Advocates who urged the Oregon legislature to increase child care funding in January 2024 hung onesies and other children’s clothes on a tent outside the Capitol in Salem. Officials in Oregon and other states are relying on their own funds to keep Head Start programs afloat during the federal government shutdown. (Photo by Julia Shumway/Oregon Capital Chronicle)

With some early childhood education centers already closing their doors because of the federal government shutdown, local leaders are scrambling to find money to keep Head Start programs available to some of the country’s most vulnerable children.

Head Start programs, which serve more than 700,000 low-income children across the country, are almost entirely federally funded. In addition to free preschool, centers provide health screenings, parent resources and meals for children up to 5 years old. But the record-long government shutdown has forced child care centers across the country to close as funding is exhausted.

The closures are creating stark choices for some of the most vulnerable families in society. Migrant farmworkers, for example, who are more likely to be without health insurance and tend not to have any vacation time, are faced with the prospect of missing work, and a paycheck, to care for their children. A network of Head Start programs for migrant farmworkers’ children that operates in states across the South closed its sites on Friday.

To keep Head Start programs operating in her state, Massachusetts Democratic Gov. Maura Healey announced plans to advance $20 million in additional funding for the program. Those grant funds were previously approved to improve and expand the Massachusetts program, which gets about 80% of its funding from the federal government.

In a statement last week, Healey said the state was doing everything it could to support those programs, “but we don’t have the resources to make up for what the federal government owes.”

In Atlanta, private funders made an $8 million loan to keep Georgia’s largest Head Start providers afloat for the coming weeks.

Frank Fernandez, the president and CEO of Community Foundation for Greater Atlanta, told CBS News that the measure was only a temporary solution: “Our elected officials must take action to end this shutdown and ensure the long-term sustainability of this critical program,” Fernandez said.

In Washington state, some school systems that operate Head Start programs are using their own funds to keep kids in classrooms, the Seattle Times reported. Still, other operations are cutting back staff and services to make do.

In neighboring Oregon, state officials are working out details of a 60-day deal to use existing funds to keep Head Start going, the Oregon Capital Chronicle reported. State officials said Head Start providers must have experienced a delay in federal funds and the state assistance will not exceed the total amount of money awarded to a program by Oregon annually.

“It’s important to note that this is not a loan to Head Start programs and is not ‘backfilling,’” Kate Gonsalves, a spokesperson for the state’s early learning department said in a statement. “These are dual-funded programs so the state dollars are not replacing federal funds but can be drawn down earlier in the cycle.”

Some sites already shuttered

Head Start sites in 18 states have already closed their doors, according to the First Five Years Fund, a nonprofit advocating for quality child care and early childhood education.

The National Head Start Association, a nonprofit representing Head Start programs, said full or partial closures have affected 8,000 children. Nationwide, programs serving 65,000 children hadn’t received their federal funds as of Saturday, according to the group.

In Ohio, seven Head Start programs have exhausted their federal funds. Two have already closed, affecting 600 children and 150 employees. In the coming weeks, the Ohio Head Start Association says the other five will be forced to close their doors, affecting nearly 3,700 Ohio kids.

“Every day the shutdown continues, Ohio children and families are paying the price,” Julie Stone, Executive Director of the association said in a statement. “Head Start isn’t a political issue — it’s a lifeline for working families.”

Farmworkers’ children

Agricultural farmworkers, many of whom travel for seasonal work, have been hit particularly hard.

East Coast Migrant Head Start Project, which runs 43 Head Start centers in multiple states, suspended services on Friday. Around 1,200 children of agricultural farmworkers are without services now, but the number of children served fluctuates by season. The network is funded to serve 3,000 children of farmworkers across Alabama, Florida, Georgia, Indiana, North Carolina, Oklahoma, South Carolina, and Virginia, and partners with other groups in a few other states.

In Florida, that means more than 800 children of agricultural workers are going without care due to the lapse in federal funding, said John Menditto, chief legal officer of East Coast Migrant Head Start Project. The group has also had to furlough its staff.

About 60% of farmworkers are American citizens or are in the country legally. Head Start is open to all children, regardless of their parents’ immigration status.

In rural North Florida, roughly 80 children have been without early education, language and disability therapies, said Leannys Mendoza Gutierrez, the campus director for the migrant Head Start program in rural Jennings, Florida, which cares for babies 6 weeks old to kids up to 5 years old.

“[Farmworkers] are putting food on our tables, for all of us,” she said. “However, they are not so far receiving services due to this situation that we don’t know when it’s going to end.”

Migrant farmworker families in Gutierrez’s program work in North Florida and South Georgia on watermelon, cucumber, cabbage, pepper, tomato, strawberry and pine straw farms.

Many parents have been forced to skip work and lose pay because they have been unable to find child care alternatives, Gutierrez said. She added that her program steps in to cover pediatrician bills for families that don’t have health insurance. The shutdown has prevented her program from offering such assistance, too, she said.

Many farmworkers don’t have health insurance and already struggle with poverty, making staying home from work difficult. Many also receive food aid through the Supplemental Nutrition Assistance Program (SNAP), which has also been affected by the shutdown.

“The shutdown just accentuates everything,” said Amy Liebman of the Migrant Clinicians Network, which works with clinics across the nation that serve migrant workers and their families. “Everyone’s concerned, they’re worried about the families they serve.”

Two other programs, one serving kids in the capital area of Tallahassee and another, Redlands Christian Migrant Association, which serves about 1,700 kids of agricultural workers in Florida, have also suspended services, according to the National Head Start Association.

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

A demonstrator stands outside the Wisconsin State Capitol in Madison, Wisc., in 2022 to commemorate missing and murdered Indigenous women and girls. Researchers have launched a new survey to determine the prevalence of brain injuries in Native survivors of sexual assault and domestic violence. (Photo by Stacy Revere/Getty Images)

Abigail Echo-Hawk, director of the Urban Indian Health Institute, recalled a Native mother in her 30s who started having memory loss and other dementia-like symptoms.

The woman had suffered multiple blows to her head and falls at the hands of her husband over the years. He had wanted to disable her, to make it more difficult for her to keep her children if she tried to leave him, Echo-Hawk said.

Many Native women have traumatic brain injury symptoms as a direct result of abuse, Echo-Hawk said. Tribal health advocates and groups serving survivors have long been aware of the problem, she said, but there has been little national research documenting the extent of it.

“It’s a very difficult thing to see,” said Echo-Hawk, of the Pawnee Nation of Oklahoma. “This is a pressing concern.”

The Urban Indian Health Institute, an Indigenous health research group, this month launched a first-of-its-kind national survey of American Indian, Alaska Native and Native Hawaiian women to determine the prevalence of brain injuries in Native survivors of sexual assault and domestic violence. The goal is to illuminate the extent of the problem, guide clinicians, raise public awareness and direct resources.

A 2015 study in Arizona found a higher incidence of traumatic brain injuries in Native women in that state, but the new survey is the first national, Indigenous-led study of its kind, according to the institute.

It comes as domestic violence groups across the nation are struggling with federal funding delays caused by the government shutdown. As the impasse continues, the Trump administration has furloughed grant workers at the Office on Violence Against Women, which is part of the U.S. Department of Justice.

Traumatic brain injuries can cause memory loss, confusion and long-term behavioral changes and raise the risk of dementia. Some abusers intentionally inflict traumatic brain injuries on their victims because it doesn’t leave visible bruises, according to the Brain Injury Association of America.

The link between domestic violence and traumatic brain injuries has been documented in women generally, and the effects of such injuries have been studied in former football players and veterans. But research on Native communities is lacking. Even when victims show up in ERs, their cases can go underreported.

In a previous survey of survivors, some Native women reported broken teeth, evidence of blows to the head, Echo-Hawk said. But pushing and strangulation also can cause traumatic brain injuries.

Violence is a public health crisis among American Indian, Alaska Native and Native Hawaiian women, who are overrepresented in intimate partner violence statistics. Fifty-five percent report experiencing intimate partner violence, and a disproportionate number of Native women and girls are murdered or go missing.

In a 2020 survey by the federal Centers for Disease Control and Prevention, nearly 44% of American Indian and Alaska Native women reported being raped in their lifetime.

“People are losing their children because of memory loss and dementia,” Echo-Hawk said. “When people are experiencing intimate partner violence, they end up in ERs. Their children suffer. The whole community suffers as a direct result. And the same with the crisis of missing and murdered Indigenous women and girls.”

Doctors and other hospital staff should receive more training on brain injuries and should know which communities are most likely to experience violence, said Nikki Cristobal, policy and research specialist for Pouhana ʻO Nā Wāhine, a nonprofit domestic violence resource center for Native Hawaiians.

Cristobal said one survivor told her clinicians hadn’t performed a brain scan or traumatic brain injury assessment on her, despite her ongoing psychological and cognitive symptoms. “It never occurred to anybody,” she said.

“We have to talk more about it,” said Cristobal, who worked with Echo-Hawk on developing the survey and is the principal investigator for the Missing and Murdered Native Hawaiian Women, Girls and Mahu state task force.

Native communities, including Native Hawaiians, have endured long-term, intergenerational traumas during colonization and forced assimilation that can’t be ignored when targeting the disproportionate rates of violence, Cristobal said.

“It’s the undercurrent,” Cristobal said. “It’s the precursor.”

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

An emergency room nurse tends to a patient at Houston Methodist The Woodlands Hospital in Texas. States, counties and nonprofits are striving to continue their work to close racial health disparity gaps but are struggling amid a loss of federal dollars. (Photo by Brandon Bell/Getty Images)

Racial health disparities may widen as states, universities and nonprofits grapple with federal funding cuts to programs that were aimed at filling gaps in care, public health experts say.

As part of its federal restructuring and crackdown on diversity, equity and inclusion (DEI) programs, the Trump administration has been shuttering federal offices and rescinding grants dedicated to addressing worse health care access and outcomes for racial minorities.

The shake-up has caused some state agencies and nonprofits to pause programs and some groups and universities to apply for foundation grants instead.

Hundreds of grants have been terminated for state, local and territorial health departments as well as nonprofits and universities, many of which addressed health equity across rural, low-income and communities of color.

The nation’s racial health disparities were laid bare during the COVID-19 pandemic, when the virus killed Black, Hispanic and Indigenous people at higher rates than white people. The police murder of George Floyd in May 2020 also fueled a racial reckoning across the nation, prompting efforts by states, universities, health systems and the federal government to address racial health disparities.

Those approaches ranged from targeted vaccine campaigns and efforts to enroll more people of color in clinical trials to corrections of diagnostic tests that relied on inaccurate information about race and biology.

Communities of color have long had less access to health care, increased exposure to environmental pollutants and higher rates of certain chronic illnesses and cancer deaths. They also have more diabetes-related amputations because of a lack of access to care. And specific genetic diseases, such as sickle cell disease, disproportionately affect Black people.

“COVID revealed the impact of health disparities to individual health — as well as how not addressing these disparities undermines the health system for everyone,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

Now, many of the programs trying to address health disparities are being rolled back.

As a result, health policy experts, clinicians and researchers fear those disparities will widen as states, universities and nonprofits grapple with lost federal dollars while the administration continues to limit federal funding for DEI programs. In July, the U.S. Department of Justice released guidance saying such initiatives should not receive federal funding, alleging they are “discriminatory.”

Entities that receive federal funds “must ensure that their programs and activities comply with federal law and do not discriminate on the basis of race, color, national origin, sex, religion, or other protected characteristics—no matter the program’s labels, objectives, or intentions,” the news release said.

Several state and local health officials were reluctant to speak with Stateline on the record about how the federal administration’s DEI crackdown has left them in a bind, fearing retaliation or targeting by the federal government. The White House did not respond to Stateline’s request for comment.

“My concern about what the administration is doing is that they are, in effect, making these disparities worse,” Benjamin said. “Everybody’s health is not the same. … It’s important to know that the disparities are really profound.”

Benjamin added that the cumulative effect of disparities means more late-stage disease — costing both patients and health systems more.

“There’s a trope or misunderstanding out there that DEI is a ‘woke’-related agenda. DEI is not a ‘woke’ agenda. DEI is an American agenda, because it’s really one that is the same thing as ‘rising tides lift all boats,’” said Brandon Wilson, senior director of Health Innovation and Public Health at Community Catalyst, a health equity advocacy organization. “When you cut [resources] off, you’re actually disproportionately impacting those who are already impacted.”

‘Increasing need’

The administration canceled billions of dollars in grants from the National Institutes of Health (NIH), the Centers for Disease Control and Prevention, the Environmental Protection Agency and the Department of Health and Human Services.

Many of the grants helped recipients create solutions tailored to their communities’ needs and strengths.

At least three dozen state, local and territorial health departments have had pandemic-era grants that addressed health equity terminated. While originally focused on COVID-19, agencies have since used that grant money for other public health efforts: testing and contact tracing for a wide range of diseases, better data reporting, and community partnerships that address social and environmental effects on health.

The money was part of a $2.2 billion national health equity initiative that aimed to address vulnerabilities and protect those communities ahead of the next outbreak.

The Department of Health and Human Services told media such cancellations were due to the pandemic emergency ending in 2023.

At NIH, the administration terminated more than 5,400 NIH research grants, although about 2,800 were reinstated. Canceled grants included research toward illnesses like HIV and AIDS, which disproportionately affect Black and Hispanic people as well as gay and transgender people.

The Trump administration has also gutted federal offices dedicated to fighting disparities, including the Offices of Minority Health under the Centers for Medicare & Medicaid Services and the Department of Health and Human Services.

At the state level, the Arkansas Department of Health recently shut down its own minority health-focused office. Ashley Whitlow, a spokesperson for the department, said in a statement that it “relies on federal grant funding to support a variety of public health programs.”

“The recent reduction in program staff reflects the Arkansas Department of Health’s ongoing efforts to operate more efficiently with the resources available. Despite these changes, ADH remains fully committed to serving communities across the state,” the statement said.

Meanwhile, Maryland’s Department of Health said its minority health office is funded through state general funds and not directly impacted by the federal cuts.

The nation has seen a spike in congenital syphilis cases, which disproportionately occur among Black and Indigenous families.

“Regardless of whether you’re at the highest risk, any outbreak that’s not controlled can spread widely and broadly, and you can see that that’s what’s happening with measles,” said Dr. Julie Morita, former executive vice president of the Robert Wood Johnson Foundation and former health commissioner Chicago Department of Public Health.

But states likely can’t replace all the lost federal dollars.

“You’ve got declining capacity, and increasing need — which is a formula for problems,” said Richard Frank, director of the Brookings Institution Center on Health Policy.

“It’s impossible to make all that up with state and local dollars,” he continued. “You’re going to see programs that serve real people getting pulled back.”

Frank and Wilson also expressed concern about the Medicaid changes included in the broad tax and spending law President Donald Trump signed in July. The law is projected to cut federal Medicaid spending by an estimated $911 billion over the next decade, largely because new work requirements will push people off the rolls. Data shows the majority of Medicaid enrollees already work, and experts say many will be kicked off the rolls due to difficulties in states’ reporting processes. Black and Hispanic people are disproportionately represented on the Medicaid rolls.

OB-GYN Dr. Versha Pleasant, a clinical assistant professor at the University of Michigan, directs the Cancer Genetics and Breast Health Clinic at Von Voigtlander Women’s Hospital. She treats patients at high risk for breast and ovarian cancers. Black women have an almost 40% higher risk of death from breast cancer than white women.

“That, to me, is unacceptable,” she said, adding that such disparities speak to the need for ongoing programs to “provide everyone with a fair chance at leading a long and healthy life.”

“If we don’t make a special effort to save the most vulnerable lives … where does that leave us?” she continued. “The changes that we’re seeing are only going to magnify preexisting challenges.”

Data and dollars

Dr. Sarah Rudman, acting public health officer at the Santa Clara County Public Health Department in California, and others have told Stateline that federal officials are informing health agencies that race and ethnicity data are no longer required to be reported.

“We are being asked to change the way we collect our own data here and report it,” Rudman said, adding that her county is going to continue collecting data to “understand who is here, who’s experiencing what health outcome and what they need.”

Many families, in the shadow of the county’s Silicon Valley, still struggle with poverty — more than 27,000 children suffer food insecurity, United Way Bay Area says.

“It is sometimes surprising and striking to people to understand how much poverty and other types of vulnerability are hidden among the more visible wealth of Silicon Valley, and that’s where we’ve dedicated our resources,” Rudman said.

“It’s hard to even imagine what my colleagues in smaller areas of California or in other parts of the country are experiencing,” she added about lower-income counties. “We are feeling extremely strained and already in our second round of layoffs, knowing that many more are likely. So I think that the hits are going to be that much more significant in areas who have less resources than we do.”

Federal officials also canceled the county’s $5.7 million grant to address COVID-19-related disparities, used to shore up vulnerable communities ahead of the next disease outbreak, natural disaster or heat wave, Rudman said. The money helped the county conduct basic laboratory testing and vaccine outreach for a wide range of diseases, not just COVID-19.

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