Ayanna Bennett, director of the District of Columbia Department of Health, said the federal government’s new stance has upended “a system that’s been stable for a very long time.”

Bennett said her agency used federal pandemic aid to shore up vaccine outreach efforts to communities of color. Now that flow of money is ending.

The changes in federal guidance and funding will “almost certainly exacerbate” maternal health disparities, said Marie Thoma, a perinatal epidemiologist and an associate professor in the University of Maryland Department of Family Science who researches pregnancy and COVID-19.

Black and Indigenous women died at higher rates. The virus exacerbated existing racial disparities in maternal health — and created new ones: Latina mothers, who generally see low rates of maternal mortality, saw deaths surge to 28 per 100,000 in 2021. Their rate was about 12 per 100,000 in 2018, according to federal data.

“We are going in with some exposure already that we didn’t have during the start of the pandemic. So, there will be some protection, but now that will erode,” said Thoma. “If we’re not getting vaccines, or if people are hesitant to take them, we could see some increase.”

Silverman said the administration’s efforts to strip mentions of race from government policies makes it difficult for institutions to reach populations at greatest risk. He called the dismissal of decades of data “saddening and infuriating.”

“The politicization of the vaccine process, or access to it, is what concerns me the most,” said Dr. Yvette Martas, a Connecticut OB-GYN who chairs the board of directors of the Hispanic Health Council.

Many women “are trying to navigate an economic system that’s not always in their favor in terms of also providing access to the kind of educational material that they need,” she said.

Not just COVID-19

In June, Kennedy ousted all 17 members of the CDC’s vaccine advisory committee, replacing them with some members who are vaccine skeptics.

The change is creating chaos. Some states have vaccine laws, such as mandates for kids and coverage statutes, that are specifically tied to the committee’s decisions.

The Vaccine Integrity Project at the University of Minnesota called on frontline health workers, health officials and professional societies to “counter the spread of inaccurate and confusing vaccine information.”

At a news briefing this month held by the Association of State and Territorial Health Officials, representatives from Alabama, Connecticut and Washington, D.C., said they will continue to recommend vaccines.

Alabama’s state health officer, Dr. Scott Harris, said clinicians will be instrumental in getting correct vaccination information to patients.

“We don’t think that we necessarily have the same authoritative voice that we might have had a decade ago in trying to guide people in what to do, but we do believe that people trust their health care providers in most cases and are certainly willing to listen to them,” he said at the briefing.

Bennett said she is hopeful that strong, consistent messaging from respected medical organizations will help combat confusion.

“Having established groups like the American Academy of Pediatrics or the American College of Obstetrics and Gynecology make very firm recommendations that keep us essentially not changed from where we have been, I think, should reassure families,” she said.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

Former AmeriCorps service member Daniel Zare, 27, visits Project Change at Sligo Middle School on Monday, Aug. 11, 2025 in Silver Spring, Maryland, where he mentored students before federal government cuts in April. (Photo by Ashley Murray/States Newsroom)

SILVER SPRING, Md. — Daniel Zare worked one-on-one as an AmeriCorps member with students going through rough times in school, lightening teachers’ workload in the classroom.

At AmeriCorps Project CHANGE, based in Silver Spring’s Sligo Middle School, Zare was one of several in his group who tracked adolescents’ emotional and social wellbeing over months using a system dubbed “My Score.” They then helped support the kids who were struggling the most.

In April, though, the program screeched to a halt. That’s when the Trump administration abruptly canceled nearly $400 million in active AmeriCorps grants across the United States that fund volunteers who embed in communities, in exchange for a small stipend and education award.

“All the work that we had culminating toward the end of the year, the relationships that we built with teachers and students and officials, it just completely went kaput because we were told we weren’t allowed to go to work at all,” Zare, 27, told States Newsroom.

Like so many longstanding federal programs and institutions severely reduced or dismantled as part of President Donald Trump and billionaire Elon Musk’s Department of Government Efficiency project, AmeriCorps — and its nonprofit partners — are now assessing the damage and seeking a way forward.

AmeriCorps programs that survived last spring’s DOGE cuts are slowly beginning a new year of service amid major uncertainty over whether they will be able to continue their work in classrooms, food banks, senior centers and other community hubs.

Winners and losers among states

AmeriCorps, a federal agency signed into law in 1993 by former President Bill Clinton, places roughly 200,000 members across the United States at 35,000 service locations, according to current agency data.

Members serve in schools, local governments and with a wide range of nonprofits that focus on health, disaster relief, environmental stewardship, workforce development and veterans.

The staffers, who pledge to “get things done for America,” are paid a modest living allowance that hovers around the poverty line. Some, but not all, can get health insurance while in the program.

Members who complete their service term, which usually lasts from 10 to 12 months, receive an education award that can be used to pursue a degree, earn a trade certificate or pay student loans.

AmeriCorps federal dollars reach programs via a couple routes. In many cases, grants flow from AmeriCorps to governor-led state and territorial commissions that divvy them up according to local priorities. In other cases, federal dollars flow straight to a program via a competitive grant process. 

Kaira Esgate, CEO of America’s Service Commissions, said when the Trump administration ordered the cuts in April, some states lost large portions of their AmeriCorps portfolio, while other states fared better.

“There were no real clear trend lines around what or who got terminated and why,” said Esgate, whose member organization represents all 49 state commissions (South Dakota doesn’t have one) and the commissions for the District of Columbia, Guam and Puerto Rico.

Abby Andre, executive director of The Impact Project, an initiative of Public Service Ventures Ltd., a private corporation that launches and scales solutions to strengthen public service and communities., has been collecting data and plotting on an interactive map where AmeriCorps programs have been canceled. Andre, a former Department of Justice litigator, has also worked with her team to build other maps showing where federal workforce cuts have been felt across the country.

“AmeriCorps is a really great example of the federal dollars being kind of invisible in communities. Communities often don’t know that a local food bank or a senior center are supported by AmeriCorps volunteers and AmeriCorps money,” said Andre, who taught administrative law at the Vermont Law School after working under President Barack Obama and in Trump’s first administration.

Andre said communities with a lack of social services, including in rural areas, will likely feel the biggest losses without an AmeriCorps presence because the agency “facilitates pennies-on-the-dollar type services through volunteer work.”

“It’s not as though if these community services folded, those communities would have the money to fund equal or better services through the private market,” she said.

Losing trust

The Maryland Governor’s Office on Service and Volunteerism gave the green light to Project CHANGE to keep its program, which serves Montgomery County in suburban Washington, D.C., running through the upcoming school year.

Paul Costello, director of Project CHANGE, is now scrambling to launch a new AmeriCorps cohort after receiving the news on July 22 that the initiative had been funded. He estimates members won’t be able to begin until almost a month into the school year.

“Sadly, AmeriCorps, as a brand name, is badly damaged, I think. I mean, I’ve got a meeting on Wednesday with a major partner who told us two weeks ago ‘We thought you were dead,’” Costello told States Newsroom in an Aug. 11 interview.

Costello’s program not only places service members in Montgomery County Public Schools, where Zare served, but also with partners including Community Bridges, Montgomery Housing Partnership and Family Learning Solutions.

The nonprofits respectively focus on helping adolescent girls from diverse backgrounds, children whose families live in community-developed affordable housing units and teens eyeing college and career paths.

The county’s school system is the largest in the state and serves a highly diverse population. About 44% of the system’s 160,000 students qualify for free and reduced meals, and close to 20% are learning English while continuing to speak another language at home.

Costello’s 18 cohort members embedded in those schools and nonprofits this past academic year were suddenly yanked in April when the government cut his grant. The partners, which had planned and budgeted to have the members through June, were thrown into “total chaos,” Costello said.

“So some of them are so desperate, they rely on their members. They had to dig into their pockets to keep them on as staff. And then we go back to them this year and say, ‘You want members this year?’ AmeriCorps has made no attempt to make them whole. So they’ve been screwed,” Costello said.

AmeriCorps did not respond to States Newsroom’s questions about nonprofits losing money.

Legal action

The federal courts granted some relief to members and organizations who abruptly lost living allowances and contractually obligated funding.

A Maryland federal district judge ordered in June that funding and positions  be restored in 24 Democratic-led states and the District of Columbia that sued the agency.

Another district judge in the state also handed a win to more than a dozen nonprofits from across the country that sued to recover funding they were owed.

But for many it was too late, and AmeriCorps’ future still feels shaky.

After suddenly losing his living allowance in April, Zare had to leave Silver Spring.

“I was renting a room off of Georgia (Avenue), and I was not able to pay rent there anymore, so I actually moved back to my mom’s in Germantown for the time being,” he told States Newsroom in August, referring to another Maryland suburb.

Hillary Kane, director of the Philadelphia Higher Education Network for Neighborhood Development, said by the time the court orders were issued, many of her AmeriCorps members had already found other positions and she had completely let go of one of her full-time staffers.

While the court injunctions were “welcome news,” reinstating the programs remained “questionable,” Kane wrote in a July 21 update for Nonprofit Quarterly.

Kane’s organization is a member of the National College Attainment Network, a Washington, D.C.-based nonprofit that was among the successful plaintiffs.

Other organizations that joined the lawsuit are based in California, Iowa, Maine, Maryland, Minnesota, New Jersey, New York, North Carolina, Pennsylvania, South Dakota and Virginia.

The Democratic-led states that won reinstatement for AmeriCorps members include Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kentucky, Maine, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and Wisconsin.

Going forward?

Kane got news on July 10 that PennSERVE, Pennsylvania’s state service commission, reinstated funding for her AmeriCorps program that places members in four West Philadelphia high schools to mentor students on their post-graduation plans.

The late notice meant Kane could only begin recruiting new members in mid-July.

“And so our start date has to be a bit fluid,” Kane told States Newsroom during a July 22 interview. “We have to essentially recruit people into this one-year cohort position, and say, ‘We’re hoping to start September 2, but we’re not 100% sure. Can you kind of just roll with it?’ It’s an awkward position to have to be in.”

Other AmeriCorps programs have not fared so well, as the Trump administration’s Office of Management and Budget continues to withhold funds that were appropriated by Congress for the ongoing fiscal year.

Trump signed legislation in March that extended the $1.26 billion for AmeriCorps for the full 2025 fiscal year, which ends on Sept. 30.

Kane said the most “insidious” part of the recent AmeriCorps storyline is that programs that receive grants directly from the federal agency are being strung along by OMB.

“So there are agencies who have been theoretically awarded money, but they’re like, ‘Is it actually going to happen? Should I spend all this money and then not be able to bill the federal government to reimburse me if OMB is going to hold it hostage?’”

Programs at risk include 130 recently expired contracts for AmeriCorps Foster Grandparent and Senior Companions programs that support roughly 6,000 senior citizen volunteers across 35 states. The programs are eligible for just over $50 million for the new service year, which should be off to a start.

Congress pleads with budget office

A bipartisan group of U.S. senators pressed the executive branch agency on Aug. 1 to release the funds.

“Further delays in grantmaking will have immediate and irreversible consequences for programs, AmeriCorps members, and communities,” the senators wrote in a letter to OMB Director Russ Vought.

Republican Sens. Bill Cassidy of Louisiana, Susan Collins of Maine, Lisa Murkowski of Alaska and Thom Tillis of North Carolina joined Democratic Sens. Chris Coons of Delaware, Jack Reed and Sheldon Whitehouse of Rhode Island, and Senate Minority Leader Chuck Schumer of New York in signing the letter. All are members of the Senate National Service Caucus.

The White House and AmeriCorps did not respond for comment.

The Republican-led Senate Committee on Appropriations voted on July 31 to preserve $1.25 billion in AmeriCorps funding for fiscal year 2026. Collins chairs the committee.

U.S. House appropriators, which for the last two years under Republican leadership have sought to cut AmeriCorps funding, are expected to debate its budget in September. But it’s almost certain Congress will have to pass a stopgap spending bill when the end of the fiscal year arrives to stave off a partial government shutdown, so a final decision on funding may not come for months.

Change for everyone

Zare never did have a chance to say goodbye to all his students in April.

And even though the option was on the table, he did not sign up to serve a third year with AmeriCorps.

Before he applied and earned a spot with Project CHANGE, Zare was working odd jobs, including as a utilities contractor for Comcast. He had also earned his associate’s degree.

“I don’t think there’s any other program to take someone like me who was working a couple of different jobs and put them in an environment like this, to see firsthand as an American citizen how our classrooms operate and what position I would need to be in to actually be of benefit,” Zare told States Newsroom.

Zare is now freelancing and debating his next move, whether that’s a new job or further higher education.

“AmeriCorps is something that I’m always going to cherish because a lot of the people there still help me,” he said.

Editor’s note: D.C. Bureau Senior Reporter Ashley Murray served in AmeriCorps in 2009-2010.

People attend the WorldPride International Rally and March on Washington for Freedom at the Lincoln Memorial in Washington, D.C., in June. Conservative judges might allow lawmakers to reinstate the practice of conversion therapy, which aims to change the sexual orientation or gender identity of LGBTQ+ people. (Photo by Kayla Bartkowski/Getty Images)

Week after week, a teenage Brandon Long sat through counseling sessions that he said framed his identity as a failure.

Now an ordained minister in northern Kentucky, Long told Kentucky state lawmakers about the years he spent undergoing therapy designed to rid him of his “same-sex attraction.”

“Just imagine yourself being told, session after session, that if you remained as you were, you would be rejected,” he said.

Long testified in February before a Kentucky House committee against a Republican-sponsored bill that would cancel Democratic Gov. Andy Beshear’s 2024 executive order that banned a controversial practice known as “conversion therapy” for minors.

Conversion therapy is a catchall term for controversial efforts to change the sexual orientation or gender identity of LGBTQ+ people. Sometimes called “reparative therapy,” it can range from talk therapy and religious counseling to electrical shocks, pain-inducing aversion therapy and physical isolation.

The bill, Long told lawmakers, “creates a legal shield for conversion therapy, allowing parents to force their children into a practice condemned by every major medical and mental health organization worldwide.”

Kentucky’s Republican-controlled legislature passed the bill, then overrode the governor’s veto in March.

Conversion therapy has been denounced by major medical organizations including the American Medical Association, American Psychological Association, American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry. They say it’s ineffective and harmful and puts LGBTQ+ people at risk for depression, substance use, suicide and other mental health issues.

More than half of states have banned or restricted the practice for underage patients since California became the first to do so in 2012, according to the Movement Advancement Project, a nonprofit research organization that tracks LGBTQ+-related laws and policies.

But political currents are shifting. Conservative majorities in the courts, in state legislatures and at the federal level have reshaped the legal landscape, opening the door for Republican lawmakers and conservative Christian groups to reinstate a practice that has been roundly discredited by the medical community.

In March, the U.S. Supreme Court agreed to hear a case challenging Colorado’s 2019 conversion therapy ban on freedom of speech grounds. The decision marks a change from 2017, when the court refused to hear a challenge to California’s ban, and 2023, when it declined to hear a challenge to Washington’s ban.

The high court’s decision, which isn’t expected until next year, could reverse — or solidify — conversion therapy bans across the country.

Last month, a Virginia court partially struck down the state’s 2020 law banning conversion therapy for minors, a win for conservative Christian organizations. GOP lawmakers in Michigan have introduced a bill to repeal the state’s ban. And Missouri‘s Republican attorney general has filed suit to overturn local conversion therapy bans.

On the flip side, in Wisconsin, the state Supreme Court cleared the way earlier this year for the state to permanently ban the practice.

‘The world has changed’

While organized attempts to “cure” homosexuality have been around for centuries, “ex-gay” groups that promised to change a person’s sexual orientation began gaining ground in the 1990s as policy debates arose over same-sex marriage and gay people serving in the military, said Dr. Jack Drescher, a psychiatrist and psychoanalyst in private practice in New York City. He is also a clinical professor of psychiatry at Columbia University whose research has focused on gender and sexuality.

But after Massachusetts legalized same-sex marriage in 2004 and more states followed, the influence of conversion therapy proponents waned.

As of this year, 23 states and Washington, D.C., prevent licensed health care providers from subjecting minors to conversion therapy, according to an analysis of state laws by the Movement Advancement Project. Four more states restrict the practice, such as by not allowing public funding to go toward conversion therapy services.

State laws typically levy fines or discipline the professional licenses of practitioners who try to engage minors in conversion therapy. They don’t necessarily prevent clergy or unlicensed counselors from attempting such counseling.

The bans are more of a public statement of acceptance of LGBTQ+ people, rather than a commonly used preventive measure, said Drescher.

“The bans are reinforcements of the belief that if homosexuality is not a mental disorder or disease, there’s no reason to pretend you can treat it, and anybody who tries is acting outside the mainstream of science,” Drescher told Stateline.

The American Medical Association has written model legislation for state lawmakers who want to ban conversion therapy, a reflection of the broad consensus in the medical community that homosexuality and gender nonconformity are not mental illnesses, said R.J. Mills, a representative from the American Medical Association, in a statement to Stateline.

In the past, some leading psychiatric and psychological associations were hesitant to support state restrictions because they saw the laws as intrusions into the doctor-patient or therapist-patient relationship, Drescher said.

Now, spurred by Trump administration policies that place new restrictions on LGBTQ+ people and the most conservative U.S. Supreme Court in generations, medical organizations are growing more vocal in their opposition to conversion therapy.

“The world has changed,” Drescher said. “Everybody understands what’s at stake now.”

Free speech argument

Conservative legal firms have filed lawsuits in states such as Colorado, Michigan and Virginia on behalf of Christian counselors who say the laws prevent them from practicing according to their faith-based values. They say the bans should be repealed so practitioners won’t face losing their careers over providing services informed by their faith.

A Virginia court last month oversaw a consent decree in which Virginia agreed to not fully enforce its 2020 conversion therapy ban and to allow counselors to engage in talk conversion therapy with minors. The plaintiffs in the case were John and Janet Raymond, state-licensed professional counselors in Virginia who were represented by the Founding Freedoms Law Center, an organization that takes on conservative legal causes.

The kind of talk therapy now allowed can involve conversation, prayer and sharing of written materials such as religious scriptures, said Josh Hetzler, the Raymonds’ attorney, during a public news conference following the court decision.

“With this court order, every counselor in Virginia will now be able to speak freely, truthfully and candidly with clients who are seeking to have those critical conversations about their identity, and to hear faith-based insights from trusted professionals,” he said.

Conservative legislators also are citing their Christian faith in their attempts to roll back state bans.

Michigan state Rep. Josh Schriver, a Republican, filed a package of bills last month aimed at repealing a handful of what he calls “anti-Christ laws,” including Michigan’s 2023 ban on conversion therapy for youth.

A legislative aide said Schriver wasn’t available for an interview, and instead referred Stateline to the recent Substack post he emailed to his constituents.

“As legislators, we’re duty-bound to remove statutes that overstep the authority given by our state and federal Constitutions,” Schriver said in the post.

Long, the Kentucky minister, said the bans are needed because “no one enters conversion therapy willingly.”

“The only reason a child would go through it is because a trusted authority in their life — a parent, a pastor or a therapist — has told them that they are broken and need to be fixed.”

At least five states have a law or policy prohibiting or deterring local-level ordinances that aim to protect youth from conversion therapy.

Some states without such laws are going after municipalities that have banned conversion therapy.

Missouri Republican Attorney General Andrew Bailey in February sued Jackson County, Missouri, home to Kansas City, challenging the county’s 2023 ordinance and Kansas City’s 2019 ordinance, both of which ban licensed counselors from engaging in conversion therapy with minors.

“Our children have a right to therapy that allows for honest, unrestricted conversations, free from transgender indoctrination,” Bailey said in a statement in February. He called the ordinances “a dangerous overreach” that violate free speech and religious liberty rights.

A Republican loss

In at least one state, conservatives have hit a legal roadblock.

In Wisconsin, Democratic Gov. Tony Evers’ administration has been trying since 2020 to enact a statewide conversion therapy ban proposed by the state agency that oversees provider licensing.

But the ban has been blocked twice by a Republican-controlled legislative committee.

Evers’ administration sued.

The Wisconsin Supreme Court sided with Evers last month, ruling that the state legislative committee was overreaching and couldn’t block the rule.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

Gov. Tony Evers signs AB 257 into law Friday. The bill creates a credential and pathway for advanced practice registered nurses to practice independently. (Photo courtesy of Office of Gov. Evers)

As expected, Gov. Tony Evers signed legislation Friday that clears the way for nurses with advanced training to practice independently.

“Nurses play a critical role in our healthcare workforce, and I’m proud of our work to expand opportunities for nurses to not only grow their career but create a system that allows for more advanced practitioners here in Wisconsin,” Evers said in a statement released Friday announcing his plans to sign AB 257, the advanced practice registered nurses (APRN) legislation, now Wisconsin Act 17.

The bill creates a new license category and a professional pathway for nurses who qualify to practice independently.

Evers vetoed two other closely watched bills — one that would have carved out app-based drivers from protections under state employment laws and one that would require the state Department of Corrections to recommend sending back to prison people charged with a crime while they are on probation, parole or extended supervision.

Altogether the governor signed 16 of the 21 bills that the Legislature formally presented to him on Thursday and vetoed five.

Advanced practice nursing bill wins approval

The Wisconsin state nursing board will oversee the credentialing of advanced practice nurses, a group that includes certified nurse-midwives, certified registered nurse anesthetists, clinical nurse specialists and nurse practitioners.

Advocates said the measure will increase the availability of health care providers, particularly in parts of Wisconsin where doctors are scarce.

Evers vetoed previous versions of the bill in 2022 and 2024. Both times he expressed support for the concept but insisted nurses should meet tighter qualifications before they can practice on their own.

The bill he signed Friday adds those requirements — increasing the amount of supervision that an APRN must have under a physician to 3,840 hours before practicing independently; adding additional supervision requirements for certified registered nurse anesthetists who specialize in pain management; and including language to restrict the titles APRN practitioners use so patients aren’t confused about their credentials.

The Wisconsin Medical Society cited those issues in opposing APRN bills in previous legislative sessions, and with the 2025 revision shifted its stance to neutral.  

In floor votes in June, lawmakers from both parties stressed the bipartisan compromise reflected in the measure that was presented to Evers this week.

In his announcement, Evers thanked lawmakers for their work on the measure, including Republican state Sens. Patrick Testin and Rachael Cabral-Guevara, Republican state Rep. Tony Kurtz and Democratic state Rep. Lisa Subeck.

He also thanked “the many nursing and physician groups that we worked with to get this bipartisan bill across the finish line to help bring more folks into the healthcare profession and ensure that Wisconsinites get the high-quality care they need when they need it while setting our nurses up for success.”

Bill classifying gig drivers vetoed

Evers vetoed AB 269, legislation that would have blocked drivers from app-based rideshare and delivery businesses from being declared employees.  

The legislation would have automatically classified drivers for Uber, Lyft, DoorDash and similar businesses as independent contractors, bypassing current Wisconsin laws that differentiate independent contractors from direct employees. 

It would have categorically excluded app-based drivers from coverage under the state’s unemployment insurance, workers compensation and minimum wage laws. 

“I object to the bill’s definition of independent contractor status in the absence of any guaranteed benefit for workers,” Evers wrote in his veto message.

In a campaign pushed most prominently by DoorDash and other app-based businesses that enlist drivers, advocates focused  on the bill’s provisions that would permit — but not require — those businesses to establish portable benefits for drivers.

Evers acknowledged in his veto message that app-based drivers “are a growing segment of Wisconsin’s workforce.” But he said changing the state’s independent contractor definitions “demands substantive conversations among several parties,” with management and  workers both at the table. 

Evers wrote that while the bill was moving through the Legislature, his staff asked lawmakers and groups with an interest in the measure to allow time for “robust dialogue and engagement to reach consensus and compromise” over the legislation. 

“Unfortunately the Legislature declined to meaningfully provide that opportunity, choosing instead to send this bill to my desk anyway,” he wrote. “My veto today will allow time for these important conversations to occur so Wisconsin can find a path forward.”

The Wisconsin AFL-CIO praised the veto. “Legislation that makes the loss of important worker rights a certainty while holding out the possibility of flexible benefits if and when the employer chooses to provide them is a bad deal for workers,” President Stephanie Bloomingdale said. 

Bill pushing revocation for offenders rejected

Evers vetoed AB 85, legislation that would require the Department of Corrections to recommend automatically returning a person to prison who is charged with a crime while on extended supervision, parole or probation. Evers vetoed a similar bill in 2019.

Evers wrote in his veto message that the legislation was “an unfunded mandate” likely to cost the state more than $330 million in the first two years, according to the fiscal estimate, “and hundreds of millions in unknown, ongoing costs.” 

In addition, he wrote, it would likely require building more prison facilities and would be expected to impose new costs on local governments, while he blamed lawmakers for “significantly underfunding existing operations at the Department of Corrections in the most recent state budget.”

The bill “would move Wisconsin in the wrong direction on criminal justice reform without improving public safety,” Evers wrote. 

Instead, he urged lawmakers, “Wisconsin should be investing in data-driven, evidence-based programming that addresses barriers to reentry, enhances educational and vocational opportunities for individuals who will be released after completing their sentence, and provides treatment for mental health and substance use issues, which will help to reduce recidivism and save taxpayer money while improving public safety.”

In a message posted on Facebook the bill’s author, state Rep. Brent Jacobson (R Mosinee), criticized the veto. “It is unacceptable to give repeat criminals the opportunity to continue to put our families and neighbors at risk again and again without facing consequences,” he wrote.

The bill was opposed by criminal justice reform organizations, including the national prison reform group Dream.Org and Wisconsin-based Ex-incarcerated People Organizing (EXPO).

“This harmful bill would have led to more people being revoked from community supervision and incarcerated, making it harder to build safe and thriving communities in Wisconsin,” Dream.Org posted on Facebook. The organization credited campaigning by advocates and community groups with persuading Evers to veto the measure. 

Primary care medicine measure falls 

Evers vetoed SB 4, legislation that would specify that subscription-based direct primary medical care arrangements are not subject to the state’s insurance laws.

While the legislation had some bipartisan support in concept, it foundered at the governor’s desk on the issue of anti-discrimination language.

Evers listed in his veto message a number of provisions in the legislation that forbid primary care providers from refusing to treat patients. 

Nevertheless, he wrote that he objected to “the Legislature failing to provide sufficient protections for patients receiving care under direct primary care agreements from being discriminated against and potentially losing access to their healthcare.”

Evers did not specify what additional protections he believed the measure should include. “I previously raised similar concerns when I vetoed earlier iterations of this legislation five years ago — concerns the Legislature has declined to satisfactorily address in the bill that is now before me and despite having ample opportunity,” he wrote.

In 2020, when Evers vetoed the version of the legislation on his desk at the time, he wrote that he objected to an amendment in which lawmakers had removed language protecting patients from being refused treatment on the grounds of “genetics, national origin, gender identity, citizenship status, or whether the patient is LGBTQ.”

In his veto message Friday, Evers wrote, “Every Wisconsinite should be able to get the healthcare they need when and where they need it — and without fear of discrimination. I welcome the Legislature revisiting this legislation and the opportunity to enact a version of this bill that sufficiently addresses my concerns.”

The announcement issued by the governor’s office Friday includes a complete list of bills that the governor signed and vetoed, with links to the enacted measures and to Evers’ veto statements.

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A teacher and students in a classroom. (Photo by Klaus Vedfelt/Getty Images)

I recently read over my son’s last report card and was overwhelmed with pride.

It showed how far he’s come — progress that, not long ago, felt out of reach. I made mental notes of the areas where we still need to do some work, but mostly I just sat with the joy of seeing comments like “participates well in class” and “a pleasure to have in class.”

A few years ago, those kinds of remarks seemed impossible.

My son is on the autism spectrum. He’s bright, curious, and kind, but he faces challenges in areas that come more naturally to his peers — things like socializing, staying focused, and following multi-step directions.

To support his growth, our family relies on services in Milwaukee made accessible through Medicaid. Without it, we couldn’t afford the therapies and supports that have made such a profound difference in his life.

One of the most transformative resources we’ve accessed through Medicaid is applied behavior analysis (ABA) therapy. Before my son began this program, he had a hard time sitting still, struggled with completing even small tasks, and rarely interacted meaningfully with others. The world often overwhelmed him, and those feelings showed up as frustration or withdrawal.

Our family was doing everything we could to support him, but we needed help. Medicaid made that possible.

The ABA therapy was intensive and, at times, exhausting — but it worked. Over time, we watched our son develop new skills, regulate his emotions, and engage with the world in a completely new way.

By the time the program ended, we had a different child. Not in that he changed who he was — but because he could finally show the world the amazing person he had always been. He could carry on a conversation, initiate play with peers, connect with adults, and begin building friendships.

Today, thanks to Medicaid, he continues to receive occupational therapy and speech therapy at school. These services help him strengthen motor skills, improve communication, and better navigate daily life. He also receives support through his Individualized Education Plan (IEP), ensuring he has the accommodations he needs to succeed. Because of this, my son is not just surviving — he is thriving.

But now, all of this is under threat.

Millions of families like mine could lose Medicaid because the Trump-GOP budget — the so-called “One Big Beautiful Act” — strips away the very support that children like my son depend on, all to finance tax breaks for corporations and the wealthy. It’s hard to describe the fear that takes hold when you realize that your child’s future has been jeopardized with the stroke of a pen.

Some 37 million children — roughly half of kids in the United States — rely on Medicaid for health care, therapies, and other essential services. For kids with disabilities, Medicaid is often the only option for accessing the support they need. Without it, families face impossible choices — foregoing therapies, draining savings, or going without care altogether.

What’s even more heartbreaking is the callousness with which some elected officials treat this issue. Watching Republican Senators dance to a disco song as they celebrated the passage of this harmful bill made me physically ill. While they partied, families across the country worried about how to care for their children, afford therapy, or keep a roof over their heads.

This isn’t political for me — it’s personal. My child is not a budget line item. He is a human being who deserves the chance to live a full and meaningful life. Every child does.

Medicaid has been a lifeline for us, and it should be protected, not gutted. No parent should have to fight this hard for basic support, and no child should have their future jeopardized by politics.

The promise of America is an opportunity for all. That promise cannot be fulfilled if we dismantle the very systems that allow families like mine to survive — let alone thrive — simply to cut taxes for the wealthy.

We need to do better. We must do better.

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• Responding to an order from President Donald Trump, several federal agencies are seeking to block undocumented immigrants and some immigrants with legal status from accessing programs that provide literacy classes, career education, medical and mental health care, substance abuse treatment, free preschool and more. 

• A range of institutions — including colleges, government agencies and nonprofits — manage the affected programs.

• The order has caused widespread confusion about which organizations must check immigration status of the people they serve and how they could do that. Parts of the order appear to conflict with federal law. 

• Wisconsin joined 20 other states in a lawsuit challenging the new restrictions.

A group of federal agencies announced in July that at least 15 federally funded health, education and social service programs would exclude undocumented immigrants and some who are living in the country legally. 

Responding to President Donald Trump’s February executive order to “identify all federally funded programs currently providing financial benefits to illegal aliens and take corrective action,” the departments of Education, Health and Human Services, Justice and Labor listed programs that provide literacy classes, career education, medical and mental health care, substance abuse treatment, free preschool and more. 

In Wisconsin alone, the state Department of Justice estimates the new federal restrictions “put at risk more than $43 million each year in substance abuse and community mental health block grants that fund services in all 72 counties, 11 Tribal nations, and approximately 50 nonprofit organizations.” 

Wisconsin Watch contacted more than a dozen Wisconsin organizations, government agencies and national experts to learn about the new policy’s effects. But we found more questions than answers. Most are unsure who is subject to the new rules or how to comply. 

While we were reporting this story, Wisconsin joined 20 other states in a lawsuit challenging the new restrictions. That suit is still pending, but the parties have agreed to a deal that would delay most of the restrictions in those states until September. 

Confusion created by the guidance could have serious consequences, experts say. Some providers might delay or cancel programs unnecessarily out of an abundance of caution, while some immigrants may avoid services for which they remain eligible, such as health care and education.

While much remains unclear, here’s what we know so far. 

Which immigrants would be barred?

A 1996 law already prohibited certain immigrants from receiving 31 “federal public benefits,” including Medicaid, Medicare, Social Security and cash assistance. The Trump administration’s new guidance bars the same immigrants from additional programs, according to the National Immigration Law Center.

Those ineligible include: 

• People with Temporary Protected Status (TPS). 
• People with nonimmigrant visas, such as student visas, work visas and U visas for survivors of serious crimes. 
• People who have pending applications for asylum or a U visa. 
• People granted Deferred Enforced Departure or deferred action. This includes Deferred Action for Childhood Arrivals (DACA) recipients — those who entered the country as children.
• Undocumented immigrants.
• Lawfully present immigrants who don’t fall into categories below. 

People in the following groups would remain eligible:

• Lawful permanent residents (green card holders). 
• Refugees. 
• People who have been granted asylum or withholding of removal. 
• Certain survivors of domestic violence.
• Certain survivors of trafficking. 
• Certain Cuban and Haitian nationals.
• People residing under a Compact of Free Association with Palau, Micronesia and the Marshall Islands.

Why the confusion? 

A range of institutions — including colleges, government agencies and nonprofits — manage the affected programs. Many did not previously check the immigration status of the people they serve; creating a process to do so may add costs and logistical challenges. It could prove especially daunting for organizations like soup kitchens and homeless shelters, which provide urgent services to people without easy access to documents. 

Meanwhile, entities that administer these federal funds include nonprofits and federally funded community health centers, which operate under laws that conflict with the guidance.

Health and Human Services said its settlement with the suing states “will permit the agency to consider, as appropriate, whether to provide additional information” about the restrictions it announced. 

How would the changes affect health care in Wisconsin?

Wisconsin has 16 federally qualified community health centers serving patients at 217 sites. They receive money from Congress to provide primary care to all, regardless of their ability to pay. Nationally, such clinics serve more than 32 million patients, making up 1 in 10 people in the United States and 1 in 5 people in rural America, according to the National Association of Community Health Centers. 

Aside from emergency rooms, they are often the only care options for undocumented immigrants or those with limited English proficiency, said Drishti Pillai, director of immigrant health policy at KFF, a national nonprofit providing information on health issues.

Federal law requiring those clinics to accept “all residents of the area served by the center” contradicts the Trump administration guidance. 

The national association said in a July 10 statement that it’s working with experts and legislators to understand the impact of the new rules and ensure centers “have the information and resources needed” to continue serving their patients. 

Access Community Health Centers, a nonprofit that provides medical, dental and mental health care at five south central Wisconsin clinics, will make “adjustments” if further federal guidance comes, CEO Ken Loving said.

“We don’t have the information we need to understand how this is going to impact us and how we can adapt to help our patients,” he said.

How would the changes affect education in Wisconsin?

The new restrictions target adult education services under the Adult Education and Family Literacy Act and career and technical education services under the Carl D. Perkins Career and Technical Education Act. Community and technical colleges would likely face the brunt of the impact, but just how much is unclear. 

The Wisconsin Technical College System has followed 1997 guidance that said public benefit restrictions did not apply to such educational services, spokesperson Katy Petterson said. She’s not sure how the updated guidance might affect the system, which will “wait to learn the impact of the lawsuit.” 

If community-college-operated programs begin checking immigration status, ineligible immigrants may remain able to take federally funded classes through nonprofits that are subject to different rules. 

The nation’s 1,600 Head Start agencies, which provide free early childhood education and family support services for low-income families, fall under the restrictions announced in the Department of Health and Human Services notice. But the document doesn’t say whether Head Start staff must verify the immigration status of children, parents or both.

“It’s very ambiguous about who this impacts. … If you read the language, it’s 26-plus-ish pages of legal jargon, and it’s shifting,” said Jennie Mauer, executive director of the Wisconsin Head Start Association, which supports the state’s roughly 300 Head Start service sites.

One thing Mauer wants families to know: Children already enrolled in Head Start won’t be forced out. 

“We want to follow the rules, but Head Start is not required to redetermine eligibility,” Mauer said, noting it has never been required to do so in 60 years. She’s been telling the center directors to sit tight, even as worried parents ask questions. 

One entity that won’t start checking immigration status: K-12 schools. The U.S. Supreme Court ruled in 1982 that denying education to undocumented students violated their constitutional rights.

Must nonprofit providers start checking immigration status?

Probably not. The 1996 law restricting public benefits says nonprofit charities are not required to “determine, verify, or otherwise require proof of eligibility of any applicant for such benefits.”

At Literacy Network, a nonprofit offering a variety of free ESL and basic education classes in Madison, staff aren’t planning changes based on the new rule. 

“It could certainly impact many of our students in other areas of their lives and therefore their ability to participate in our programs, but not who we can serve,” spokesperson Margaret Franchino said.

Still, guidance from the Department of Education is vague. It states that the exemption for nonprofits is “narrowly crafted,” and “the Department does not interpret (it) to relieve states or other governmental entities … from the requirements to ensure that all relevant programs are in compliance.”

Ryan Graham is the homeless systems manager at Wisconsin Balance of State Continuum of Care, a nonprofit that supports agencies responding to homelessness across most of the state. 

As his agency discusses updates with partner agencies, it is preparing for an “increased administrative burden on already stretched staff.”

“We don’t yet know whether there will be delays caused by having to check or validate someone’s citizenship status, especially in emergency situations where time is critical,” Graham said. 

When do the new rules take effect?

The notices published in July took effect immediately, though some federal agencies said they would likely not enforce them for about a month. The Trump administration later agreed to pause enforcement until Sept. 3 in the 21 states that sued. 

The Department of Health and Human Services, meanwhile, has voluntarily stayed enforcement of its directive in all states until Sept. 10. 

What is the basis of legal challenges? 

The multistate lawsuit argues the Trump administration failed to follow proper procedures in implementation and that it can’t retroactively change the rules after states accept grants to administer programs. Requirements to check the immigration status of every person served would unreasonably burden program staff and possibly force programs to close, the states argue. 

States “will suffer continued, irreparable harm if forced to dramatically restructure their social safety nets and render them inaccessible to countless of the States’ most vulnerable residents,” the plaintiffs wrote.

The American Civil Liberties Union and Head Start groups nationwide had already sued before the Trump administration published new guidance. That suit argued staffing cuts, funding delays and bans on diversity efforts threatened to destabilize Head Start — a long-standing, congressionally mandated program. A hearing in that suit was held Aug. 5 on a request to temporarily block the Health and Human Services notice. 

What does the Trump administration say? 

The 1996 public benefits ban exempted federal programs that offered services available to all people on the grounds that they were “necessary for the protection of life and safety.” 

Trump calls that exemption too broad. 

“A surge in illegal immigration, enabled by the previous Administration, is siphoning dollars and essential services from American citizens while state and local budgets grow increasingly strained,” the White House said.

Citing studies from congressional committees and groups that seek to severely curtail immigration, the White House argues that allowing broad access to federal resources incentivizes illegal immigration and costs U.S. taxpayers. The recent federal spending package also eliminated access to Medicaid, Medicare and food stamps for some authorized immigrants, including refugees and asylees.

Trump ran for office on a promise to carry out mass deportations, and the bureaucratic moves appear to be a new frontier in that immigration crackdown. Since he took office, the administration has raided stores and workplaces, built new detention centers and attempted to shut down the asylum process at the southern border. It has also urged many immigrants without permanent legal status, including DACA recipients, to self-deport. 

Why does this policy change matter?

Experts worry the confusion about the new rule could have a chilling effect, leading even eligible immigrants to stop using services. 

Pillai of KFF noted that the restrictions on community health centers, alongside congressionally approved changes “that limit health coverage to a smaller group of lawfully present immigrants,” will likely make immigrant families even more reluctant to seek health care and social services. 

The changes “may increase their reliance on emergency room care, which can be more costly in the long term,” she added. 

Graham, the homeless systems manager, believes the Trump change will create “a direct barrier to safe and stable shelter for undocumented individuals and mixed-status families” and qualified immigrants or citizens who “may not have identification or the means to attain identification after fleeing a dangerous situation or crisis.”

It could also prompt administrators of some programs not covered by the rule to start screening participants as a precaution, or shut down programs to avoid screening challenges.

That has happened before. When Trump issued an executive order in January saying the administration would no longer “fund, sponsor, promote, assist, or support” gender-affirming health care for people under 19, some providers stopped offering those services even though state law protected them. 

Likewise, a 2023 KFF study found that in states that institute abortion bans, the majority of health care providers say they worry about accidentally running afoul of the law.

Braden Goetz, who worked for more than 20 years in the U.S. Department of Education and now works as a senior policy adviser at the New America Foundation’s Center on Education and Labor, said it’s unusual for federal guidance to be so sparse and ambiguous. 

“​​Maybe that’s the intention: to confuse people and chill services to people who are not citizens or not legal permanent residents, and scare people,” Goetz said.

Natalie Yahr reports on pathways to success in Wisconsin, working in partnership with Open Campus. Sreejita Patra is statehouse reporting intern for Wisconsin Watch.

Trump is trying to exclude immigrants from many federally funded programs. Here’s what it means for Wisconsin. is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

The James H. Shannon Building (Building One) on the NIH campus in Bethesda, Maryland. (Photo by Lydia Polimeni,/National Institutes of Health)

President Donald Trump’s freeze on $8 billion of congressionally appropriated funding to the National Institutes of Health was illegal, the Government Accountability Office reported Tuesday.

Orders Trump signed in the early days of his return to office and related administration directives violated the Impoundment Control Act by failing to spend money that Congress, which holds the power of the purse under the Constitution, had approved, the GAO report said.

Roughly 1,800 grants for health research were held up by the administration, the report said.

Trump’s Inauguration Day order ceased funding for a variety of health research grants that related to diversity, equity and inclusion, transgender issues or environmental harms. The Department of Health and Human Services issued a memo directing its agencies, including NIH, to cease publishing notices in the Federal Register of meetings of grant review boards.

GAO, an independent investigatory agency that reports to Congress, called those meetings “a key step in NIH’s grant review process.” HHS has since restarted notices of the meetings.

From February to June, the NIH released $8 billion less than it obligated in the past two years, representing a drop-off of more than one-third, according to the GAO. The gap between 2025 spending and that of previous years continued to grow, GAO said, with NIH obligating a lower amount of grant funding each month.

Illegal impoundment

The failure to fund grant awards violated the Impoundment Control Act and the Constitution, which certified Congress as the branch of government responsible for funding decisions, said GAO.

If a law is passed by Congress and signed by a president, it must be carried out by the executive branch, the watchdog said.

“The President must ‘faithfully execute’ the law as Congress enacts it,” the report said. “Once enacted, an appropriation is a law like any other, and the President must implement it by ensuring that appropriated funds are obligated and expended prudently during their period of availability unless and until Congress enacts another law providing otherwise. … The Constitution grants the President no unilateral authority to withhold funds from obligation.”

There are specific circumstances that allow for a funding freeze — a rescissions law, such as the one Congress passed last month to defund public broadcasters and foreign aid, is one example — but they did not apply to this case, the GAO said.

Delays may be permissible to allow a new presidential administration to ensure grants are awarded based on its priorities. But a complete block on funding is illegal, the GAO said. There is no evidence that other grant awards — or any other type of funding at HHS — took the place of the $8 billion in unspent grant money, the report said.

“While it can be argued that NIH reviewed grants to ensure that funds were spent in alignment with the priorities of the new administration, NIH did not simply delay the planned obligations of the funds,” the GAO said. “Rather, NIH eliminated obligations entirely by terminating grants it had already awarded.”

GAO can sue the executive branch based on its findings. The report noted there is already litigation from other parties over the frozen grants.

Dems call for reinstatement

Congressional Democrats responded to the report by harshly criticizing Trump and White House Office of Management and Budget Director Russ Vought and calling for the funds’ release.

“This is simple – Congress passed and the President signed into law investments in NIH research to help find cures and treatments for cancer, Alzheimer’s disease, ALS, diabetes, mental health issues, and maternal mortality,” U.S. House Appropriations Committee ranking Democrat Rosa DeLauro of Connecticut said in a statement. “But now, GAO has determined that President Trump and OMB Director Vought illegally withheld billions in funding for research on diseases affecting millions of American families—research that brings hope to countless people suffering.”

Senate Appropriations Vice Chair Patty Murray, a Washington state Democrat, said in a statement the funding freeze “dangerously set back” efforts to cure cancer, Alzheimer’s and other diseases.

“Today’s decision affirms what we’ve known for months: President Trump is illegally blocking funding for medical research and shredding the hopes of patients across the country who are counting on NIH-backed research to propel new treatments and cures that could save their lives,” Murray said. “It is critical President Trump reverse course, stop decimating the NIH, and get every last bit of this funding out.”

An HHS spokesperson deferred a request for comment Tuesday to OMB.

An agency investigated by the GAO is generally given a draft of the watchdog’s findings and asked to respond.

The HHS response, obtained by States Newsroom, said grant reviews were back on schedule, though it did not address grant obligations.

“Despite the short delay in scheduling and holding peer review and advisory council meetings to allow for the administration transition, NIH has been on pace with its reviewing grant applications and holding meetings and has caught up from the pause when compared to prior years,” the response said.

GAO’s summary of the HHS response said the department had restarted meetings of grant review boards and provided some “factual information” but did not justify the lack of grant spending or provide current status of payments for previously approved grants. 

A nurse gives an MMR vaccine at the Utah County Health Department on April 29, 2019, in Provo, Utah. The vaccine is 97% effective against measles when two doses are administered. (Photo by George Frey/Getty Images)

The Wisconsin Department of Health Services (DHS) is urging residents to get vaccinated amid the confirmation of the first measles cases in the state this year and as families begin back-to-school preparation with vaccine rates still down. 

DHS confirmed nine cases of measles in Oconto County over the weekend — the first cases in the state this year. The agency said no public points of exposure have been identified and the risk to the community remains low. 

The first case was confirmed through testing at the Wisconsin State Laboratory of Hygiene, and the eight other cases were confirmed based on exposure and symptoms. Each person was exposed from a common source during out-of-state travel.

Dr. Ryan Westergaard, chief medical officer of DHS’s Bureau of Communicable Diseases, told reporters during a press conference Monday afternoon that given the number of cases across the country, the agency has been preparing for its case investigations and outbreak response for months. 

“While we were surprised that we had our first cases this past week, we were prepared,” Westergaard said. “We’ve been making sure that we have adequate MMR vaccine in stock and have worked in partnership with all of our local and tribal health departments to make sure that we have a solid response that everyone is aware of, and so far for this case,… things have gone well.”

Cases of the highly contagious disease have hit a 33-year high nationally, according to the Centers for Disease Control and Prevention (CDC). There are reports of over 1,300 cases this year, with more than 150 people having been hospitalized for measles. Three people have died this year. 

Measles was declared eliminated in 2000, but decreasing vaccine rates, which have fallen below herd immunity, have led to a resurgence of the disease. Prior to 2025, the last similar outbreak was in 2019 when more than 1,200 cases were confirmed in the U.S. 

Westergaard said the state agency is not considering the nine cases in Wisconsin an outbreak because  the investigation found a common source during out-of-state travel. He said the agency won’t be releasing additional information about the cases due to state privacy laws. The agency has said it is working to identify and notify people who may have been exposed. 

The agency is urging families to get vaccinated in light of the cluster of cases and reported Monday that vaccination rates among students mostly held steady during the 2024-25 school year. Vaccination rates are still below pre-pandemic levels. 

“Vaccination is the first line of defense for your child’s health. Each vaccine is approved only after being proven safe and effective,” Stephanie Schauer, director of the Wisconsin Immunization Program, said in a statement. “Taking time now to ensure your children have received the recommended vaccines will make them less likely to get seriously ill, meaning less time out of school and away from work. And routine vaccines don’t just protect your child — they help keep classrooms and the whole community safe.”

During the 2024-25 school year, 86.4% of students met the minimum immunization requirements — a 2.8 percentage point decrease from the 2023-24 school year. 

“This tells us that most Wisconsin families are protecting their children with vaccines,” Westergaard said at the press conference. “Unfortunately, this level is below where we need to be to protect our state against outbreaks of vaccine-preventable diseases. As we head into the new school year as a physician and as the father of kids who attend public schools, I want to encourage all caregivers to reach out to a trusted health care provider with any questions or concerns that you have to concern to ensure that students are up to date on their vaccines this year.” 

The agency attributed the overall decrease in meeting the immunization requirement to people being unfamiliar with a new meningitis vaccination requirement for 7th and 12th grade students. Without data on the meningitis vaccination, 89.3% of Wisconsin students met the minimum requirements — a 0.1% increase from the 2023-24 school year.

DHS reported in December that families in the state have fallen behind other states when it comes to receiving childhood vaccines including polio, pertussis, diphtheria and tetanus (DTaP), and measles, mumps, and rubella (MMR). When it comes to measles in particular, Wisconsin has one of the lowest vaccination rates in the country.

Measles can spread from person to person through the air, and the vaccines to prevent it are highly effective. One dose of the MMR vaccine provides about 93% protection from measles, while two doses are about 97% effective.

“Our school vaccination data tells us there are children in our schools who are not protected from an outbreak of preventable diseases like measles,” State Health Officer Paula Tran said in a statement. “In public health, we know that 95% of people in a community need to be vaccinated against measles in order to prevent an outbreak, which is why it’s so important to get children the vaccines they need on time.”

Milwaukee city leaders, looking to take preventative steps due to the measles cases, also urged residents to get vaccinated on Monday.

“As a father and as mayor, I take this threat seriously,” Mayor Cavalier Johnson said in a statement. “We’ve seen how quickly diseases can spread when vaccination rates fall behind.”

Children’s Wisconsin President of Pediatrics Dr. Mike Gutzeit emphasized that serious side effects from the MMR vaccine are rare. 

“The risk from measles itself is far greater. When families choose not to vaccinate, they’re not just putting their own children at risk, but also newborns and people with weakened immune systems,” Gutzeit said. “Measles was nearly eliminated in the U.S., but now we’re seeing hundreds of cases and hospitalizations again. We can’t afford to go backward.”

Other vaccine-preventable illnesses surged in classrooms last year, according to DHS. Nearly 3,000 cases of pertussis, or whooping cough, were reported.

The measles cases and data on school vaccine rates come as some Republican lawmakers are seeking to increase awareness of vaccine exemptions. Sen. Rachael Cabral-Guevara (R-Appleton) and Rep. Lindee Brill (R-Sheboygan Falls) recently introduced a bill that seeks to highlight Wisconsin’s vaccine exemptions, saying there isn’t enough transparency around them. Current law already requires that schools and day care providers “inform the person in writing of the person’s right to a waiver.” 

During the 2024–2025 school year, 6.7% of students had a waiver for one or more vaccinations. Of those, 5.8% of students had a personal conviction waiver, 1% had a religious waiver and 0.4% had a health waiver. 

Westergaard said the rate of waivers in Wisconsin is higher than other states. 

“We’re one of only 13 states that has the personal conviction waiver. Many states do not allow that,” Westergaard said, adding that health forms typically include notice of the waiver availability. 

“We feel in public health that knowledge of the exemptions of the waivers is commonplace,” Westergaard said. “We don’t hide them, but our recommendation is that people get their kids vaccinated because we, as a public health entity, feel any risks far outweighed by the benefit, both to individual health and to our community health.”

Westergaard said those with concerns should speak with a trusted physician and be open with their questions. 

“For many families, childhood immunizations are a fact of life, and they’ve accepted them when they’re recommended, but we know other families have questions and concerns,” Westergaard said. “If there are questions you have, if there is information that you’ve seen online or heard that makes you question the safety or the effectiveness, let’s talk about them… There’s near unanimity among people who have seriously reviewed MMR safety data and other childhood vaccine data that they are on balance very safe and very effective and continually monitored for safety and adverse effects.”

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A health care provider bandages a child after giving a vaccination shot. (Photo by Scott Housely/CDC)

A pair of Wisconsin Republicans want to increase awareness of the state’s vaccine exemptions by requiring waiver forms be given to parents with the health forms they receive from schools and child care center providers. 

Coauthors of the bill Rep. Lindee Brill (R-Sheboygan Falls) and Sen. Rachael Cabral-Guevara (R-Appleton) said in a cosponsorship memo that there is a “lack of transparency” around the exemptions that “can create confusion and unnecessary barriers for parents” and “increase administrative burden on schools when immunization documentation is incomplete or delayed.” 

Wisconsin law requires children in elementary, middle, junior or senior high school, a child care center, or a nursery school to get vaccinated for various diseases based on their grade or age. The vaccine and booster schedule covers mumps, measles, rubella, diphtheria, pertussis, poliomyelitis and tetanus. 

Wisconsin allows parents to get the requirement waived if they submit a written statement objecting for reasons including health, religious or personal conviction. 

Lawmakers noted that the bill would not change current requirements for vaccines. The bill would require schools, child care centers and nursery schools to create a process to present a vaccine waiver form with each health-related form it requires before a student can be enrolled.

“Many parents are unaware of this right or are unclear about how to obtain that waiver and feel pressured to make medical decisions for their children that they otherwise would not have,” Brill said in a statement. “This bill ensures that schools make parents aware of the rights already afforded them by Wisconsin law and include information about the waiver from the vaccine requirement and a procedure for presenting it in any required pre-enrollment health-related forms.”

The proposal comes as Wisconsin’s vaccination rates have not caught up with pre-pandemic levels. According to a 2024 U.S. Centers for Disease Control report, Wisconsin is falling behind other states in childhood immunizations for illnesses including polio, pertussis, diphtheria and tetanus, and measles, mumps and rubella. 

The decline in vaccine rates is partially to blame for diseases, including measles and pertussis, increasing across the country, according to health officials. 

According to the Wisconsin Department of Health Services, 86.4% of students met the minimum immunization requirements during the 2024-25 school year — a 2.8 percentage-point decrease from the prior year. The agency also reports that 6.7% of students had a waiver for one or more immunizations, representing a 0.6 percentage-point increase from last year, though the number of students waiving all vaccines fell to 1.3%. 

Amid falling rates, DHS officials have ramped up efforts to encourage vaccinations to help improve effectiveness. 

Wisconsin has one of the lowest measles vaccination rates in the country, with only Alaska falling below it. One dose of the MMR vaccine, which fights measles, provides approximately 93% protection, while two doses are about 97% effective.

As measles vaccine rates have fallen, cases of the highly contagious disease have hit the highest level in 33 years, according to the CDC with 1,288 cases this year. More than 150 people have been hospitalized from measles, and three people have died this year. No cases have been reported in Wisconsin so far, but its neighboring states, including Illinois and Minnesota, have had cases.

The lawmakers’ efforts to increase awareness of vaccine exceptions comes amid a national wave of skepticism to vaccination, including from U.S. Health Secretary Robert F. Kennedy Jr., who is a leading and prominent vaccine skeptic and was appointed by President Donald Trump this year. 

Brill thanked Kennedy for his work on his “Make America Health Again” agenda in her statement about the bill.

Cabral-Guevara, a board certified family nurse practitioner, has supported legislation that would loosen vaccine requirements before including a 2024 bill that would have allowed immunization exemptions at higher education institutions without documentation. 

The bill passed the Senate and Assembly, but was vetoed by Gov. Tony Evers, who said in a veto message that he objected to “the Wisconsin State Legislature’s efforts to micromanage decisions to respond to public health incidents and restrict existing tools available to higher education institutions to keep students, faculty, staff safe and healthy on their campuses.”

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U.S. Senate Appropriations Chair Susan Collins, a Maine Republican, left, and the top Democrat on the committee, Sen. Patty Murray of Washington state, at a committee markup on Thursday, July 31, 2025. (Photos from committee webcast)

WASHINGTON — The U.S. Senate Committee on Appropriations Thursday largely rejected Trump administration proposals to slash funding for education programs, medical research grants, health initiatives and Ukraine security assistance.

Instead, senators from both parties agreed to increase spending in the Labor, Health and Human Services and Education spending bill for fiscal year 2026, as well as the Defense bill, and rebuked the White House’s move to dismantle the Department of Education.

The pushback against President Donald Trump was significant as Congress heads toward a possible standoff and partial government shutdown when the fiscal year expires on Sept. 30.

In response to the Trump administration’s separate cancellation of grants and freezing of funds approved by Congress, senators also included language in the Labor-HHS-Education spending bill to create deadlines for formula grants to be released to states on time.

Senate Appropriations Committee Chair Susan Collins, Republican of Maine, said the bill to fund the departments of Labor, Health and Human Services and Education “prioritizes funding to make Americans healthier and supports life-saving medical research through targeted funding.”

The measure provides $116.6 billion for HHS, an increase of $446 million in discretionary funding over the previous fiscal year. Included is a $150 million increase for cancer research and a $100 million increase for Alzheimer’s disease research, as well as a ban on an administration cap on indirect costs at the National Institutes of Health, according to a summary from Democrats. The cap on how much NIH pays research universities and medical schools for indirect costs is the subject of a permanent injunction in an ongoing lawsuit.

Trump’s budget proposal also cut funding for the Atlanta-based Centers for Disease Control and Prevention to $4.2 billion, but senators voted to instead allocate $9.1 billion for the agency.

Also included is $8.8 billion for the Child Care and Development Block Grant and nearly $12.4 billion for Head Start.

The top Democrat on the committee, Sen. Patty Murray of Washington state, said that while the bill rejects many of the funding cuts from the Trump administration, it’s “only half of the equation.”

“We have an administration right now that is intent on ignoring Congress, breaking the law, and doing everything it can without any transparency, to dismantle programs and agencies that help families,” she said. “There is no magic bullet that will change that unfortunate reality.”

Murray also expressed her disappointment that the bill did not fund the Corporation for Public Broadcasting. Trump sent what is known as a rescissions request to Congress, approved by both chambers, that yanked $1.1 billion in previously approved funding over the next two years for the agency, which funds NPR and PBS.

The Labor-HHS-Education spending bill for fiscal year 2026 passed out of the Senate committee with a bipartisan 26-3 vote.

Senators also passed the Defense appropriations bill for fiscal year 2026 on a 26-3 vote.

Dismantling of Education Department spurned

The bill text tightens requirements so that Education Department staffing levels must be sufficient to carry out the agency’s missions, and its work cannot be outsourced to other agencies or departments to fulfill statutory responsibilities, according to Sen. Tammy Baldwin of Wisconsin, the top Democrat on the spending panel dealing with Labor-HHS-Education spending. 

The agency saw a reduction in force, or RIF, earlier this year that gutted more than 1,300 employees and hit wide swaths of the department. The Supreme Court cleared the way earlier in July for the agency to temporarily proceed with those mass layoffs.

The bill also provides $5.78 billion for School Improvement Programs — which support before- and after-school programs, rural education, STEM education and college and career counseling, among other initiatives.

Trump’s fiscal 2026 budget request had called for $12 billion in spending cuts at the Education Department but the committee allocated $79 billion in discretionary funding.

Education Secretary Linda McMahon defended Trump’s sweeping proposals while appearing in June before the Senate Labor-HHS-Education subcommittee.

During Thursday’s markup, Murray called the president’s proposal to defund the Department of Education “absurd.”

“I still hope we can do more when it comes to demanding accountability, transparency, and that this administration actually follows our laws,” Murray said. “We all know President Trump cannot dismantle the Department of Education or ship education programs to other agencies. Authorizing laws prevent that.”

The agency has witnessed a dizzying array of cuts and changes since Trump took office, as he and his administration look to dramatically overhaul the federal role in education and dismantle the department.

The bill maintains the same maximum annual award for the Pell Grant from the previous award year at $7,395. The government subsidy helps low-income students pay for college.

Trump’s budget request had called for cutting nearly $1,700 from the maximum award.

Health spending

Baldwin said the overall bill is a “compromise.” She pointed to how Republicans and Democrats agreed to increase funds for the 988 Suicide hotline by $2 million and by another $20 million for substance abuse recovery.

The spending bill will also provide $1.6 billion for State Opioid Response grants, which is a formula-based grant for states to address the opioid crisis.

Senators rejected the Trump administration’s request to cut National Institutes of Health research by 40% and instead included a more than $400 million bump in funding for a total of $48.7 billion.

Georgia Sen. Jon Ossoff said that he was grateful that the committee worked on a bipartisan basis to reject major Trump cuts for the Centers for Disease Control and Prevention, in his home state.

“I made (it) very clear that I would not accept the destruction of the CDC,” Ossoff said. “I am grateful that Republicans and Democrats on this committee are coming together to defend this vital institution based in the state of Georgia.”

Advocates for medical research praised the legislation.

“Chair Collins and Vice Chair Murray deserve special recognition for their leadership in making this a priority. Thousands of ACS CAN volunteers from across the country have been writing to their lawmakers on this issue and it’s deeply encouraging to see their voices have been heard loud and clear,” Lisa Lacasse, president of the American Cancer Society Cancer Action Network, said in a statement.

AmeriCorps, Job Corps funding sustained

Trump’s budget request also proposed $4.6 billion in spending cuts at the Department of Labor. 

The spending bill also maintains funding for Job Corps, a residential career training program for young adults, at $1.76 billion.

Trump’s budget request sought to eliminate the program entirely.

The administration says the program is “financially unsustainable, has an exorbitant perparticipant cost, risks the safety of young adults, and has often made participants worse off,” according to a summary of the budget request.

The spending bill also includes $15 billion for the Social Security Administration, an increase of $100 million from the president’s budget request, to address staffing shortages.

The administration also proposed the elimination of AmeriCorps.

However, senators kept funding for AmeriCorps for fiscal year 2026 at $1.25 billion.

Defense spending also increased

The Defense appropriations spending bill for fiscal year 2026 that senators worked on represented an increase from the president’s budget request.

“I think not only the prior administration, but this administration as well, have underestimated the level of challenge that we have,” said Sen. Mitch McConnell, chairman of the Defense appropriations panel.

The Kentucky Republican said the bill provides $851.9 billion for fiscal year 2026.

He said the topline is higher than the president’s budget request because “we cannot seriously address these challenges while artificially constraining our resources” — challenges such as the war in Ukraine and conflicts in the Middle East.

The bill also rejects the Trump administration’s effort to slash funding to aid Ukraine in its war against Russia.

“Shutting off engagement with Ukraine would undermine our military’s efforts to prepare for the modern battlefield,” McConnell said.

During the markup of the defense spending bill, Sen. Dick Durbin, Democrat of Illinois, introduced an amendment to require the Department of Homeland Security to reimburse costs to the Department of Defense for immigration enforcement.

As the Trump administration aims to carry out its plans for mass deportation of people without permanent legal status, it’s intertwined the U.S. military and immigration enforcement, ranging from deploying the National Guard to quell immigration protests in Los Angeles to housing immigrants on the Guantanamo Bay, Cuba military base.

Durbin said that so far, DHS has cost the Defense Department $900 million, from personnel costs to housing immigrants on military bases.

Durbin said the cost to house 180 people on Guantanamo Bay cost the Department of Defense $40 million over three months.

His amendment failed on a 14-15 vote. 

A medical worker prepares to vaccinate people at a pop-up COVID-19 vaccination clinic in a rural Delta community in April 2021 in Leland, Miss. The Mississippi State Department of Health, like other state health departments, is concerned about the potential loss of federal funding. (Photo by Spencer Platt/Getty Images)

Between 2016 and 2022, as congenital syphilis cases rose nationally and especially in the South, Mississippi saw a one thousand percent increase — from 10 to 110 — in the number of newborn babies who were hospitalized after contracting the disease, known to cause developmental issues, intellectual disabilities, and even death.

So in 2023, the state Department of Health mandated that all medical practitioners screen for the disease in pregnant mothers, and it has been running advertisements to spread awareness.

Annual congenital syphilis cases in Mississippi rose from 62 in 2021 to 132 in 2023, according to state data. The number fell to 114 last year. There have been 33 cases so far this year.

That work won’t stop despite potential budget cuts, Dr. Daniel Edney, Mississippi’s state health officer, said in an interview. “We’re going to keep doing what we have to do, you know, to keep it under control.”

State by state, public health departments take a similar approach: They monitor, treat and try to stem preventable diseases, alongside their host of other duties. But in the coming year, health department officials — with their agencies already strapped for cash — fear they’ll find it much more difficult to do their jobs.

President Donald Trump’s budget proposal for fiscal year 2026 would cut the federal Centers for Disease Control and Prevention budget by more than half, from $9.3 billion to $4.2 billion. The proposal serves as a wish list from the administration, a blueprint for the Republican-controlled Congress as it works through upcoming spending legislation.

If lawmakers hew to Trump’s vision, then state and county public health departments would be hit hard. States contribute to their own health departments, but a lot of them rely heavily on federal funding.

And around half of local public health department funding comes from federal sources, primarily the CDC, as noted in a 2022 report from the National Association of County & City Health Officials.

Medicaid cuts are likely to worsen mental health care in rural America

“The federal government provides a lot of funding, but the actual implementation of public health programs happens at the state and local level,” said Josh Michaud, associate director of global health policy at KFF, a health policy research group. “Each state has its own approach, in many ways, to how public health programs are overseen, how they’re funded, how they are implemented.”

In announcing his department’s share of the proposed budget, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. said Trump’s goals align with “new priorities in reversing the chronic disease epidemic.”

But many local health leaders point to the longtime mission of state public health departments in preventing the spread of disease.

“Local public health is on the front lines preventing communicable disease, operating programs to prevent chronic disease, ensuring our septic and well water systems are safe,” said Dr. Kelly Kimple, acting director of North Carolina’s Division of Public Health within the Department of Health and Human Services.

“I’m very concerned,” Kimple said, “especially given the magnitude of funding that we’re talking about, as we can’t keep doing more with less.”

Clawing back COVID-era grants

Other federal budget cuts also have states worried.

Many state public health departments grew alarmed when the Trump administration announced in March that it would be clawing back $11.4 billion in COVID-era funding for grants that were slated to extend into 2026.

Twenty-three states and the District of Columbia sued. A federal district court in Rhode Island temporarily blocked the cuts, and the case remains tied up in court.

The court’s preliminary injunction may not protect temporary staff or contractors, though. Public health departments have been laying off staff, cutting lab capacity and reducing immunization clinics, said Dr. Susan Kansagra, chief medical officer for the Association of State and Territorial Health Officials.

Historically, public health departments receive funding in “boom and bust” cycles, meaning they tend to get more federal support during emergencies, said Michaud, of KFF. But “since the Great Recession of 2008, there was a general decline in public health support funding until the COVID pandemic.”

For example, KHN and The Associated Press reported that between 2010 and 2019, spending on state public health departments declined by 16% per capita and spending for local health departments fell by 18%.

Nationally, syphilis cases reached historic lows in the 2000s, thanks to robust prevention efforts and education from public health officials. By 2022, however, cases reached their highest numbers nationally since the 1950s.

“In the wake of the COVID emergency, you’ve seen a sort of backlash to what people had been calling the overreach of public health and imposing vaccination requirements and lockdowns and other public health measures,” Michaud told Stateline.

Smallpox, cholera and typhoid

Public health departments and officials go back to the 19th century, when there was a greater emphasis on sanitation efforts to prevent spread of diseases such as smallpox, cholera and typhoid, which were rampant at the time.

By the end of the century, 40 states had established health departments, which to this day are responsible for water sanitation, tracking the spread of disease, administering vaccinations, furnishing health education, providing screenings for infants and some prenatal care for moms at local clinics, offering family planning services, and tracking and treating sexually transmitted infections, among other things.

Kimple pointed to measles as a current example of a disease that’s spreading fast. When North Carolina’s health department detected a case in the state, she said, the department “identified and contacted everyone who might have been exposed, helped people get tested, worked with doctors to make sure they knew how to respond.”

That’s the legacy of local public health, Michaud said.

“The federal government cannot decide, ‘This public health program will happen in this state, but not that state,’ that kind of thing. And cannot declare a national lockdown. The COVID pandemic tested a lot of those boundaries. It really is a state and local responsibility to protect public health. And that’s always been the case, since the beginning of our country,” Michaud said.

“And what we’re seeing now is a complete upheaval of the funding going into public health.”

A major cut in services

Kimple said she’s seen recent progress in her state in the support for funding public health.

“North Carolinians viewed our work as highly important to improving health and well-being in the state, and appreciated the local presence, the reliable information, the role in prevention and efforts to protect, in particular, vulnerable communities,” she said.

Similarly, Edney said that Mississippi state lawmakers were showing more support, despite some setbacks in 2016 and 2017. New federal cuts could throw a wrench in the health department’s economic plans and its ability to reach small communities.

“Now the federal rug is being pulled out from under us,” he said.

Edney said he expects the federal share of his department’s public health funding to fall from its current 65% to around 50%.

Edney said he’s been trying to strengthen Mississippi health department’s longevity by diversifying its revenue streams by, for example, accepting private donations.

The state will not stop doing its “core” work, he said, regardless of federal funding.

“We’re not going to cut back on services at the county health department, because what we do now is all mission critical,” Edney said.

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

Earlier this month, Washington Gov. Bob Ferguson said the state would provide $11 million in funding if Planned Parenthood loses its lawsuit and federal support. There are 30 clinics in the state that serve 10,000 patients every year. (Photo by Jake Goldstein-Street/Washington State Standard)

Planned Parenthood affiliates nationwide are once again protected from a “defunding” provision passed by Congress after a federal judge in Massachusetts granted an emergency request for a new preliminary injunction.

The order from U.S. District Judge Indira Talwani, appointed by former Democratic President Barack Obama, comes one week after an initial injunction blocked only certain clinics from receiving Medicaid funds under the new law. One of the affiliates that filed the lawsuit, Planned Parenthood Association of Utah, along with affiliates that did not provide abortion services or that did not bill Medicaid more than $800,000 in fiscal year 2023 were protected, which covered a fraction of the 600 clinics nationwide.

In the weeks since President Donald Trump signed massive budget reconciliation bill H.R. 1 on July 4, the mere threat of cuts has caused clinics to close or restrict services in several states. Two clinics shut their doors in rural areas of Ohio, two closed in the Houston area of Texas, and five closed in California, according to news reports. In California alone, the Medicaid cuts would create a loss of $300 million in funding for the state’s 114 clinics that serve more than 1 million patients per year, according to CalMatters. 

In Washington state, where abortion access is legal and available until fetal viability, Gov. Bob Ferguson announced on July 9 that the state would provide the $11 million in federal funding lost if the lawsuit is unsuccessful. There are 30 Planned Parenthood clinics in Washington that serve 100,000 patients every year, and Medicaid covers about half of them, Washington State Standard reported.

The national group, Planned Parenthood Federation of America, said the initial decision was disappointing and asked the court to reconsider, which Talwani granted Monday.

Attorneys for the Trump administration appealed the initial injunction on July 23, and told the court they opposed the emergency request for a new injunction.

Planned Parenthood Federation of America and affiliates in Massachusetts and Utah sued just a few days after Congress passed the bill that included the provision the organization said directly targeted their services for Medicaid funding cuts  — a longstanding goal of anti-abortion advocates and many Republican elected officials. Federal Medicaid dollars cannot be used for abortion services except in cases of rape, incest, or certain health conditions.

The clinics rely heavily on Medicaid funding to provide standard reproductive health care at little to no cost, including treatment for sexually transmitted infections, cancer screenings and contraception. Planned Parenthood provides services for about 2 million patients every year, and 64% of clinics are in rural areas or places with health care provider shortages.

In the order, Talwani said the law — part of a sweeping package of tax and spending cuts approved by a party-line vote — unfairly targets Planned Parenthood for punishment without a trial, and violates free speech constitutional rights by preventing the organization from advocating for reproductive health care.

Attorneys for the U.S. Department of Justice have argued Congress was free to target those clinics because “larger providers carry out more abortions and receive more government subsidies,” and said the law is meant to “stop federal subsidies for Big Abortion.” Talwani said those arguments were not persuasive, and that it is unlikely they can justify the defunding as part of a goal to reduce abortion.

“… it is unclear how including only entities that are non-profits and provide medical services in underserved communities is in any way related to reducing abortion. Nor is it clear how withholding Medicaid reimbursements from Planned Parenthood Members who do not provide abortion furthers that end,” Talwani wrote.

Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts, called the ruling a “powerful reminder that patients, not politics, should guide health care.”

Lee said in a statement: “In Massachusetts and beyond, we will keep fighting to ensure everyone can turn to the provider they trust, no matter their insurance or zip code.”

Editor’s note: This story was updated July 31, 2025 to correct the number of patients served annually by Planned Parenthood clinics in Washington state.

The U.S. Capitol building in Washington, D.C., is pictured on Sunday, June 29, 2025, as the reconciliation package was under debate. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — A majority of Americans believe Republicans’ “big, beautiful” law will either hurt them or not make much of a difference, according to a poll released Thursday by the nonpartisan health research organization KFF.

The survey shows 46% of people expect the new tax and spending cuts law will generally hurt them or their family, while 28% said it likely won’t make much difference and 26% said it will help them.

Those beliefs were skewed by political parties, with 54% of Republicans saying the law will help them or their family, compared to 19% of independents and 7% of Democrats.

People enrolled in Medicaid, the state-federal health program for lower income individuals and people with disabilities, have significant concerns about how changes to the program will impact them.

Sixty-five percent of Medicaid patients under the age of 65 said they expect the law to hurt them or their family. Another 17% said it won’t make much of a difference for them and 18% expect the policy changes to help.

The law makes more than a dozen changes to how Medicaid is run, resulting in a $1.058 trillion spending cut to the program during the next decade, according to an analysis released earlier this week by the nonpartisan Congressional Budget Office.

The report projects that 10 million people will lose access to health insurance before 2034.

The law made permanent the 2017 tax cuts from President Donald Trump’s first term and provided billions to carry out his plans of mass deportations, an immigration crackdown and increased defense spending.

Some know little about new law

KFF’s survey shows most Americans know at least something about the new law, though 9% of those polled said they know nothing at all and 23% said they know just a little.

Democrats had the highest percent of respondents who said they knew either a lot, 35%, or some, 45%, about the law. Twenty-two percent of Republicans said they knew a lot about their party’s top legislative achievement this year, with 44% saying they knew something, 27% saying they knew a little and 7% saying they knew nothing.

Social media

The vast majority of those polled, 78%, said they saw information about Republicans’ new law on social media during the last month.

Facebook and YouTube were the more popular social media platforms for people to see information about the tax and spending cuts law, followed by Instagram, TikTok, X and Reddit.

Forty-seven percent of those surveyed said the content they saw on social media opposed the policy changes included in the law, while 41% said it was mixed and 11% said it supported the GOP’s work.

Republicans said 26% of what they viewed on social media was in support of the law, with 53% mixed and 21% opposed. Democrats polled said 76% of what they saw was opposed, 21% mixed and 3% was supportive.

Most of those surveyed said the social media content helped them understand what the new law actually does. Sixteen percent said it was very helpful, 46% said it was somewhat helpful, 27% said it was not too helpful and 11% said it wasn’t helpful at all. 

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Michael Adams, president of JobsWork MKE, ignored the warning signs his body gave him before having a heart attack on Jan. 29, 2024. 

He now encourages Black men to pay attention to their health and trust the health care system. 

“I think Black men aren’t trusting the system due to economics and the feeling of not being in control of the situation,” Adams said. 

Ignored warning signs

Before his heart attack, Adams woke up vomiting with a burning throat. He took an Alka-Seltzer hoping it was indigestion. 

Later that day, he gave a presentation at the Medical College of Wisconsin for work. During the presentation, his symptoms got worse. He experienced severe sweating, shortness of breath and body aches. 

“I try to stay as active as I can, but I couldn’t understand why I’m walking across the street from the parking lot to the building out of breath,” Adams said. 

Friendship and health 

Timothy Grove, a network senior director of Trauma Informed Strategy and Practice at Wellpoint Care Network and a friend of Adams, was with him that day. He noticed before the presentation while walking with Adams that his friend was struggling.  

“The way he was talking about his symptoms made me think it was important to encourage him to get checked out right away. I was also concerned about my friend and wanted him to be OK,” Grove said. 

After the presentation, Grove took him to the doctor before he was sent to the emergency room. 

Adams described Grove as a good friend for being there for him.

“Tim got on my nerves because I wanted him to drop me off and leave. Through it all, he was there, and stayed until I was OK,” Adams said.

Black men and hospitals

When he was admitted to the ER, hospital staff tried to calm Adams to prevent distress before they told him he was having a heart attack. 

“Black men don’t listen to themselves. We don’t go to the ER because we don’t want all that comes with it,” Adams said. “At the end of the day, we are dying because we don’t listen to ourselves and our body.”

According to a study by the Milwaukee Health Department, the top cause of death for Milwaukee men is heart disease. 

Understanding a heart attack 

Adams discovered there was 95% blockage in one of his arteries. The day after his heart attack, doctors inserted a stent to open his artery and help restore blood flow. 

“I came to the realization that over a year I haven’t felt right and my circulation has been off all along,” Adams said. 

Adams experienced cramps and had inconsistent blood pressure readings. 

After the stent was inserted, Adams was prescribed medication, and it was recommended he attend water physical therapy because of its low impact on the body. 

A new lifestyle 

Before his heart attack, Adams, a native of Milwaukee’s North Side, lived an active lifestyle, teaching martial arts and hiking regularly. 

Now, Adams attends Noyes Pool three days a week. He swims laps there and is trained by a lifeguard and private swim coach. 

“People always tell me ‘sorry for the heart attack,’ but I have a different perspective on it, and the best of life opened up to me since then,” Adams said.

Adams has lost 40 pounds and is glad he’s eating higher-quality food such as lean beef, vegetables and fruits. He also cut salt from his diet and drinks only water.

Witnessing transforming moments 

Adams’ daughter, Lauren, proudly supports her father’s decision to make health a priority as a Black man. 

“I tell my dad all the time that one day he’s going to break my heart by passing away. To know that he’s taking his health so seriously, I love that,” she said. “I’m an only child, and my dad is my favorite person.” 

Heart disease runs in their family, Lauren said. Both of Michael’s parents died from heart disease. 

Since his life-changing medical emergency, Michael has met other individuals who also experienced heart attacks. Some are members from his church, All Saints Catholic Church. 

“When I was released to go to church, the men came up to me and said ‘Welcome to the club,’ ” he said.  

Feeling a part of the process 

Adams felt cautious about the steps he would have to take with his health. He felt the need to attach himself to his health care providers so he could trust the work they’re doing.

His initial doctor, Ian Gilson of Froedtert Hospital, retired after 20 years of caring for him.

“I liked that doctor because he understood Black anatomy really well,” Adams said. 

Benjamin Tobin, a Black doctor at Froedtert & the Medical College of Wisconsin, is his current provider.

Adams appreciates how his health providers are making him feel seen and heard. 

“As Black men, we often get dictated to on how our health should go. My health providers made me a part of the plan, and I just signed off on it,” Adams said.

He urges Black men to take their health seriously. 

“I survived, and I want other people to understand that you can, too,” Adams said.

He survived a heart attack. Now he wants other Black men to do the same. is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

People listen to a sermon before being admitted to lunch at the Hope Center, which assists homeless and addicted residents in Hagerstown, Md. Experts say Medicaid cuts will exacerbate rural communities’ access to mental health care. (Photo by Spencer Platt/Getty Images)

Across the nation, Medicaid is the single largest payer for mental health care, and in rural America, residents disproportionately rely on the public insurance program.

But Medicaid cuts in the massive tax and spending bill signed into law earlier this month will worsen mental health disparities in those communities, experts say, as patients lose coverage and rural health centers are unable to remain open amid a loss of funds.

“The context to begin with is, even with no Medicaid cuts, the access to mental health services in rural communities is spotty at best, just very spotty at best — and in many communities, there’s literally no care,” said Ron Manderscheid, former executive director of the National Association of County Behavioral Health and Developmental Disability Directors.

Cuts over the next 10 years could force low-income rural families to pay for mental health care out of pocket on top of driving farther for care, experts say. Many will simply forgo care for depression, bipolar disorder and other illnesses that need consistent treatment.

“Not only do you have very few services available, but you don’t have the resources to pay for the services,” Manderscheid said. “That makes the problem even worse.”

Rural communities are already at higher risk of suicide, with rates almost doubling over the past two decades. Already, rural communities are grappling with a shortage in mental health professionals, making them more vulnerable to losses compared with more urban areas, experts say.

Paul Mackie, assistant director of the Center for Rural Behavioral Health at Minnesota State University, Mankato, studies rural mental health workforce shortages.

“If it [coverage] goes away, what would then be the person’s next option if they already don’t have the resources?” said Mackie, who grew up on a rural Michigan dairy farm. “You can have a rural psychologist or a rural clinical social worker working under a shingle, literally alone.”

Small rural hospitals often provide critical behavioral health care access, he said. One analysis found the cuts next year would leave 380 rural hospitals at risk of shutting down.

States such as Mackie’s Minnesota, which expanded Medicaid eligibility under the 2010 Affordable Care Act, would suffer significant slashes in federal matches as a result of President Donald Trump’s signature legislation. The law, which includes tax cuts that disproportionately benefit the wealthy, cuts the federal government’s 90% matching rate for enrollees covered under expansion to anywhere from 50% to 74%.

States will have to redetermine eligibility twice a year on millions enrolled under Medicaid expansion. Some Medicaid recipients also will have to prove work history. The new law creates work requirement exceptions for those with severe medical conditions — including mental disorders and substance use — but experts say proving those conditions may be convoluted. The exact qualifications and diagnoses for the exceptions haven’t been spelled out, according to a report by KFF, a health policy research organization.

“You can’t work when your mental illness is not treated,” said Dr. Heidi Alvey, an emergency and critical care medicine physician in Indiana. “It’s so counter to the reality of the situation.”

Alvey worked seven years at Baylor Scott & White Health’s hospital in Temple, Texas. As nearby rural critical access hospitals and other mental health centers shut down, the hospital became the only access point for people hours away, she said.

“People who just had absolutely no access to care were coming hours in to see us,” she said. Many had serious untreated mental health conditions, she said, and had to wait days or weeks in the emergency department until a care facility had an open bed.

She’s concerned that Medicaid cuts will only make those problems worse.

Jamie Freeny, director of the Center for School Behavioral Health at advocacy group Mental Health America of Greater Houston, worries for the rural families her center serves. The organization works with school districts across the state, including those in rural communities. Nearly 40% of the state’s more than 1,200 school districts are classified as rural.

She remembers one child whose family had to drive to another county for behavioral health. The family lost coverage during the Medicaid unwinding, as pandemic provisions for automatic re-reenrollment expired. The child stopped taking mental health medication and ended up dropping out of school.

“The child wasn’t getting the medicine that they needed, because their family couldn’t afford it,” Freeny said. “The catalyst for that was a lack of Medicaid. That’s just one family.

“Now, you’re multiplying that.”

Family medicine physician Dr. Ian Bennett sees Medicaid patients at the Vallejo Family Health Services Center of Solano County in California’s Bay Area. The community health clinic serves patients from across the area’s rural farm communities and combines primary care with mental health care services, Bennett said.

“When our patients lose Medicaid, which we expect that they will, then we’ll have to continue to take them, and that will be quite a strain on the finances of that system,” Bennett said. The center could even close, he said.

“The folks who are having the most difficulty managing their lives — and that’s made worse by having depression or substance use disorder — are going to be the folks most likely to drop off,” said Bennett, a University of Washington mental health services researcher. “The impacts down the road are clearly going to be much worse for society as we have less people able to function.”

The psychiatric care landscape across Michigan’s rural western lower peninsula is already scarce, said Joseph “Chip” Johnston. He’s the executive director of the Centra Wellness Network, a publicly funded community mental health care provider for Manistee and Benzie counties. The network serves Medicaid and uninsured patients from high-poverty communities.

“I used to have psychiatric units close by as an adjunct to my service,” he said. “And they’ve all closed. So, now the closest [psychiatric bed] for a child, for example, is at least two hours away.”

Those facilities are also expensive. A one-night stay in an inpatient psychiatric facility can be anywhere from $1,000 to $1,500 a night, he said.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

With a new law cutting Medicaid funding to certain clinics, Planned Parenthood estimated 200 of its clinics in 24 states are at risk of closure with the cuts, and nearly all of those clinics — 90% — are in states where abortion is legal. (Photo by Kayla Bartkowski/Getty Images)

Planned Parenthood had already begun the arduous task of closing some clinics and curtailing services immediately after Congress passed the massive budget reconciliation bill that included a new law cutting Medicaid funding to certain clinics on July 3.

Now that a federal judge only partially blocked the enforcement of the bill, that situation may only get worse in the coming weeks and months.

The provision – which the organization said directly targeted their services for defunding and fulfills a longstanding goal of anti-abortion advocates and many Republican elected officials – prohibits Medicaid funding for clinics that provide abortion care and billed Medicaid more than $800,000 in fiscal year 2023. Federal Medicaid dollars cannot be used for abortion care, except in cases of rape, incest or certain medical conditions, and are instead most often used to provide standard reproductive health care at little to no cost. That includes treatment for sexually transmitted infections, cancer screenings and contraception. Planned Parenthood provides services for about 2 million patients every year, and 64% of clinics are in rural areas or places with health care provider shortages.

Within days of President Donald Trump’s signature on the bill, Planned Parenthood and affiliates in Utah and Massachusetts sued federal authorities, quickly winning a temporary restraining order. But on Monday, U.S. District Judge Indira Talwani’s order only blocked enforcement against one of the affiliates that filed the lawsuit, Planned Parenthood Association of Utah, and affiliates “who will not provide abortion services” as of Oct. 1. Clinics that didn’t bill Medicaid more than $800,000 in fiscal year 2023 are also protected from cuts.

On Tuesday afternoon, attorneys for the Trump administration filed a notice of appeal to the 1st Circuit Court of Appeals seeking to reverse the preliminary injunction decision.

Clinic and affiliate leaders say the fallout from the funding measure has already resulted in chaos, and they are still trying to determine what it means for their operations.

Clinics were already hampered by frozen Title X funding

Erica Wilson-Domer, president and CEO of Planned Parenthood of Greater Ohio, told States Newsroom on Thursday that they temporarily paused Medicaid services after the bill became law, but were back to regular operations under the restraining order. She acknowledged it will vary by state and county, and it’s unclear how the clinics will respond to Monday’s preliminary injunction.

“We have a saying that if you’ve seen one Planned Parenthood, you’ve seen one Planned Parenthood,” Wilson-Domer said. “We sort of all have to independently make a decision based on our financial situation and what’s going on in our states.”

Each affiliate operates as an independent nonprofit organization that can make its own financial and administrative decisions. Similar to the landscape for abortion access after the U.S. Supreme Court’s Dobbs decision in 2022, the availability of services for Medicaid patients at Planned Parenthood and other high-volume reproductive health clinics now largely depends on where someone lives.

The national group estimated 200 of its clinics in 24 states are at risk of closure with the cuts, and nearly all of those clinics — 90% — are in states where abortion is legal. In 12 states, approximately 75% of abortion-providing Planned Parenthood health centers are threatened. The entire organization has about 600 clinics in 48 states.

Wilson-Domer said even before the budget bill became law, the clinics limited what contraceptives they could offer after the U.S. Health and Human Services Department froze Title X funds for specific clinics that the agency said provided care to undocumented immigrants and promoted messages of diversity, equity and inclusion. The loss of that funding increased the costs of obtaining contraception such as Nexplanon from $425 to more than $1,200, and no longer made it feasible for the clinics to offer.

Two clinics in rural Ohio that did not provide abortion services will close on Aug. 1, the Planned Parenthood Southwest Ohio Region announced on Thursday. Those clinics provided contraception, cancer screenings, testing and treatment for sexually transmitted infections and other wellness services.

“Our challenge isn’t just the federal lawsuit, but we’re in a state … where the state legislature pays no attention to the needs of its community,” said Nan Whaley, president and CEO of the Ohio affiliate, during a press conference on Thursday. She added that Ohio also passed a budget bill that allows the rollback of Medicaid expansion if federal support for the program drops by even 1%.

Although the affiliate’s four other clinics will remain open, they are no longer accepting or billing Medicaid for services. In an emailed statement, spokesperson Maya McKenzie said the restraining order wasn’t enough.

“For many smaller affiliates, the risk of the federal government requesting back pay if the order or an injunction expires is too great,” McKenzie said.

In a court brief filed by the U.S. Department of Justice on July 14 opposing Planned Parenthood’s request for an injunction, DOJ attorneys said, “an injunction won’t provide the certainty that Planned Parenthood wants, because the government will be able to deny (or claw back) payments if and when it ultimately succeeds.”

Some Pennsylvania clinics limited contraception options

In Pennsylvania, Planned Parenthood Keystone said it temporarily paused Medicaid billing for contraceptive devices such as IUDs, Nexplanon, and Depo Provera, among other services, while it assessed the legal risks of the new law. Instead, sliding scale fees and referrals to other providers were made. After the restraining order, CEO Melissa Reed said they resumed billing.

“That court order is set to expire soon, and the legal landscape remains uncertain,” Reed wrote in an emailed statement. “We’re hopeful for a lasting resolution, but regardless of the outcome, our focus will always be on making sure patients can continue getting the care they need.”

Elsewhere, Planned Parenthood of Western Pennsylvania said they could not share internal protocols but remained committed to protecting access to care for every patient.

Affiliates in the West, including Planned Parenthood Columbia Willamette in Oregon and Washington, said their nine health centers are providing the full scope of usual services. That includes the Ontario Health Center, which is a critical border clinic for patients in western Idaho, which has a near-total abortion ban. Christopher Coburn, the affiliate’s chief of external affairs, said they are not limiting appointments for patients covered by Medicaid either. Planned Parenthood Great Northwest, which has health centers in Idaho, Alaska, Hawaii, Indiana and Kentucky, also said it is not limiting services.

Like many others who provide family planning services, Planned Parenthood of Greater Ohio CEO Wilson-Domer said the cuts to Medicaid won’t affect abortion rates, and will likely increase them further by cutting off contraception access.

“What I hope people are really thinking about is that statistic that 1 in 4 women will visit Planned Parenthood in their lifetime, and … preventative care is what’s actually being defunded here,” she said. “If the intention is to reduce abortion, this is the exact opposite of that.”