More than 200 American mayors are calling on the federal government to reverse changes that will cost states billions and push millions of people off the food stamp program.

This week, the United States Conference of Mayors asked the U.S. Senate’s agriculture committee to reconsider the deep cuts to the Supplemental Nutrition Assistance Program, or SNAP,  enacted in last year’s One Big Beautiful Bill Act. In addition to imposing new eligibility and work requirements for recipients, the law will require states for the first time to fund some SNAP benefits themselves beginning in fall 2027.

The 210 mayors who signed a letter to Senate leaders said they are on the “front lines of a deepening food security crisis” and said the federal government should be expanding access to food, not creating new obstacles.

That letter was signed by Democratic and Republican mayors leading major cities such as Baltimore, Las Vegas, Oklahoma City and St. Louis, as well as smaller communities including Lima, Ohio; Manhattan, Kansas; and Muskegon, Michigan. The U.S. Conference of Mayors is a nonpartisan organization representing the more than 1,400 leaders of cities with populations of 30,000 or more.

“When we’re talking about how to make sure that our residents are fed, that is something that worries Republican mayors, it worries Democratic mayors, it worries independent mayors. It worries everybody,” Matt Tuerk, the Democratic mayor of Allentown, Pennsylvania, said in an interview with Stateline.

Tuerk, who leads the national organization’s Children, Health, and Human Services Standing Committee, said his constituents are already struggling with the high costs of housing, utilities and groceries. 

“Now they’re worrying about their ability to even pay for those needed groceries without those SNAP benefits,” he said. 

Already, more than 4 million Americans have lost SNAP benefits, putting more pressure on food banks and food pantries across the country.

Federal officials have argued that changes were necessary to root out fraud and waste from the food stamp program. 

Tuerk said philanthropic groups don’t have the resources to serve as the national safety net, and city and states are already facing tight budgets that cannot fill the void left from federal cuts. 

“And there’s no adequate replacement for food,” he said. “And I can say that as a kid who had a free lunch card … Without food stamps, I wouldn’t be where I am right now.”

The mayors are also asking Congress to delay implementation of new requirements that some experts expect could cost states more than $9 billion.

The new law will penalize states depending on their payment error rates — a technical calculation by the feds of SNAP overpayments and underpayments, not fraud. States with a payment error rate above 6% will have to fund 5% to 15% of their benefit payments. Previously, the feds provided the aid.

Last month, Agriculture Secretary Brooke Rollins said in a statement new error rate data was “further proof that state accountability is severely lacking” in the SNAP program.

But the mayors group said states need more time to improve their error rates and budget for additional costs.

“Rising costs of living, stagnant wages, and reduced federal support are converging to create conditions that municipal governments are increasingly challenged to address on their own,” the mayors’ letter said.

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

WASHINGTON — Advocates and public health experts urged Republicans in Congress on Wednesday to implement a two-year delay on requiring states to begin sharing the costs for Supplemental Nutrition Assistance Program benefits. 

Provisions of the Republican-backed law that President Donald Trump signed last year that go into effect in October 2027 will require states with high SNAP error rates — the percentage of benefits that are overpaid, underpaid or go to recipients who are ineligible — to begin covering some of the program’s costs. It marks a stark change for SNAP, which is solely funded by the federal government. 

In an online briefing hosted by the left-leaning think tank Center on Budget and Policy Priorities, the American Academy of Pediatrics and Invest in Louisiana, speakers said Congress should use the government funding process to protect access to affordable food for American families. 

Sharon Parrott, the center’s president, said that Republicans are “looking right past this emergency” and using their current budget resolution to help farmers struggling with increased costs that have resulted from Trump’s tariffs and oil prices that have been driven up by the war with Iran — but not low-income grocery shoppers.

“Republican leaders in Congress are ignoring the urgent need to help low-income families and kids who are losing SNAP and can’t afford groceries,” she said. “Congress could use the budget process to help both farmers and families. At a minimum, Congress needs to slow down the hasty implementation of the massive cost-shift in SNAP costs to states.”

She said that since the GOP law, called the One Big Beautiful Bill Act, altered SNAP eligibility requirements, more than 4.5 million people have stopped receiving food assistance benefits. Nearly one-third, 1.5 million, are children. 

The nonpartisan Congressional Budget Office estimated the changes to SNAP would reduce federal spending by nearly $190 billion over the next 10 years.

Local leaders push back

Wednesday’s briefing comes amid similar calls from community organizations and state and local leaders from across the country. 

On Monday, the United States Conference of Mayors sent a letter to leaders of the Senate Agriculture Committee asking them to reconsider SNAP changes enacted over the last year and shifting funding to states. 

“At a time when many Americans continue to face economic challenges, we should be working to expand opportunity and food security, not create new barriers to assistance,” the letter, signed by more than 200 mayors, read. 

Senate Minority Leader Chuck Schumer said in a statement Monday that Republicans and Democrats must work together to draft a farm bill that restores SNAP and protects funding for food assistance. 

Schumer added that he will not support any farm bill that does not provide states more time to prepare to shoulder the program’s costs. 

Time is running out to get a cost-shift pause through Congress. 

The House is scheduled to adjourn Friday, and won’t be back in session until Aug. 31. Even then, it will just be back for a few weeks, before again adjourning for almost all of October. The Senate will adjourn after the first week in August and will similarly be out for the beginning of September and almost all of October. 

All about the error rates

The One Big Beautiful Bill Act will require most states with error rates of above 6% to cover between 5% and 15% percent of the benefits’ total cost. States under a 6% error rate will be exempt. 

But some states with the highest SNAP error rates — of about 13.3% or higher — will be given an extension to lower their error rates before being forced to bear some of the program’s costs. Depending on the error rate, the states will be granted up to an extra two years to begin sharing costs. 

“Congress can act right now to stop the bleeding and steer us away from this oncoming childhood hunger crisis by extending that same two-year delay to every state — not just the few that benefit from the existing carveout,” said Ty Jones Cox, the budget and policy center’s vice president for food assistance. 

States with the highest error rates in fiscal 2025 included Alaska at 23%, and Delaware and New Mexico both at approximately 16%, according to U.S. Department of Agriculture data. 

Cox said the center estimates nearly half of U.S. states will likely have to pay $100 million or more because of the cost-sharing changes. 

“These are huge costs,” she said. “States are working hard to reduce their error rates, but they’re up against the wall. The law didn’t give them any time or resources to do so.”

Cox said that states that plan to maintain SNAP benefits will have to find the funding from other places, if they are unable to generate more revenue. She said some states may choose to eliminate summer EBT or end universal school meals to continue funding the program. 

Given the steep costs, some states, such as Alabama, have floated the possibility of cutting their SNAP programs entirely if they are unable to lower error rates, Parrott said. 

Public health impacts

The effect of losing SNAP benefits extends beyond food insecurity, said Andrew Racine, president of the American Academy of Pediatrics. 

Besides clean air and water, and a supportive family and environment, he said, food is the most important determinant of a child’s health and future success. 

Racine added that the long-term benefits of SNAP are not being taken into account when decisions regarding its future are made. 

“The benefits of SNAP accrue to that child, accrue to that family, but they accrue to people around them,” he said. “[If] you have a child who’s not suffering from hunger in the classroom, and their ability to concentrate is improved, that has impact on their fellow classmates who are not on SNAP.”

Wisconsin Republican U.S. Sen. Ron Johnson is set to take up the gavel as chairman of the Senate Budget Committee following the death of Sen. Lindsey Graham (R-South Carolina) — giving Johnson significant sway over federal spending decisions as President Donald Trump and congressional Republicans push to pass a third budget bill before this fall’s midterm elections. 

Johnson, the fourth most senior Republican on the budget committee, is in line to get the position because Sens. Chuck Grassley (R-Iowa) and Mike Crapo (R-Idaho) already chair the Judiciary and Finance committees and Sen. John Cornyn (R-Texas) is on his way out of the Senate after losing his May primary. 

In a statement, Johnson’s office said he would focus on working with the House and White House to determine what is possible to include in a budget reconciliation bill in the limited time before November. 

“Senator Johnson supports drafting and passing Reconciliation 3.0, and he will work diligently with all the relevant parties in the Senate, House, and White House to determine what is possible to achieve,” Johnson spokesperson Grace Carnathan said. 

The push for a third reconciliation bill includes Trump’s proposed $350 billion in additional money for  the Pentagon during the ongoing war in Iran. Johnson also said he’s working with Wisconsin Republican U.S. Rep. Bryan Steil to sidestep the filibuster and push through the SAVE America Act, imposing new restrictions on voting, through the budget reconciliation process, Politico reported. 

Johnson told the outlet that despite not officially having the gavel yet, he’s working to get ready for the job. 

“I’ve already met with Lindsey’s staff this afternoon,” he said Monday about picking up where Graham’s effort left off. 

Since being elected to the Senate for the first time in 2010, Johnson has promoted an image of himself as a budget hawk devoted to shrinking the size of the federal government. He’s also regularly supported Republican tax cut bills while using his platform to spread his anti-vaccine beliefs, climate change denial and support for Republican conspiracy theories about election administration. 

“Johnson is likely to do as much as he can to cut government spending in the remaining months of 2026,” Barry Burden, a professor of political science at UW-Madison, told the Examiner. “His party is very likely to lose control of the House and possibly the Senate, ending the opportunity to use the streamlined budget reconciliation process to enact cuts when the new Congress is seated in early 2027.”

Burden added that Johnson will “probably be more aggressive” about reducing federal spending, adding restrictions on voting and expanding the healthcare cuts made in last year’s One Big Beautiful Bill Act. 

“Without a reelection of his own to worry about in Wisconsin, Johnson has the freedom to devote himself to being a budget warrior in the waning days of the Republican trifecta,” Burden said. 

In recent months, Johnson has endorsed calls from some Republicans and Trump to end the Senate’s filibuster rules,  which require that non-budget legislation receive 60 votes to pass, in order to push through the SAVE America Act. Johnson said at the Republican Party of Wisconsin convention in May that Republicans should nix the filibuster now to preempt Democrats doing so if and when they get control of Congress and the White House. 

Wisconsin Sen. Tammy Baldwin, a Democrat, said in a statement she hopes Johnson uses the role to help Wisconsinites rather than focusing on slashing government services.

“Senator Ron Johnson and the budget committee greenlit the biggest cut to Medicaid and food assistance in history, all while increasing the national debt by $3.4 trillion over the next decade,” Baldwin said. “Now that he’s poised to take the gavel, I hope he will use this opportunity to deliver for the people of Wisconsin and help lower their costs moving forward – not deliver more cuts to Wisconsinites’ health care or spend more on this war in Iran.”

Jeff Mandell, general counsel of the voting rights focused firm Law Forward, said that given Johnson’s history of advocacy for harsh restrictions on voting and on behalf of Trump’s efforts to overturn the 2020 election, putting him in control of the budget committee is alarming. 

“The Save Act would interfere with long-standing and well functioning election laws in Wisconsin leading to disenfranchisement of Wisconsin voters,” Mandell said. 

Upcoming funding shifts in the federal food stamp program are poised to cost states billions of dollars, heightening fears that more Americans will lose access to the nation’s largest food assistance program.

Last year’s One Big Beautiful Bill Act made major changes to the Supplemental Nutritional Assistance Program, or SNAP, including new eligibility and work requirements. Already, more than 4 million Americans have lost SNAP benefits, putting more pressure on food banks and food pantries across the country.

But beginning in fall 2027, states for the first time must begin to fund some SNAP benefits themselves. Analyses of newly released data from the U.S. Department of Agriculture show states could be on the hook for more than $9 billion. Some states, county officials and advocates fear this will remove more Americans from the safety net program and even push some states to consider dropping out of SNAP altogether.  

The new law will penalize states depending on their payment error rates — a technical calculation by the feds of SNAP overpayments and underpayments, not fraud. States with a payment error rate above 6% will have to fund 5% to 15% of their benefit payments. Previously, the feds provided the aid.

In USDA’s most recent analysis, the error rate slightly improved across the states in fiscal year 2025, but officials said states still made a collective $10.1 billion in improper payments. 

“These payment error rates are further proof that state accountability is severely lacking in SNAP,” Agriculture Secretary Brooke Rollins said in a June news release. 

As many as 36 states will face new cost share requirements in the fall of 2027. And nearly half of those are expected to be on the hook for $100 million or more a year, according to the left-leaning Center on Budget and Policy Priorities.

For example, in Michigan, the current error rate could cost the state $300 million a year, the center estimates. Texas could be on the hook for an estimated $725 million and New York may need to spend more than $1 billion. 

“States are going to have to make some really painful decisions as they have to balance their budgets about how they are going to cover those costs, and if they can’t fully cover the required cost-sharing requirement, by raising revenue or cutting elsewhere in their budget,” said Katie Bergh, senior policy analyst at the center. 

The change is heightening fears that states will slow down benefit approval, cut access or even choose to drop out of the program altogether, Bergh said. While advocates and some officials have unsuccessfully pushed Congress to reverse its SNAP changes, many are now asking for at least a delay in implementation to give states time to improve their payment error rates.

After USDA released its new data last month, New Jersey Human Services Commissioner Stephen Cha said the error rate measurement is “fundamentally flawed.” Though the state significantly cut its error rate from 14.33% to 6.86%, it could still be on the hook for an estimated $100 million. 

Cha reiterated previous calls for Congress and the Trump administration to eliminate or delay the changes.

“Penalizing states will do nothing to improve payment accuracy or meaningfully address waste, fraud, or abuse,” Cha said in a statement. “Instead, they impose a significant financial and administrative burden on State and county governments, threatening our ability to effectively administer SNAP and meet the critical needs of families across New Jersey.”

In a statement to Stateline, a USDA spokesperson noted states have had decades to improve erroneous payments. “Perhaps now, States will stop spending other people’s money so recklessly,” the statement said. 

Looming budget pressures

In 10 states — California, Colorado, Minnesota, New Jersey, New York, North Carolina, North Dakota, Ohio, Virginia and Wisconsin — counties administer the SNAP program. 

The National Association of Counties has said the cost shift will threaten not only food access, but could squeeze the ability of counties to fund public safety, emergency management and infrastructure needs.

“These cost shifts threaten to destabilize county budgets, forcing reductions in staffing and delaying critical nutrition assistance for vulnerable residents,” association CEO Matthew Chase said in a letter last year to congressional leaders. 

The National Conference of State Legislatures, which represents lawmakers and legislative staff, said states are committed to administering SNAP benefits accurately and to being held accountable for their performance. But in a statement, the organization said USDA’s most recent data “make clear that additional time is needed” to implement meaningful improvements. 

State efforts to improve their payment accuracy also have substantial tradeoffs.

This spring, the Urban Institute and the American Public Human Services Association surveyed all SNAP agencies across the country. Thirty-nine states responded to the survey, representing a 78% response rate.

The survey found that SNAP administrators are investing in staffing, technology and automation to respond to the federal law. But many states are turning away from efforts to improve timeliness and may have to reduce staffing and benefits to comply. 

In the survey, 29% of states identified narrowing eligibility policies as a potential risk and 11% saw a wholesale withdrawal from SNAP as a potential risk. 

Oklahoma Gov. Kevin Stitt, a Republican, said churches, food banks and other organizations would ensure that people are fed there.

Stitt, the chair of the bipartisan National Governors Association, said he believes federal programs like SNAP are operated with “a lot of fraud and abuse.” He also suggested that the program had become too seamless, with cards that resemble credit cards allowing recipients to easily purchase groceries. 

“Maybe it’s going back to the day where there was a little stigma attached and you had to actually go to a food bank and pick up commodity cheese and commodity groceries, and it had a little stigma so you were a little bit embarrassed,” he told Stateline. “Maybe we should go back to a little bit of that instead of just making it so easy…” 

“Nobody’s going to go hungry in Oklahoma,” he said. “…I can assure you people were eating, getting married, graduating from high school before we even had anything called SNAP benefits.”

The error rate

The federal focus on error rates is incentivizing states to slow down or entirely halt benefits in some cases, said Gina Plata-Nino, SNAP director at the Food Research & Action Center, a nonprofit working to combat hunger.

That’s because states face no penalty for wrongfully denying benefits, she said, only for paying too much or too little in benefits. The rate, calculated by a random sample of households, adds the number of overpayments and underpayments together. And states can still be penalized for overpayments they later recover from recipients. 

Missouri could be on the hook for $150 million in food benefits due to error rate

“There is no oversight in terms of the people who are eligible and being cut off,” Plata-Nino said. 

In Massachusetts, nearly 175,000 people lost SNAP benefits between July of last year and May of this year. And understaffing at the Department of Transitional Assistance has caused thousands of incoming phone calls from residents to get disconnected, according to the Massachusetts Law Reform Institute, a poverty law and policy center.

That organization has pushed for more caseworkers, though a legislative budget proposal last week would cut $26 million from existing operations, said Victoria Negus, senior economic justice advocate at the institute.  

“What is happening is a version of what I’ve been calling ‘can’t see the forest for the payment error rate trees,’” she said. “They have set up this system that forces states to try to meet a number that is almost impossible for them to meet without fully decimated access to SNAP, because it takes time to methodically and carefully reduce payment error rates.”

In Alabama, officials said the state continues to prioritize staff training, automation and other changes to reduce the state’s error rate. The current error rate of 9.52% could cost the state an estimated $170 million.

Tennessee taxpayers could foot bill for some SNAP costs if state’s error rate doesn’t improve

Alabama’s legislature has set aside nearly $150 million for the SNAP program. But state Sen. Greg Albritton, a Republican who leads the budget committee, told the Alabama Reflector in April that those funds won’t be released unless the state can reduce its error rate to 6% or develop another plan to cover costs of the federal cuts. 

Kathryn Shoupe, spokesperson for the Alabama Department of Human Resources, noted that the federal data can be over a year old. She also noted that it isn’t evidence of fraud, but usually unintentional reporting errors from recipients.

LaTrell Clifford Wood, the hunger policy advocate at the anti-poverty nonprofit Alabama Arise, said the state needs hundreds more employees to fully meet the need. She noted that more than 52,000 people have already lost SNAP benefits in Alabama. And with rising grocery prices, she said the focus on the error rate will force difficult budgetary decisions that could affect other parts of the state budget, such as education.

“It is a metric with moral ambiguity,” she said. “We are putting paper pushing over people.” 

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

One year ago, President Donald Trump signed the first piece of legislation Republicans in Congress had introduced at the start of his second term.

Passed using the complicated budget reconciliation process that enabled GOP lawmakers to enact the legislation without Democratic votes, HR 1 paired $4.5 trillion in tax cuts over 10 years with $1 trillion in cuts to federal healthcare programs as well as other initiatives to cut federal spending.

With the legislation’s first birthday on July 4, critics of the Trump administration and Democratic politicians have been using every opportunity to highlight the legislation’s role in driving unpopular results.

Healthcare cuts are among the most prominent of those outcomes. They include a series of changes to Medicaid — the state-federal health insurance program for people at or below the federal poverty guideline, with annual incomes of just under $16,000 per year for a single person or $33,000 for a family of four.

For medical and hospital care, Medicaid is called BadgerCare in Wisconsin. Medicaid also covers long-term care services for people who qualify, including home healthcare for the elderly and people with disabilities, and goes under a variety of names including Family Care and IRIS.

On Tuesday, the anti-Trump political activist group Indivisible and members of the healthcare union SEIU Wisconsin gathered in front of the Wisconsin Republican Party headquarters in Madison with an out-of-service ambulance to denounce  cuts to healthcare attributed to HR 1.

“We are here to give voice to the millions of Americans who have lost access to healthcare and to the tens of thousands of Wisconsinites who have lost healthcare,” said Jean Grow, co-leader of Indivisible’s Milwaukee chapter.

The group aimed its barbs not just at Trump but at Republican U.S. Rep. Tom Tiffany, the party’s nominee for governor in the November 2026 election, who voted with the rest of his party in the U.S. House of Representatives for HR 1.

“Who in this state is primarily responsible for these cuts? Tom Tiffany,” Grow said, to hearty jeers from the crowd of about two dozen during the lunchtime protest.

HR 1 also cut the federal nutrition assistance program SNAP — known as FoodShare in Wisconsin — by 20% by 2034, about $187 billion.

The changes will pass on to most states a portion of the program’s costs, which the Center on Budget and Policy Priorities in Washington says could lead “the lowest-income people, including children, older adults, veterans, and people with disabilities” in every state to lose access to food assistance.

The so-called One Big Beautiful Bill Act “has been brutal for Wisconsin families,” said Secretary of State Sarah Godlewski, a Democrat who is running for lieutenant governor, at a press conference Wednesday at the Democratic Party’s Capitol Square offices that focused on Tiffany’s record.

“We know that the impact it’s going to cause — things like potentially 270,000 Wisconsinites are going to lose healthcare,” said Godlewski. “We know tens of thousands of Wisconsinites are going to lose access to FoodShare.”

While Trump and GOP congressional leaders initially called HR 1 the “One Big Beautiful Bill Act,” critics quickly mocked it as “the Big Ugly Law” or variations on that theme. In September, the Republicans rebranded the bill as “The Working Families Tax Cut.”

The CBPP, however, found that the tax cuts are “tilted to the wealthiest households.”

The Congressional Budget Office “finds that the new law’s program cuts and tax cuts will make households with incomes in the bottom 20 percent of the income scale worse off: they will lose more from the cuts in health coverage, food assistance, and other programs than they will gain in tax cuts,” the  CBPP reported in February.

For the bottom 10% by income, average annual incomes will fall by $1,200 — 3.1% — the CBPP reported, citing the CBO. Meanwhile, the top 10% will see their annual incomes rise $13,600 on average.

HR 1’s advocates said the healthcare spending reductions would only address waste, fraud and abuse.

Sen. Tammy Baldwin (D-Wisconsin) said during a virtual press conference in June that the changes — such as new work-reporting requirements for some Medicaid participants — would impose administrative burdens and red tape that will block people who are qualified to receive benefits.

“They’re trying to kick people who are fully eligible off the program,” Baldwin said. The press conference was organized by the advocacy groups Protect Our Care and Main Street Alliance.

Most of the Medicaid changes won’t take effect until 2027. Enrollment in the program has already been dropping, however. Federal data tracked by the Georgetown University Center for Children and Families show that in Wisconsin, more than 75,000 Medicaid recipients had left the program in the first five months of 2026.

Dr. Kristen Dall-Winther, a family physician in Birchwood, Wisconsin, also took part in the press conference with Baldwin.

“I see how access to affordable healthcare can make the difference between something that’s a manageable condition and a medical crisis. I also see the difficult choices patients are forced to make when healthcare becomes too expensive, which it generally, universally is now,” Dall-Winther said. “When funding is reduced, healthcare providers face greater financial strain, especially in rural areas where many of our facilities are already operating on razor-thin margins.”

State Medicaid agencies are concerned that many sick and disabled enrollees will lose their coverage because the Trump administration is narrowing the definition of who is “medically frail” enough to get an exemption from new work requirements.

Under the tax and spending law President Donald Trump signed a year ago, states that have expanded Medicaid to cover more adults under the Affordable Care Act — 40 states plus the District of Columbia — must mandate that those adults work, go to school or volunteer for at least 80 hours a month.

The so-called One Big Beautiful Bill Act exempts Medicaid recipients who are “medically frail,” with serious illnesses or disabilities. However, on June 1 the Trump administration published interim guidelines for implementing the law that specify that in order to qualify for the “medically frail” designation, a person must have a significant health condition and be significantly impaired in their ability to work.

“This rule helps Americans build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families,” said Dr. Mehmet Oz, director for the federal Centers for Medicare & Medicaid Services, in a statement earlier this month announcing the new guidance.

But states had been operating under the assumption that they would use the federal government’s traditional “medically frail” designation, which includes five distinct categories of disabilities and illnesses but does not require Medicaid agencies to determine whether the person can work.

States already were scrambling to set up systems to enforce the new work rules by the January 2027 deadline, according to Jocelyn Guyer, senior managing director at Manatt Health, a consulting firm that advises state Medicaid agencies.

“Now, it’s not enough just to have that diagnosis. You may need to go to your doctor and get a special note,” Guyer said. “So, it’s turned it from a very straightforward protection of people with disabilities and significant health conditions into a paperwork morass, where all of a sudden they have to get their healthcare providers involved in documenting and assessing their capacity to work.”

Earlier this week, 25 Democratic-led states plus the District of Columbia sued the Trump administration over the work requirement, largely on the basis of the changed “medically frail” guidelines.

Several state Medicaid agencies said they’re struggling to understand what they’ll have to do to comply. Even before the “medically frail” change, states were hiring consultants and creating IT systems to verify and track enrollees’ working status, which they never had to do before.

“Most states were working on identifying a number of diagnoses that may be able to meet that definition in hopes that that would align with what the final guidance said,” Melanie Bush, deputy secretary for the North Carolina Medicaid Division of Health Benefits, said. “But the layering in of impaired ability to work — there’s not necessarily a data source that aligns with that.”

Bush said states are focused on figuring out how to prevent eligible people from dropping off the rolls just because of paperwork and logistical challenges. One analysis estimates that five million people could lose coverage from the original work requirements alone. State leaders and consultants worry that figure could rise significantly with the new guidance.

Healthcare providers are worried, too.

“This is not what we’re trained to do. Most of us do not do disability determinations and employability assessments regularly, and even if we do feel comfortable with that role, we don’t have time, we’re not like we’re not paid to do that,” said Dr. Benjamin Sommers, a health economist at the Harvard T.H. Chan School of Public Health.

“Primary care providers, in particular, are already overworked and burning out.”

Still, Medicaid directors have experience in dealing with major shifts within the program, according to Michael Heifetz, a managing director at consulting firm Alvarez & Marsal and a former Medicaid director in Wisconsin. Heifetz said states regularly face major rule changes and tight timeline challenges, and with greater access to advanced technology to help automate some tasks, he’s confident they will be able to mitigate enrollment losses.

Another big help, he said, is that Medicaid enrollees will be allowed to “self-attest” to their eligibility for an exemption through 2027.

“States will work through it, and they will again work with the advocacy community to minimize the impact on beneficiaries,” Heifetz said. “There is still some ambiguity in the rule about how self-attestation will work in 2027, because the rule reads that other sources of information and documentation must still be sought, but in the end, self-attestation will prevail.”

Jennifer Tolbert, an expert on state health policy at health research group KFF, said there are several data sources states might tap to determine a person’s ability to work, such as insurance claims, prescriptions and a person’s use of durable medical equipment.

She cautioned, however, that it will be a challenge to use such data to make thoughtful determinations, especially for people with substance use disorders and mental health issues.

To keep eligible people enrolled, California will use text message alerts, mailed notices, and electronic reminders to make sure recipients meet verification deadlines, according to Anthony Cava, a spokesperson for California Department of Health Care Services. Nevertheless, Cava said, the state is concerned that people, including those with serious illnesses and disabilities, will drop off the rolls “solely due to paperwork barriers.”

Adela Flores-Brennan, Colorado’s Medicaid director, said states could come under fire for making errors.

“We’re also worried about audits,” Flores-Brennan said. “There are new penalties for states, bigger penalties for states related to error rates, and the level of complexity that is being introduced into eligibility right now is making an environment that is ripe for errors because it’s confusing and it’s complex.”

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

Twenty-five Democratic-led states plus the District of Columbia have sued the Trump administration over its new work requirements for people who get their health insurance through Medicaid.

At issue is a “medically frail” designation that the states say is too narrow and will make it too difficult for ill and disabled people to remain on Medicaid.

They’re challenging the administration’s guidance on who can be exempt from the work requirements included in the so-called One Big Beautiful Bill Act, the broad tax and spending measure President Donald Trump signed a year ago.

Medicaid is the publicly-funded health insurance for people with low incomes. Under the One Big Beautiful Bill Act, states that have expanded Medicaid eligibility to more adults under the Affordable Care Act — 40 states plus the District of Columbia — must require those adults to prove they’re working, going to school or serving their communities for at least 80 hours a month to receive Medicaid. Georgia, Tennessee, and Wisconsin, which have used federal waivers to expand their Medicaid programs, are also subject to the new work rules.

The new lawsuit specifically targets new federal guidance that narrows the definition of who can qualify as “medically frail,” a key exemption used to excuse Medicaid recipients from work requirements if they have serious disabilities or illnesses. The guidance came in the form of an interim final rule published this month by the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS).

The Democratic attorneys general and governors who are plaintiffs in the suit claim the feds surprised them with this new rule months after they’d already been working with CMS on how to implement the work requirements.

“This eleventh-hour attempt to further narrow protections for medically frail Medicaid recipients seeks to punish those who cannot fend for themselves,” said Rhode Island Attorney General Peter Neronha, a Democrat, in a statement.

“Further, this Administration is once again attempting to sidestep Congress by unlawfully reinterpreting the law, and coercing the states to rush to implement their last-minute changes or face penalties,” he said.

To qualify as “medically frail” and therefore exempt from work requirements, the new guidance says, a Medicaid recipient must have a significant health condition and be significantly impaired in their ability to work. It’s a distinction the states say Congress did not make in the One Big Beautiful Bill Act.

The states also claim the new guidance violates federal law by ignoring evidence that work requirements cause people to lose coverage due to red tape.

For example, Arkansas tried instituting work requirements for Medicaid recipients in 2018, during Trump’s first term. A federal judge halted the policy less than a year later, after 18,000 adults had lost coverage. Studies later found that Arkansas’ work requirements didn’t increase employment. A recent analysis from the Urban Institute projects that 3-7 million people could lose coverage because of the new work requirements.

Supporters of the new work rules say they are sufficiently flexible and that the category of who qualifies as “medically frail” remains broad.

“This rule helps Americans build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families,” said Dr. Mehmet Oz, director for the Centers for Medicare & Medicaid Services, in a statement earlier this month announcing the new guidance.

The lawsuit says states have already invested significant resources into implementing the new work requirements based on the original law’s language and prior federal guidance. They’re staring down an August 31, 2026, deadline for notifying Medicaid recipients about changes to the “medically frail” designation, a timeline the states say is not workable. They face financial penalties for not meeting the deadline.

States are expected to put the new work requirements into place by January 1, 2027, though the feds could choose to grant them temporary extensions through 2028.

The lawsuit was filed by the attorneys general of Arizona, California, Colorado, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, Virginia, Washington and Wisconsin, as well as the governors of Kentucky and Pennsylvania.

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

WASHINGTON — Republicans have one more opportunity to use the complex process they relied on to enact their “big, beautiful” law and provide tens of billions in additional funding for immigration enforcement — a chance that becomes less likely the more divisions over a voter identification bill splinter the party. 

Debate over a third reconciliation bill has been simmering in the background for months, though GOP lawmakers have yet to reach consensus about whether they should draft another massive package, like they approved last year, or a more narrow one that could help the party boost defense spending.

That budget reconciliation process gives Republican leaders a way to get around Senate rules that would otherwise force bipartisanship, giving them a loophole out of negotiating major legislation with Democrats. 

But it comes with several hurdles in order to get that special treatment, including that each provision in the bill have an impact on federal revenue or spending that is not deemed “merely incidental” by the Senate parliamentarian. 

Those in-the-weeds restrictions aren’t especially important to President Donald Trump, who wants Republicans in Congress to prioritize a voter identification bill, which cannot move through reconciliation, over everything else.

House Speaker Mike Johnson, R-La., tried to find middle ground in late June, proposing lawmakers use reconciliation to create a grant program for states that implement voter identification requirements. 

Johnson acknowledged the challenges to using reconciliation amid narrow majorities in each chamber, but said he thinks Republicans can accomplish their goals if they “stick together.” 

He, however, didn’t have details to share. 

“Stay tuned. We’re working through that,” Johnson said. “Doing a reconciliation bill is a very complicated process of consensus building, where we have a collection of ideas that, I think, every Republican, certainly, agrees with in principle.”

A few hours later, sitting in the Oval Office, the president batted down the idea of any compromise on the elections bill, creating more public disagreement between the top Republicans in the country. 

“Not really. No,” Trump said when asked whether he’d “be open to a compromise measure” moving through the reconciliation process. 

Hardball tactics

Lobbying for the full bill, which would require people show proof of citizenship to register to vote and a photo ID when casting a ballot, isn’t only coming from the president. 

Far-right Republicans in both chambers are using hardball tactics to cajole their leaders to get the legislation to Trump’s desk, even if it means delaying work on their colleagues’ priorities.

Utah Sen. Mike Lee is one of several Republicans posting on social media and holding press conferences. He recently called for Americans to “encourage your senators to resume debate on the Senate floor—with a plan to keep debating it until it passes.”

“Tell your senators: Pass the SAVE America Act,” Lee wrote in another post. “Accept no excuses or half measures.”

Senate Majority Leader John Thune, R-S.D., has become somewhat frustrated with constant pressure from some of his members, who are diverting time and resources to a bill that cannot pass. 

“At the end of the day, I have to deal with reality,” Thune said. “And sometimes the alternative universe that is X doesn’t reflect the facts on the ground.”

Thune said it’s been “very clear” for some time there isn’t enough support among Republicans to change the Senate rule that requires at least 60 lawmakers vote to limit debate on most bills. That legislative filibuster forces bipartisanship and gives the minority party, which could be Republicans as soon as next year, a seat at the table. 

“There are not the votes to nuke the filibuster and there aren’t going to be 10 Democrat votes to all of a sudden support the SAVE America Act,” Thune said. “Those are just hard realities and I think people at some point have to come to grips with that.”

Trump cancels signing for housing bill

West Virginia Republican Sen. Shelley Moore Capito said that despite months of effort, the voter identification bill doesn’t have the votes to become law. 

“If you can’t get to 60, you can’t pass it. I mean, that’s pretty simple,” she said. “Now, he says talk it to death and people will change their minds. I don’t think that’s a strategy that’s going to be in success. We tried that earlier this year to keep talking, we didn’t get to the end.” 

Capito said voters want to see Republicans focus on issues that can improve people’s lives, like the broadly bipartisan housing affordability bill both chambers approved this month. Trump was set to sign that bill during a ceremony on Capitol Hill but canceled at the last minute to try to push through the election bill. 

“So, yeah, they want to see us do something,” she said. “They don’t want to see us sitting up there yakking all the time.”

Senate Appropriations Chairwoman Susan Collins, R-Maine, wants to use the time to avoid another government shutdown when the next fiscal year begins Oct. 1 — no easy feat following three shutdowns over the last year. 

Senate Agriculture Committee Chairman John Boozman, R-Ark., hopes to reach final agreement on the farm bill in the months ahead after years of delays and stopgap measures for those agriculture and food safety net programs. 

He brushed aside demands from some other GOP lawmakers to use the budget reconciliation process to pass another party-line package.

“We had trouble with the one that we just did and that was very, very narrow. I mean, that was strictly Homeland Security,” Boozman said. “When you start doing a bigger package, like they’re talking about and you start involving various committees, it becomes a lot more issues involved that you have to work out. And so it just gets very complex.”

Boozman added that working through the several steps of that process takes weeks, which lawmakers may not have. 

Other priorities

Missouri Republican Sen. Josh Hawley said the party needs to focus on legislation that would lower “the cost of everything,” in part, by eliminating taxes on gasoline and health care.  

“That’s something that would be a huge benefit to every working person out there immediately,” he said. “Let them take all health care costs off of their federal taxes, so they paid no taxes on it.”

Louisiana Republican Sen. John Kennedy said he thinks lawmakers should use the budget reconciliation process to significantly bolster defense funding. But he said “duh” when asked by States Newsroom whether the limited number of days in session would make that difficult. 

Lawmakers are set to be out of session for nearly all of August and September.

“I think if we want to get more money for defense, we have to do it through reconciliation, which means we need to start immediately,” he said. 

Ohio Sen. Bernie Moreno has a lengthy list of issues he wants to see Republicans address before November, including a bill he’s set to release later this summer with Massachusetts Democratic Sen. Elizabeth Warren that would shore up the Social Security trust fund. 

“It’s not really a third-rail issue, because what we’re saying is that everybody should pay the same amount of money for Social Security,” he said. “When you have something that literally 90% of Americans support, I think we should be able to get something on that across the finish line.”

The two lawmakers wrote in an op-ed published in The New York Times the bill would raise the cap that ensures people don’t pay into Social Security on earnings more than $184,500.

“Since the vast majority of Americans make less than that, most people are paying Social Security taxes on 100 percent of their earnings while the highest earners are paying on only part of theirs,” they wrote.

“Why should a middle-class nurse pay a larger share of her paycheck — than a wealthy corporate lawyer?” they added. “This is doubly unfair in an economy in which top earners’ wages, over time, have pulled far ahead of those of the average worker.”

Iowa Republican Sen. Chuck Grassley said he’d like lawmakers to ensure E15 gasoline, a blend that includes 15% ethanol and is usually unavailable in summer, can be sold year-round, though he hadn’t thought about any other issues the party should press for ahead of November. 

“I guess I can’t answer your question,” he said. “I just haven’t thought about it.”

The days of ground beef and chicken legs are long gone at the Ritenour Co-Care Food Pantry just outside of St. Louis. The nonprofit has swapped out those staple proteins for cheaper ground chicken and hot dogs as it faces higher food costs and surging demand.

“We have to adapt just like everybody else,” Executive Director Angela Gabel said about rising grocery prices.

Last year, Ritenour spent about $120,000 on food. The pantry budgeted $180,000 for this year, though Gabel said that may not be sufficient.

And the number of people looking for food has increased: The pantry signed up seven new families on a recent weekday morning and expected to add 15 by the end of the day. Gabel said more people are traveling further to visit multiple food pantries each month to stock their shelves.

Families are facing rising grocery prices at the same time that many of the most vulnerable are losing access to the nation’s largest food assistance program, the Supplemental Nutrition Assistance Program, or SNAP. More than 4 million Americans lost SNAP benefits between February 2025 and this February, according to analyses of the most recent federal data. The numbers are expected to increase as states whittle the rolls further as required by the broad tax and spending law President Donald Trump signed last summer, known as the One Big Beautiful Bill Act.

“I’m absolutely terrified,” Gabel said. “We will absolutely do our best, but I think we were meant to supplement SNAP or to help in emergency situations. I just don’t think we can replace the government.”

After One Big Beautiful Bill Act, 100,000 Tennesseans’ lose SNAP food aid

Since the fall, states and counties that administer SNAP have been notifying residents who rely on food stamps that they must meet new work requirements or lose their food assistance. The federal tax and spending law ended exemptions to work requirements for older adults, homeless people, veterans and some rural residents, among others. The changes will put more pressure on states, likely leading to further benefit cuts as they reevaluate eligibility and begin paying for more program costs. The new rules also will further stress the already-stretched charitable food system.

Gina Plata-Nino, SNAP director at the Food Research & Action Center, a nonprofit working to combat hunger, noted that children, older adults and people with disabilities are most reliant on the program. The left-leaning Center on Budget and Policy Priorities estimated the average benefit per person this year would be $188 per month, or $6.17 per day.

“And a majority of them are making less than $1,100 a month,” she said. “So when you lose your SNAP benefit, it really does exacerbate your situation of having to choose between shelter, food, and other basic needs.”

Rising need for food

National data on hunger is limited since the Trump administration terminated the annual Household Food Security report last year. But other measures indicate that more people are missing regular meals.

In May, the federal Reserve Bank of New York found a “remarkable” increase in food insecurity across the country, with more people struggling than during the peak of the pandemic. Its national surveys last October and this February found more households dipped into savings accounts, relied on food donations or had trouble finding enough food to eat or had kids who missed meals.

Democrats and anti-hunger advocates have been urging Congress to rescind SNAP cuts for months. Current negotiations over reauthorizing the federal farm bill, which includes SNAP, have put the issue front and center in Congress. The House has passed a version of that legislation that won’t reverse the cuts.

Republicans have downplayed the effect of the changes and defended the SNAP cuts, arguing they are aimed at rooting out fraud and abuse.

U.S. Rep. Derrick Van Orden, a Wisconsin Republican, said he was raised in “abject, rural poverty,” by a single mother who relied on food stamps, subsidized lunches and government cheese.

But in late April, he urged support of the farm bill that cements cuts to the food stamp program.

“We do have to know that there is a tremendous amount of fraud that takes place in SNAP,” he said on the House floor, “and we want to make sure that every single dollar that is allocated to go to a hungry child or a veteran or one of our senior citizens goes to them.”

Last week, 23 state attorneys general wrote to Senate leaders who are now considering the farm bill, saying the Senate has an opportunity to “reverse course and reaffirm a bipartisan commitment that no American should go hungry because they cannot afford food.”

In Nebraska, where SNAP participation has dropped by about 11%, state lawmakers this year proposed legislation to ask the federal government for waivers from some of the new restrictions. Those bills, which did not advance, sought to protect benefits for veterans, former foster youth, homeless people and refugees.

But the problem demands a federal response, said Megan Hamann, the senior community organizer for food and nutrition access at Nebraska Appleseed, an advocacy nonprofit that works against poverty and discrimination.

“We’re going to be working with patchwork solutions in the meantime,” Hamann said. She described “a real reckoning as a result of loss of federal support and programming that has for a long time in our state and others offered stability and consistency that is no longer present.”

She said putting food on the table has become a widespread challenge for many in Nebraska as the price of housing, utilities and other everyday necessities squeezes household budgets.

“I talk to people on the daily who say, ‘I’m worried about the price of groceries, I’m worried about the price of gas, I feel like everything except for my wage is going up,’” she said.

Though generally focused on housing, the Omaha organization Restoring Dignity has launched a new food assistance program to help refugees who lost SNAP benefits late last year.

“A big chunk of what we do now revolves around food,” said founder and executive director Hannah Vlach.

Community donations allow Restoring Dignity to provide grocery store gift cards to those refugees. But the organization, which generally serves about 5,000 refugees per year, is helping only about 200 of the most vulnerable.

“Right now we’re just focused on the families who absolutely will be evicted and will be on the streets if they don’t get any assistance,” she said, “and I have no idea how those other families are surviving.”

Vlach emphasized that the federal government has specifically sanctioned the arrival of refugees her organization serves, many of whom served with U.S. troops in Afghanistan.

“This can’t become our new normal — this just can’t,” she said. “It’s unethical, it’s immoral.”

States triaging needs

West Virginian Raine Gibbons said she relies more on cheap staples such as pasta and pasta sauce, trimming the amount of meat and treats she buys.

She said her family of five recently saw a reduction in monthly SNAP benefits, which now provide just over $300 per month.

Gibbons supervises an in-home education program for parents at one of the state-run Family Support Centers, which provide parenting classes, baby supplies such as diapers and emergency food aid.

Aside from grappling with higher prices and reduced SNAP eligibility among clients, the West Virginians who rely on those 57 federally funded centers face an uncertain future because of unresolved state contracting issues.

“It’s really, really stressful,” Gibbons said. “It’s so hard to stay present and be the parent that you want to be when you’re worried about those daily struggles of just how to feed your family.”

Gibbons said SNAP is not a luxury, but an essential support for many families.

“It’s really what’s keeping families like mine — who do work outside of the home, who do have a full-time job — afloat to be able to feed our families and our babies, and try to just get through this economy.”

California lawmakers are trying to help fill some of the federal void in their state. Democratic Assemblymember Alex Lee is pushing to add $100 million to a state program that doubles the purchasing power of SNAP when used for fresh fruits and vegetables. Separate pending legislation would petition the federal government for a waiver, allowing California to maintain an exemption from work requirements for former foster youth.

In California, nearly one-third of all families with young children struggled to put food on the table between July 2024 and January 2026, according to survey results from the Stanford University Center on Early Childhood.

“States are in a position of trying to triage what is the most important need for families, when really families have all of these needs that are considered pretty basic,” said Abigail Stewart-Kahn, managing director of the center. “It puts states in an untenable position to try to make decisions of which gaps to fill and for whom.”

Stewart-Kahn said many families face immediate decisions of which bills to pay and which needs to forgo, but that the parental stress and childhood distress will have long-term consequences for society.

“Every time we make a policy change that potentially increases stress in the lives of a child, we are deciding as a society that we’re okay with harming their healthy development, so that the next generation will struggle further with everything from educational attainment to mental health challenges,” she said.

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