Kaitlin Cooke of Cartersville, Georgia, was contemplating suicide when she started calling a statewide mental health crisis line in 2018. She said she would sneak outside and call the hotline behind her car, where her boyfriend would not hear her.

The counselors who answered her calls were there for her when no one else was, she said. Each time she called, they spoke to her for at least 45 minutes. And they told her that life “does get better.”

“If it weren’t for this resource, I might have been a statistic,” said Cooke, now 31, who found a local therapist.

Starting in March, the call response record for that resource, the Georgia Crisis and Access Line, and its newer national counterpart, the 988 Suicide & Crisis Lifeline, plummeted in the state. The 988 line was created during President Donald Trump’s first term.

National data shows Georgia is one of several states that have struggled to keep their rates of disconnected or rerouted 988 calls low. Disconnected calls typically involve the caller hanging up, possibly after a long wait time. States are largely responsible for funding and staffing their 988 systems, with some money from the federal government. Mental health experts said proper funding for the 988 system in a state, through a well-staffed response network, can influence whether a caller is connected to a local counselor — or chooses to hang up.

The future of mental health services appears uncertain amid massive changes from the Trump administration, including Medicaid cuts that could limit access to care. The cuts could also lead states to consider reducing their allocations to crisis lines, said Heather Saunders, senior research manager for the Program on Medicaid and the Uninsured at KFF, a health information nonprofit that includes KFF Health News.

The stakes couldn’t be higher for callers experiencing severe mental health crises.

“Some of the callers are actively experiencing suicidal thoughts,” Saunders said. “Sometimes they actively have a suicide plan and it’s a very urgent situation.”

Alarm About Call Abandonment Rate

Georgia has contracted with Carelon Behavioral Health, a unit of insurance giant Elevance Health, to run its crisis lines. When Carelon dropped a subcontractor that managed staffing the lines, performance plunged. Abandoned calls spiked, which means more callers were hanging up or disconnecting before a counselor answered the phone, Kevin Tanner, commissioner of the state Department of Behavioral Health and Developmental Disabilities, pointed out in a letter to Carelon.

The state requires a call abandonment rate of 3% or less, and, Tanner wrote, the current rate was 18%. After sending the letter, the state narrowed its definition of abandoned calls, lowering the current rate. The state now counts only calls disconnected after being on hold for more than 30 seconds and not those rerouted to backup centers.

Carelon officials have acknowledged the dip in performance. They said it reflected a “necessary” transition from the company’s vendor and that they were hiring more staff to ensure the crisis lines could handle the demand. Carelon spokesperson Hieu Nguyen said the company is “committed to ensuring that every Georgian in crisis can access help through 988,” noting that calls not answered locally are routed to national backup centers.

With the help of some federal funding, Georgia is paying Carelon $17 million annually to manage 988 and its predecessor, the Georgia Crisis and Access Line, which is still operating. Crisis calls go to the same response team, whether someone calls 988 or the original state line. Carelon and state officials declined to disclose how much of the money went to the subcontractor, Behavioral Health Link, with Carelon saying it is proprietary information. The state can extend its contract with Carelon to 2032.

Camille Taylor, a spokesperson for the state Department of Behavioral Health and Developmental Disabilities, said in December that Carelon had improved its call response performance but that the state continues to monitor the company’s answer rates.

‘Enormous’ Staffing Challenges

Launched in 2022, the national 988 Suicide & Crisis Lifeline connects people experiencing mental health problems, emotional distress, or alcohol or drug use concerns to trained counselors. The free hotline, with the three-digit number mirroring the ease of dialing 911, aims to help avert mental health crises and reduce suicide risk. It also supports people who call for someone they care about.

“All behavioral health is having enormous challenges in terms of staffing,” said Margie Balfour, an Arizona psychiatrist and a member of a national 988 advisory committee. Being a crisis line counselor “is a very stressful job,” she said. “You’re talking to people at the peak of their crisis.”

In December, Georgia ranked near the bottom of the 50 states in percentage of calls answered that it kept in state, according to Vibrant Emotional Health, which administers the 988 line nationally. A high number of Georgia calls were routed to national call centers, data showed.

The latest national data also showed how different the response times to a 988 call can be. In December, it took one second on average if someone called from Mississippi. It took 74 seconds for a caller from Virginia.

While the unofficial industry target rate for answering in-state calls is 90%, more than half the states fell below that mark in December, according to the national data. In Georgia, the tracking data for 988 showed that more than 80% of crisis calls were answered within the state — until March, when the number dropped to 73%. Then it fell again in April, to 62%. The rate rose to 72% in October and reached 79% in December.

Local counselors “should be more familiar with the state infrastructure, mental health system, and resources that are available to people who live in the state,” said Saunders of KFF.

Pierluigi Mancini, interim president and CEO of Mental Health America, said it’s unlikely that an out-of-state counselor would know much about that state’s mental health system and providers. The service also sends many predominantly Spanish-speaking callers to out-of-state call centers, possibly hindering their connection to local help, Mancini said.

Since the 988 rollout, the volume of calls, texts, and chats to the crisis line totaled more than 19 million by November, according to the Substance Abuse and Mental Health Services Administration. A study found that with the national predecessor to 988, the National Suicide Prevention Lifeline, most suicidal callers who were later interviewed said their call helped stop them from killing themselves.

More than 49,000 Americans died by suicide in 2023. Nearly 17 million Americans ages 12 and older said in 2024 they had seriously thought about suicide in the previous year, according to the National Survey on Drug Use and Health.

For Generation Z adults, the oldest of whom are now reaching their late 20s, suicide is taking more lives than a decade ago when millennials were the same age, according to a Stateline analysis of federal death statistics. The largest increase in suicide rates for the age group was in Georgia, which jumped 65% from 2014 to 2024.

Mike Hogan, a consultant who ran mental health systems in three states, said recent Georgia data reflects “a bungled transition. It looks like performance fell off a cliff.”

For people calling a crisis line, he said, “counselors, with the right training, can talk people down and away from the suicidal crisis.”

Balfour noted that 988 has bipartisan support. The system can be improved, she said, emphasizing that it’s still an important resource that’s effectively helping people in crisis.

“988 is a success,” Balfour said. “And it’s work in progress.”

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Dressed in blue with a big ribbon in her blond curls, the 3-year-old sat in her mother’s lap carefully enunciating a classmate’s first name after hearing the words “best friend.” Just months ago, Gaile Osborne didn’t expect her adoptive daughter would make friends at school.

Diagnosed with autism at 14 months, Aubreigh Osborne started this year struggling to control outbursts and sometimes hurting herself. Her trouble with social interactions made her family reluctant to go out in public.

But this summer, they started applied behavior analysis therapy, commonly called ABA, which often is used to help people diagnosed with autism improve social interactions and communication. A tech comes to the family’s home five days a week to work with Aubreigh.

Since then, she has started preschool, begun eating more consistently, succeeded at toilet training, had a quiet, in-and-out grocery run with her mom, and made a best friend. All firsts.

“That’s what ABA is giving us: moments of normalcy,” Gaile Osborne said.

But in October, Aubreigh’s weekly therapy hours were abruptly halved from 30 to 15, a byproduct of her state’s effort to cut Medicaid spending.

Other families around the country have also recently had their access to the therapy challenged as state officials make deep cuts to Medicaid — the public health insurance that covers people with low incomes and disabilities. North Carolina attempted to cut payments to ABA providers by 10%. Nebraska cut payments by nearly 50% for some ABA providers. Payment reductions also are on the table in Colorado and Indiana, among other states.

Efforts to scale back come as state Medicaid programs have seen spending on the autism therapy balloon in recent years. Payments for the therapy in North Carolina, which were $122 million in fiscal year 2022, are projected to hit $639 million in fiscal 2026, a 423% increase. Nebraska saw a 1,700% jump in spending in recent years. Indiana saw a 2,800% rise.

Heightened awareness and diagnosis of autism means more families are seeking treatment for their children, which can range from 10 to 40 hours of services a week, according to Mariel Fernandez, vice president of government affairs at the Council of Autism Service Providers. The treatment is intensive: Comprehensive therapy can include 30-40 hours of direct treatment a week, while more focused therapy may still consist of 10-25 hours a week, according to guidelines released by the council.

It’s also a relatively recent coverage area for Medicaid. The federal government ordered states to cover autism treatments in 2014, but not all covered ABA, which Fernandez called the “gold standard,” until 2022.

State budget shortfalls and the nearly $1 trillion in looming Medicaid spending reductions from President Donald Trump’s One Big Beautiful Bill Act have prompted state budget managers to trim the autism therapy and other growing line items in their Medicaid spending.

So, too, have a series of state and federal audits that raised questions about payments to some ABA providers. A federal audit of Indiana’s Medicaid program estimated at least $56 million in improper payments in 2019 and 2020, noting some providers had billed for excessive hours, including during nap time. A similar audit in Wisconsin estimated at least $18.5 million in improper payments in 2021 and 2022. In Minnesota, state officials had 85 open investigations into autism providers as of this summer, after the FBI raided two providers late last year as part of an investigation into Medicaid fraud.

Families Fight Back

But efforts to rein in spending on the therapy have also triggered backlash from families who depend on it.

In North Carolina, families of 21 children with autism filed a lawsuit challenging the 10% provider payment cut. In Colorado, a group of providers and parents is suing the state over its move to require prior authorization and reduce reimbursement rates for the therapy.

And in Nebraska, families and advocates say cuts of the magnitude the state implemented — from 28% to 79%, depending on the service — could jeopardize their access to the treatment.

“They’re scared that they’ve had this access, their children have made great progress, and now the rug is being yanked out from under them,” said Cathy Martinez, president of the Autism Family Network, a nonprofit in Lincoln, Nebraska, that supports autistic people and their families.

Martinez spent years advocating for Nebraska to mandate coverage of ABA therapy after her family went bankrupt paying out-of-pocket for the treatment for her son Jake. He was diagnosed with autism as a 2-year-old in 2005 and began ABA therapy in 2006, which Martinez credited with helping him learn to read, write, use an assistive communication device, and use the bathroom.

To pay for the $60,000-a-year treatment, Martinez said, her family borrowed money from a relative and took out a second mortgage before ultimately filing for bankruptcy.

“I was very angry that my family had to file bankruptcy in order to provide our son with something that every doctor that he saw recommended,” Martinez said. “No family should have to choose between bankruptcy and helping their child.”

Nebraska mandated insurance coverage for autism services in 2014. Now, Martinez worries the state’s rate cuts could prompt providers to pull out, limiting the access she fought hard to win.

Her fears appeared substantiated in late September when Above and Beyond Therapy, one of the largest ABA service providers in Nebraska, notified families it planned to terminate its participation in Nebraska’s Medicaid program, citing the provider rate cuts.

Above and Beyond’s website advertises services in at least eight states. The company was paid more than $28.5 million by Nebraska’s Medicaid managed-care program in 2024, according to a state audit. That was about a third of the program’s total spending on the therapy that year and four times as much as the next largest provider. CEO Matt Rokowsky did not respond to multiple interview requests.

A week after announcing it would stop participating in Nebraska Medicaid, the company reversed course, citing a “tremendous outpouring of calls, emails, and heartfelt messages” in a letter to families.

Danielle Westman, whose 15-year-old son, Caleb, receives 10 hours of at-home ABA services a week from Above and Beyond, was relieved by the announcement. Caleb is semiverbal and has a history of wandering away from caregivers.

“I won’t go to any other company,” Westman said. “A lot of other ABA companies want us to go to a center during normal business hours. My son has a lot of anxiety, high anxiety, so being at home in his safe area has been amazing.”

Nebraska officials have said the state previously had the highest Medicaid reimbursement rates for ABA in the nation and that the new rates still compare favorably to neighboring states’ but will ensure the services are “available and sustainable going forward.”

States Struggle With High Spending

State Medicaid Director Drew Gonshorowski said his agency is closely tracking fallout. Deputy Director Matthew Ahern said that while no ABA providers have left the state following the cuts, one provider stopped taking Medicaid payments for the therapy. New providers have also entered Nebraska since officials announced the cuts.

One Nebraska ABA provider has even applauded the rate cuts. Corey Cohrs, CEO of Radical Minds, which has seven locations in the Omaha area, has been critical of what he sees as an overemphasis by some ABA providers on providing a blanket 40 hours of services per child per week. He likened it to prescribing chemotherapy to every cancer patient, regardless of severity, because it’s the most expensive.

“You can then, as a result, make more money per patient and you’re not using clinical decision-making to determine what’s the right path,” Cohrs said.

Nebraska put a 30 hour-a-week cap on the services without additional review, and the new rates are workable for providers, Cohrs said, unless their business model is overly predicated on high Medicaid rates.

In North Carolina, Aubreigh Osborne’s ABA services were restored largely due to her mother’s persistence in calling person after person in the state’s Medicaid system to make the case for her daughter’s care.

And for the time being, Gaile Osborne won’t have to worry about the legislative squabbles affecting her daughter’s care. In early December, North Carolina Gov. Josh Stein canceled all the Medicaid cuts enacted in October, citing lawsuits like the one brought by families of children with autism.

“DHHS can read the writing on the wall,” Stein said, announcing the state health department’s reversal. “That’s what’s changed. Here’s what has not changed. Medicaid still does not have enough money to get through the rest of the budget year.”

Osborne is executive director of Foster Family Alliance, a prominent foster care advocacy organization in the state, and taught special education for nearly 20 years. Despite her experience, she didn’t know how to help Aubreigh improve socially. Initially skeptical about ABA, she now sees it as a bridge to her daughter’s well-being.

“It’s not perfect,” Osborne said. “But the growth in under a year is just unreal.”

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For those in or near Columbia Memorial, the city’s only hospital, there will soon be a different plan: Shelter in place. The hospital is building a new facility next door with an on-site tsunami shelter — an elevated refuge atop columns deeply anchored in the ground, where nearly 2,000 people can safely wait out a flood.

Oregon needs more shelters like the one that Columbia Memorial is building, emergency managers say. Hospitals in the region are likely to incur serious damage, if not ruin, and could take more than three years to fully recover in the event of a major earthquake and tsunami, according to a state report.

Columbia Memorial’s current facility is a single-story building, made of wood a half-century ago, that would likely collapse and sink into the ground or be swallowed by a landslide after a major earthquake or a tsunami, said Erik Thorsen, the hospital’s chief executive.

“It is just not built to survive either one of those natural disaster events,” Thorsen said.

At least 10 other hospitals along the Oregon coast are in danger as well. So Columbia Memorial leaders proposed building a hospital capable of withstanding an earthquake and landslide, with a tsunami shelter, instead of relocating the facility to higher ground. Residents and state officials supported the plans, and the federal government awarded a $14 million grant from the Federal Emergency Management Agency to help pay for the tsunami shelter.

The project broke ground in October 2024. Within six months, the Trump administration had canceled the grant program, known as Building Resilient Infrastructure and Communities, or BRIC, calling it “yet another example of a wasteful and ineffective FEMA program … more concerned with political agendas than helping Americans affected by natural disasters.”

Molly Wing, director of the expansion project, said losing the BRIC grant felt like “a punch to the gut.”

“We really didn’t see that coming,” she said.

This summer, Oregon and 19 other states sued to restore the FEMA grants. On Dec. 11, a judge ruled that the Trump administration had unlawfully ended the program without congressional approval.

The administration did not immediately indicate it would appeal the decision, but Department of Homeland Security spokesperson Tricia McLaughlin said by email: “DHS has not terminated BRIC. Any suggestion to the contrary is a lie. The Biden Administration abandoned true mitigation and used BRIC as a green new deal slush fund. It’s unfortunate that an activist judge either didn’t understand that or didn’t care.” FEMA is a subdivision of DHS.

Columbia Memorial was one of the few hospitals slated to receive grants from the BRIC program, which had announced more than $4.5 billion for nearly 2,000 building projects since 2022.

Hospital leaders have decided to keep building — with uncertain funding — because they say waiting is too dangerous. With the Trump administration reversing course on BRIC, fewer communities will receive help from FEMA to reduce their disaster risk, even places where catastrophes are likely.

More than three centuries have passed since a major earthquake caused the Pacific Northwest’s coastline to drop several feet and unleashed a tsunami that crashed onto the land in January 1700, according to scientists who study the evolution of the Oregon coast.

The greatest danger is an underwater fault line known as the Cascadia Subduction Zone, which lies 70 to 100 miles off the coast, from Northern California to British Columbia.

The Cascadia zone can produce a megathrust earthquake, with a magnitude of 9 or higher — the type capable of triggering a catastrophic tsunami — every 500 years, according to the U.S. Geological Survey. Scientists predict a 10% to 15% chance of such an earthquake along the fault zone in the next 50 years.

“We can’t wait any longer,” Thorsen said. “The risk is high.”

Building for the Future

The BRIC program started in 2020, during the first Trump administration, to provide communities and institutions with funding and technical assistance to fortify their structures against natural disasters.

Joel Scata, a senior attorney with the environmental advocacy group Natural Resources Defense Council, said the program helped communities better prepare so they could reduce the cost of rebuilding after a flood, tornado, wildfire, or extreme weather event.

To qualify for a grant, a hospital had to show that the project’s benefits were greater than the future danger and cost. In some cases, that benefit might not be readily apparent.

“It prevents bad disasters from happening, and so you don’t necessarily see it in action,” Scata said.

Scata noted that the Trump administration has also stopped awarding grants through FEMA’s Hazard Mitigation Grant Program, which predates BRIC.

“There really is no money going out the door from the federal government to help communities reduce their disaster risk,” he said.

A recent KFF Health News investigation using proprietary data from Fathom, a global leader in flood modeling, found that at least 170 U.S. hospitals are at risk of significant and potentially dangerous flooding from more intense and frequent storms. That count did not include Columbia Memorial, as Fathom’s data did not account for tsunamis. It models flooding from rivers, sea level rise, and extreme rainfall.

In recent days, an atmospheric river — a narrow storm band carrying significant amounts of moisture — dumped more than 15 inches of rain on parts of Oregon and Washington, causing catastrophic flooding along rivers and the coast. In the Washington town of Sedro-Woolley, which sits along the Skagit River, the PeaceHealth United General Medical Center evacuated nonemergency patients.

High winds battered Astoria, leaving the city with some minor landslides, according to news reports. But flooding on the road to the nearby beach town of Seaside made the drive nearly impassable.

The Trump administration is leaning on states to take greater responsibility for recovering from natural disasters, Scata said, but most states are not financially prepared to do so.

“The disasters are just going to keep on piling up,” he said, “and the federal government’s going to have to keep stepping in.”

A Hospital at Risk

Columbia Memorial is blocks from the southern shore of the Columbia River, near the Washington border, where the area’s natural hazards include earthquakes, tsunamis, landslides, and floods. A critical access hospital with 25 beds, it opened in 1977 — before state building codes addressed tsunami protections.

Thorsen said the new facility and shelter would be a “model design” for other hospitals. Design plans show a five-level hospital built atop a foundation anchored to the bedrock and surrounded by concrete columns to shield it from tsunami debris.

The shelter will be on the roof of the second floor, above the projected maximum tsunami inundation. It will be accessible via an outdoor staircase and interior staircases and elevators, with enough room for up to 1,900 people, plus food, water, tents, and other supplies to sustain them for five days.

With most patient care provided on the second and third levels, generators on the fourth level, and utility lines underground, the hospital is expected to remain operational after a natural disaster.

Thorsen said an earthquake and tsunami threaten not only vast flooding but also liquefaction, in which the ground loosens and causes structures above it to collapse. Deep foundations, thick slabs, and other structural supports are expected to protect the new hospital and tsunami structure against such failure.

Through the years, hospital administrators and civic leaders in Astoria have sought other locations for Columbia Memorial. But relocation wasn’t economical. Columbia Memorial committed to invest in a new hospital and tsunami shelter to protect not only patients and staff but also nearby residents.

“Your community should count on your hospital to be a safe haven in a natural disaster,” Thorsen said.

Fighting To Restore Funds

The estimated construction budget for Columbia Memorial’s expansion is $300 million, mostly financed through new debt from the hospital. The tsunami shelter is budgeted at about $20 million, for which FEMA’s BRIC program awarded nearly $14 million, with a $6 million matching grant from the state, which has maintained its support.

The shelter and the building’s structural protections — featuring reinforced steel, deeper foundations, and thicker slabs — are integral to the design and cannot be removed without compromising the rest of the structure, said Michelle Checkis, the project architect.

“We can’t pull the TVERS [tsunami vertical evacuation refuge structure] out without pulling the hospital back apart again,” she said. “It’s kind of like, if I was going to stack it up with Legos, I would have to take all those Legos apart and stack it up completely differently.”

Columbia Memorial has sought help from Oregon’s congressional delegation. In a letter to Department of Homeland Security Secretary Kristi Noem and former FEMA acting administrator David Richardson, the lawmakers demanded that the agencies restore the hospital’s grant.

The hospital’s leadership is seeking other grants and philanthropic donations to make up for the loss. As a last resort, Thorsen said, the board will consider removing “nonessential features” from the building, though he added that there is little fat to trim from the project.

The lawsuit brought by states in July alleged that FEMA lacks the authority to cancel the BRIC program or redirect its funding for other purposes.

The states argued that canceling the program ran counter to Congress’ intent and undermined projects underway.

In their response to the lawsuit, the Trump administration said repeatedly that the defendants “deny that the BRIC program has been terminated.”

The lawsuit cites examples of projects at risk in each state due to FEMA’s termination of the grants. Oregon’s first example is Columbia Memorial’s tsunami shelter. “Neither the County nor the State can afford to resume the project without federal funding,” the lawsuit states.

In response to questions about the impact of canceling the grant on Astoria and the surrounding community, DHS spokesperson Tricia McLaughlin said BRIC had “deviated from its statutory intent.”

“BRIC was more focused on climate change initiatives like bicycle lanes, shaded bus stops, and planting trees, rather than disaster relief or mitigation,” McLaughlin said. DHS and FEMA provided no further comment about BRIC or the Astoria hospital.

Preparing for a Tsunami Disaster

Located near the end of the Lewis & Clark National Historic Trail, Astoria sits on a peninsula that juts into the Columbia River near the Pacific Ocean.

Much of the city is not in the tsunami inundation area. But Astoria’s downtown commercial district — where gift shops, hotels, and seafood restaurants line the streets — is nearly all an evacuation zone.

Two hospitals — Ocean Beach Health in nearby Washington, and Providence Seaside Hospital in Oregon — are about 20 miles from Columbia Memorial. Both are 25-bed hospitals, and neither is designed to withstand a tsunami.

Ocean Beach Health regularly conducts drills for mass-casualty and natural disasters, said Brenda Sharkey, its chief nursing officer.

“We focus our planning and investments on areas where we can make a real difference for our community before, during, and after an event — such as maintaining continuity of care, ensuring rapid triage, and coordinating with regional emergency partners,” Sharkey said in an email.

Gary Walker, a spokesperson for Providence Seaside, said in a statement that the hospital has a “comprehensive emergency plan for earthquakes and tsunamis, including alternative sites and mobile resources.”

Walker added that Providence Seaside has hired “a team of consultants and experts to conduct a conceptual resilience study” that would evaluate the hospital’s vulnerabilities and recommend ways to address them.

Oregon’s emergency managers advise residents and visitors in coastal communities to immediately seek higher ground after a major earthquake — and not to rely on tsunami sirens, social media, or most technology.

“There may not even be cellphone towers operating after an event like this,” said Jonathan Allan, a coastal geomorphologist with the Oregon Department of Geology and Mineral Industries. “The earthquake shaking, its intensity, and particularly the length of time in which the shaking persists, is the warning message.”

The stronger the earthquake and the longer the shaking, he said, the more likely a tsunami will head to shore.

A tsunami triggered by a Cascadia zone earthquake could strike land in less than 30 minutes, according to state estimates.

Many of Oregon’s seaside communities are near high-enough ground to seek safety from a tsunami in a relatively short time, Allan said. But he estimated that, to save lives, Oregon would need about a dozen vertical tsunami evacuation shelters along the coast, including in seaside towns that attract tourists and where the nearest high ground is a mile or more away.

Willis Van Dusen’s family has lived in Astoria since the mid-19th century. A former mayor of Astoria, Van Dusen stressed that tsunamis are not a hypothetical danger. He recalled seeing one in Seaside in 1964. The wave was only about 18 inches high, he said, but it flooded a road and destroyed a bridge and some homes. The memory has stayed with him.

“It’s not like … ‘Oh, that’ll never happen,’” he said. “We have to be prepared for it.”

KFF Health News correspondent Brett Kelman contributed to this report.

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 27-year-old resident of Bloomington, Indiana, has a pacemaker and a painful joint disease. She also has fused vertebrae in her neck from a spinal injury, preventing her from turning her head.

Indiana’s Medicaid agency currently considers Brader “medically frail,” giving her access to an expanded set of benefits, such as physical therapy.

New federal rules will require more than 18 million Medicaid enrollees nationwide to show they’re working, volunteering, or going to school for 80 hours a month starting in 2027 to keep their coverage. Brader is exempt as long as she’s deemed medically frail.

But lacking sufficient federal guidance, states are wrestling with how to define medical frailty — a consequential decision that could cut Medicaid coverage for many people, said state officials, consumer advocates, and health policy researchers.

“It’s terrifying,” Brader said. “I already have fought so hard to get my health care.”

‘Incredibly High’ Stakes

President Donald Trump’s One Big Beautiful Bill Act slashes nearly $1 trillion from Medicaid over the next decade, with much of the savings projected to come from no longer covering those who don’t qualify under the new work rules. Those spending cuts help offset the costs of GOP priorities, such as extra border security and tax cuts that mainly benefit the wealthy.

Conservative lawmakers have argued that Medicaid, the government health insurance program for people with low incomes or with disabilities, has grown too large and expensive, especially in the wake of its expansion to more low-income adults under the Affordable Care Act. They also say that requiring participants to work is common sense.

The work rules in Trump’s tax-and-spending law offer exemptions for several groups who might struggle to meet them, including people deemed “medically frail.” The law spells out certain “medically frail” conditions such as blindness, disability, and substance use disorder. But it does not list many others.

Instead, the law exempts those with a “serious or complex medical condition,” a term whose interpretation could vary by state.

State officials say they need more clarity to ensure that people who cannot work for health reasons retain rightful access to Medicaid. They also worry that, even with a clear definition, people will face the onerous task of having to regularly vouch for being medically frail, which is a challenge without reliable access to medical care.

“The stakes are incredibly high,” said Kinda Serafi, a partner at consulting firm Manatt Health.

The new work requirements will affect Medicaid recipients in 42 states and Washington, D.C. Eight states — Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming — did not expand their Medicaid programs to cover additional low-income adults, so they won’t have to implement the work rules.

The Medicaid work rules are expected to be the largest driver of health insurance coverage losses over the next decade, according to the nonpartisan Congressional Budget Office.

Forty-four percent of all adults covered by states’ expanded Medicaid programs have at least one chronic health condition, according to KFF.

A Challenge for States

State Medicaid agencies are scrambling to implement the rules with little direction from the U.S. Department of Health and Human Services, which has yet to issue specific guidance. Federal officials will clarify the “medically frail” definition next year, said Andrew Nixon, an agency spokesperson.

Ultimately, states will have to decide who is unhealthy enough to be exempt from work rules. And it won’t be easy for state workers and their computer systems to track.

Every year, state eligibility systems screen millions of applicants to check if they qualify for Medicaid and other government programs. Now, these same systems must screen applicants and existing enrollees to determine whether they meet the new work rules.

Jessica Kahn, a partner at consulting firm McKinsey & Co., has urged states to start planning how to adapt eligibility systems to verify work status. States can do a “tremendous amount” of work without direction from the federal government, said Kahn, a former federal Medicaid systems official, who spoke during a recent Medicaid advisory panel hearing. “Time is a-wasting already.”

State Medicaid directors are pondering the challenge.

“Medical frailty gets so complex,” Emma Sandoe, Oregon’s Medicaid director, said during a recent panel discussion. Conditions that can keep people from working, such as mental health disorders, can be hard to prove, she said.

A state might try to use data pulled from a person’s health records, for instance, to determine medical frailty. But information from a patient’s chart may not paint a clear picture of someone’s health, especially if they lack regular access to medical care.

It’s a tall order for eligibility systems that historically have not had to scrape medical records to screen applicants, said Serafi of Manatt Health.

“That is an incredibly new thing that eligibility enrollment systems are just not fluent in at all,” Serafi said.

Lobbying groups for the private health insurance companies that help run Medicaid in many states also have urged federal regulators to clearly define medical frailty so it can be applied uniformly.

In a Nov. 3 letter to federal officials, the Medicaid Health Plans of America and the Association for Community Affiliated Plans advocated for allowing enrollees to qualify for the exemption by saying on their applications that they have conditions that make them medically frail. Successfully implementing exemptions for the medically frail will be “crucial” given the “severe health risks of coverage loss for these populations,” the groups said.

Some state officials worry about unintended consequences of the work rules for people with chronic conditions.

Jennifer Strohecker, who recently resigned as Utah’s Medicaid director, reiterated the high stakes, especially for those with diabetes on Medicaid. They may be very healthy and functional with insulin, but if they fail to complete the work requirements, that may change, Strohecker said during a recent Medicaid advisory hearing.

Whether someone is deemed medically frail already depends heavily on where they live.

For example, in Arkansas, people indicate on their Medicaid applications that they’re disabled, blind, or need help with daily living activities.

Approximately 6% of the roughly 221,000 people enrolled in Arkansas’ Medicaid expansion program are deemed medically frail, according to Gavin Lesnick, a spokesperson for the Arkansas Department of Human Services.

In West Virginia, the state accepts a medical frailty designation when an applicant self-reports it.

The burden of proof is higher in North Dakota. Applicants there must answer a questionnaire about their health and submit additional documentation, which may include medical chart notes and treatment plans. More than half of applicants were denied last year, according to Health and Human Services Department spokesperson Mindy Michaels.

Indiana’s Family and Social Services Administration, which runs its Medicaid program, declined an interview and said it could not comment on individual cases, like Brader’s.

Brader worries the additional red tape will cause her to lose Medicaid again. She said she was temporarily kicked off the program in 2019 for failing to meet the state’s work rules when Indiana said her work-study job didn’t count as employment.

“Anytime I have tried to receive help from the state of Indiana, it has been a bureaucratic nightmare,” she said.

As states await federal guidance, Kristi Putnam, a senior fellow at the conservative Cicero Institute and former secretary of the Arkansas Department of Human Services, which oversees the state Medicaid program, said even if a state creates an extensive list of qualifying “medically frail” conditions, the line must be drawn somewhere.

“You can’t possibly create a policy for exemptions that will catch everything,” she said.

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Agentes del Servicio de Inmigración y Control de Aduanas (ICE) también se han presentado en clínicas comunitarias.

Proveedores de salud dicen que intentaron entrar en un estacionamiento donde había una clínica móvil, apuntaron a las caras de médicos que atendían a personas sin hogar y detuvieron a un transeúnte, subiéndolo a un auto sin identificación, frente a un centro comunitario de salud.

En respuesta a estas actividades de control migratorio alrededor de clínicas y hospitales, el gobernador demócrata Gavin Newsom promulgó el mes pasado la ley SB 81, que prohíbe a los centros médicos permitir el acceso de agentes federales a áreas privadas, incluidos los lugares donde los pacientes reciben tratamiento o hablan sobre temas de salud, sin una orden judicial o de registro válidas.

Si bien el proyecto de ley recibió un amplio apoyo de grupos médicos, trabajadores de salud y defensores de los derechos de los inmigrantes, expertos legales afirman que California no puede impedir que las autoridades federales realicen sus funciones en lugares públicos, como vestíbulos y salas de espera de hospitales, estacionamientos de centros de salud y vecindarios aledaños: lugares donde las recientes actividades del ICE han generado indignación y temor.

En enero, la administración Trump revocó las restricciones federales previas sobre la aplicación de las leyes de inmigración en o cerca de áreas sensibles, incluidos los establecimientos de salud.

“El problema que enfrentan los estados es la cláusula de supremacía”, dijo la abogada Sophia Genovese, profesora en la Facultad de Leyes de Georgetown. Explicó que el gobierno federal tiene derecho a realizar actividades de control migratorio y que existen límites a lo que el estado puede hacer para impedirlas.

La ley de California designa el estatus migratorio y el lugar de nacimiento de un paciente como información protegida, la cual, al igual que los expedientes médicos, no puede divulgarse a las autoridades sin una orden judicial.

Además, requiere que los centros de salud establezcan procedimientos claros para gestionar los pedidos de las autoridades de inmigración, incluyendo la capacitación del personal para notificar de inmediato a un administrador designado o a un asesor legal si los agentes intentan entrar a un área privada o revisar los expedientes de los pacientes.

Otros estados gobernados por demócratas han promulgado leyes para proteger a los pacientes en hospitales y centros de salud.

En mayo, el gobernador de Colorado, Jared Polis, promulgó la  Protect Civil Rights Immigration Status, que penaliza a los hospitales por compartir sin autorización información sobre personas que se encuentran en el país de manera irregular y prohíbe a los agentes del ICE ingresar a áreas privadas de los centros de salud sin una orden judicial.

En junio, entró en vigencia en Maryland una ley que exige al fiscal general crear directrices para mantener al ICE fuera de los centros de salud. Nuevo México ha implementado nuevas protecciones para los datos de pacientes, y Rhode Island ha prohibido a los establecimientos de salud preguntar a los pacientes sobre su estatus migratorio.

Los estados gobernados por republicanos se han alineado con los esfuerzos federales para evitar que se gaste en atención médica de inmigrantes sin papeles.

Estos inmigrantes no son elegibles para la cobertura integral de Medicaid, pero los estados sí facturan al gobierno federal por la atención de emergencia en ciertos casos. Bajo una ley que entró en vigencia en 2023, Florida exige que los hospitales que aceptan Medicaid pregunten sobre el estatus migratorio del paciente. En Texas, los hospitales ahora deben informar cuánto gastan en la atención de inmigrantes indocumentados.

“Los texanos no deberían tener que asumir el costo de la atención médica de los inmigrantes ilegales”, declaró el gobernador Greg Abbott al emitir su orden ejecutiva el año pasado.

Los esfuerzos de California por limitar la aplicación de la ley federal se producen en un momento en que el estado, donde más de una cuarta parte de los residentes han nacido en el extranjero, se ha convertido en blanco de la represión migratoria del presidente Donald Trump.

Newsom promulgó la SB 81 como parte de un paquete de leyes que prohíbe a los agentes de inmigración entrar en las escuelas sin una orden judicial, exige que los agentes se identifiquen y prohíbe el uso de máscaras. La SB 81 se aprobó con una votación partidista sin oposición formal.

“No somos Corea del Norte”, expresó Newsom durante una ceremonia de firma de leyes en septiembre. “Estamos rechazando estas tendencias y acciones autoritarias de esta administración”.

Algunos partidarios del proyecto de ley y expertos legales afirmaron que la ley de California puede impedir que el ICE viole los derechos de privacidad de los pacientes ya existentes.

Entre estos derechos se incluye la Cuarta Enmienda, que prohíbe los registros sin orden judicial en lugares donde las personas tienen una expectativa razonable de privacidad. Las órdenes judiciales válidas deben ser emitidas por un tribunal y firmadas por un juez. Sin embargo, con frecuencia los agentes del ICE utilizan órdenes administrativas para intentar acceder a áreas privadas para las que no tienen autoridad, dijo Genovese.

“La gente no siempre entiende la diferencia entre una orden administrativa, que es un simple documento, y una orden judicial, que es ejecutable”, dijo Genovese. Añadió que las órdenes judiciales rara vez se emiten en casos de inmigración.

El Departamento de Seguridad Nacional (DHS) ha dicho que no acatará la prohibición del uso de máscaras ni los requisitos de identificación para los agentes del orden público en California, calificándolos de inconstitucionales. El departamento no respondió a la solicitud de comentarios sobre las nuevas normas estatales para centros de salud, que entraron en vigencia de inmediato.

Tanya Broder, asesora principal del National Immigration Law Center, afirmó que las detenciones de inmigrantes en centros de salud parecen ser relativamente raras. Sin embargo, la decisión federal de revocar las protecciones en torno a áreas sensibles, dijo, “ha generado temor e incertidumbre en todo el país”.

Muchos de los informes periodísticos más destacados sobre agentes de inmigración en centros de salud ocurrieron en California, principalmente en relación con pacientes detenidos que habían sido trasladados a un establecimiento de salud para recibir atención médica.

La California Nurses Association, el sindicato de enfermeras más grande del estado, copatrocinó el proyecto de ley y expresó su preocupación por el trato que recibió Milagro Solis-Portillo, una salvadoreña de 36 años que estuvo bajo vigilancia constante del ICE en el Hospital Glendale Memorial durante el verano.

Los líderes sindicales también condenaron la presencia de agentes en el California Hospital Medical Center, al sur del centro de Los Ángeles. Según Anne Caputo-Pearl, enfermera de parto y representante sindical principal del hospital, los agentes llevaron a una paciente el 21 de octubre y permanecieron en su habitación durante casi una semana. El diario Los Angeles Times informó que a Carlitos Ricardo Parias, creador de contenido de TikTok, lo llevaron al hospital ese mismo día tras resultar herido durante un operativo de control migratorio en el sur de Los Ángeles.

La presencia del ICE intimidó tanto a enfermeras como a pacientes, aseguró Caputo-Pearl, y motivó restricciones de visitas en el hospital. “Queremos una explicación más clara”, dijo. “¿Por qué se permite que estos agentes estén en la habitación?”.

Sin embargo, representantes de hospitales y clínicas dijeron que ya cumplen con los requisitos de la ley, los cuales refuerzan en gran medida las extensas directrices publicadas por el fiscal general del estado, Rob Bonta, en diciembre.

Las clínicas comunitarias a lo largo del condado de Los Ángeles, que atienden a más de dos millones de pacientes al año, incluyendo una gran proporción de inmigrantes, han estado implementando las directrices del fiscal general durante meses, según dijo Louise McCarthy, presidenta y directora ejecutiva de la Asociación de Clínicas Comunitarias del Condado de Los Ángeles.

Agregó que la ley debería ayudar a garantizar estándares unificados en todos los establecimientos de salud a los que las clínicas derivan pacientes y brindarles la tranquilidad de que hay procedimientos para protegerlos.

Aun así, no se puede evitar que se produzcan redadas migratorias en la comunidad, lo que ha provocado que algunos pacientes e incluso trabajadores de salud teman salir a la calle, señaló McCarthy. Se han producido algunos incidentes cerca de clínicas, incluyendo el arresto de un transeúnte frente a una clínica en el este de Los Ángeles, que un guardia de seguridad grabó en video, contó.

“Hemos escuchado a personal de las clínicas preguntar: ‘¿Es seguro para mí salir?'”, dijo.

En St. John’s Community Health, una red de 24 centros de salud comunitarios y cinco clínicas móviles en el sur de Los Ángeles y el Inland Empire, el director ejecutivo Jim Mangia coincidió en que la nueva ley no puede prevenir toda la actividad de control migratorio, pero afirmó que sí les brinda a las clínicas una herramienta para defenderse si se presentan agentes, algo que su personal ya ha tenido que hacer.

Mangia dijo que el personal de St. John’s tuvo dos encuentros con agentes de inmigración durante el verano. En uno de ellos, impidió que agentes armados ingresaran a un estacionamiento con rejas en un centro de rehabilitación de adicciones donde médicos y enfermeras atendían a pacientes en una clínica móvil.

Otro incidente ocurrió en julio, cuando agentes de inmigración llegaron a MacArthur Park a caballo y en vehículos blindados, en una demostración de fuerza por parte del gobierno de Trump.

Mangia dijo que agentes enmascarados con equipo táctico completo rodearon una carpa de atención médica callejera donde el personal de St. John’s atendía a personas sin hogar, les gritaron que se fueran y les apuntaron con un arma. Según Mangia, los proveedores quedaron tan conmocionados por el incidente que tuvieron que recurrir a profesionales de salud mental para ayudarlos a sentirse seguros al regresar de nuevo a la calle.

Un vocero del DHS declaró a CalMatters que, en raras ocasiones, cuando los agentes entran a ciertos lugares sensibles, los oficiales necesitan la aprobación de un supervisor secundario.

Desde entonces, St. John’s ha intensificado sus esfuerzos para brindar apoyo y capacitación al personal y ha ofrecido a los pacientes con miedo a salir la opción de visitas médicas a domicilio y entrega de alimentos. Los temores de los pacientes y la actividad del ICE han disminuido desde el verano, afirmó Mangia, pero con el DHS planeando contratar a 10.000 agentes adicionales, duda que esta situación se mantenga.

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U.S. Immigration and Customs Enforcement agents have also shown up at community clinics. Health providers say that officers have tried to enter a parking lot hosting a mobile clinic, waved a machine gun in the faces of clinicians serving the homeless, and hauled a passerby into an unmarked car outside a community health center.

In response to such immigration enforcement activity in and around clinics and hospitals, Democratic Gov. Gavin Newsom last month signed SB 81, which prohibits medical establishments from allowing federal agents without a valid search warrant or court order into private areas, including places where patients receive treatment or discuss health matters.

But while the bill received broad support from medical groups, health care workers, and immigrant rights advocates, legal experts say California can’t stop federal authorities from carrying out duties in public places, which include hospital lobbies and general waiting areas, health facility parking lots, and surrounding neighborhoods — places where recent ICE activities have sparked outrage and fear. Previous federal restrictions on immigration enforcement in or near sensitive areas, including health care establishments, were rescinded by the Trump administration in January.

“The issue that states encounter is the supremacy clause,” said Sophia Genovese, a supervising attorney and clinical teaching fellow at Georgetown Law. She said the federal government does have the right to conduct enforcement activities, and there are limits to what the state can do to stop them.

California’s law designates a patient’s immigration status and birthplace as protected information, which like medical records cannot be disclosed to law enforcement without a warrant or court order. And it requires health care facilities to have clear procedures for handling requests from immigration authorities, including training staff to immediately notify a designated administrator or legal counsel if agents ask to enter a private area or review patient records.

Several other Democratic-led states have also taken up legislation to protect patients at hospitals and health centers. In May, Colorado Gov. Jared Polis signed the Protect Civil Rights Immigration Status bill, which penalizes hospitals for unauthorized sharing of information about people in the country illegally and bars ICE agents from entering private areas of health care facilities without a judicial warrant. In Maryland, a law requiring the attorney general to create guidance on keeping ICE out of health care facilities went into effect in June. New Mexico has instituted new patient data protections, and Rhode Island has prohibited health care facilities from asking patients about their immigration status.

Republican-led states have aligned with federal efforts to prevent health care spending on immigrants without legal authorization. Such immigrants are not eligible for comprehensive Medicaid coverage, but states do bill the federal government for emergency care in certain cases. Under a law that took effect in 2023, Florida requires hospitals that accept Medicaid to ask about a patient’s legal status. In Texas, hospitals now have to report how much they spend on care for immigrants without legal authorization.

“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Gov. Greg Abbott said in issuing his executive order last year.

California’s efforts to rein in federal enforcement come as the state, where more than a quarter of residents are foreign-born, has become a target of President Donald Trump’s immigration crackdown. Newsom signed SB 81 as part of a bill package prohibiting immigration agents from entering schools without a warrant, requiring law enforcement officers to identify themselves, and banning officers from wearing masks. SB 81 was passed on a party-line vote with no formal opposition.

“We’re not North Korea,” Newsom said during a September bill-signing ceremony. “We’re pushing back against these authoritarian tendencies and actions of this administration.”

Some supporters of the bill and legal experts said California’s law can prevent ICE from violating existing patient privacy rights. Those include the Fourth Amendment, which prohibits searches without a warrant in places where people have a reasonable expectation of privacy. Valid warrants must be issued by a court and signed by a judge. But ICE agents frequently use administrative warrants to try to gain access to private areas they don’t have the authority to enter, Genovese said.

“People don’t always understand the difference between an administrative warrant, which is a meaningless piece of paper, versus a judicial warrant that is enforceable,” Genovese said. Judicial warrants are rarely issued in immigration cases, she added.

The Department of Homeland Security has said it won’t abide by California’s mask ban or identification requirements for law enforcement officers, slamming them as unconstitutional. The department did not respond to a request for comment on the state’s new rules for health care facilities, which went into immediate effect.

Tanya Broder, a senior counsel with the National Immigration Law Center, said immigration arrests at health care facilities appear to be relatively rare. But the federal decision to rescind protections around sensitive areas, she said, “has generated fear and uncertainty across the country.” Many of the most high-profile news reports of immigration agents at health care facilities have been in California, largely involving detained patients brought in for care.

The California Nurses Association, the state’s largest nurses union, was a co-sponsor of the bill and raised concerns about the treatment of Milagro Solis-Portillo, a 36-year-old Salvadoran woman who was under round-the-clock ICE surveillance at Glendale Memorial Hospital over the summer.

Union leaders also condemned the presence of agents at California Hospital Medical Center south of downtown Los Angeles. According to Anne Caputo-Pearl, a labor and delivery nurse and the chief union representative at the hospital, agents brought in a patient on Oct. 21 and remained in the patient’s room for almost a week. The Los Angeles Times reported that a TikTok streamer, Carlitos Ricardo Parias, was taken to the hospital that day after he was wounded during an immigration enforcement operation in South Los Angeles.

The presence of ICE was intimidating for nurses and patients, Caputo-Pearl said, and prompted visitor restrictions at the hospital. “We want better clarification,” she said. “Why is it that these agents are allowed to be in the room?”

Hospital and clinic representatives, however, said they are already following the law’s requirements, which largely reinforce extensive guidance put out by state Attorney General Rob Bonta in December.

Community clinics throughout Los Angeles County, which serve over 2 million patients a year, including a large portion of immigrants, have been implementing the attorney general’s guidelines for months, said Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County. But she said the law should help ensure uniform standards across health facilities that clinics refer out to and reassure patients that procedures are in place to protect them.

Still, it can’t prevent immigration raids from happening in the broader community, which have made some patients and even health workers afraid to venture outside, McCarthy said. Some incidents have occurred near clinics, including an arrest of a passerby outside a clinic in East Los Angeles, which a security guard caught on video, she said.

“We’ve had clinic staff say, ‘Is it safe for me to go out?’” she said.

At St. John’s Community Health, a network of 24 community health centers and five mobile clinics in South Los Angeles and the Inland Empire, CEO Jim Mangia agreed that the new law can’t prevent all immigration enforcement activity, but he said it does give clinics a tool to push back if agents show up, something his staff has already had to do.

Mangia said St. John’s staff had two encounters with immigration agents over the summer. In one, he said, staff stopped armed officers from entering a gated parking lot at a drug and alcohol recovery center where doctors and nurses were seeing patients at a mobile health clinic.

Another occurred in July, when immigration agents descended upon MacArthur Park on horses and in armored vehicles, in a show of force by the Trump administration. Mangia said masked officers in full tactical gear surrounded a street medicine tent where St. John’s providers were tending to homeless patients, screamed at staff to get out, and pointed a gun at them. The providers were so shaken by the episode, Mangia said, that he had to bring in mental health professionals to help them feel safe going back out on the street.

A DHS spokesperson told CalMatters that in the rare instance where agents enter certain sensitive locations, officers would need “secondary supervisor approval.”

Since then, St. John’s has doubled down on providing support and training to staff and has offered patients afraid to go out the option of home medical visits and grocery deliveries. Patient fears and ICE activity have decreased since the summer, Mangia said, but with DHS planning to hire an additional 10,000 ICE agents, he doubts that will last.

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Their victory in Held v. Montana, later upheld by the state Supreme Court, resounded across the country, showing that young people have a stake in the issue of climate change, advocates say. Yet, state policies to address the causes of climate change in Montana — home to large coal, oil, and natural gas deposits — haven’t changed in the wake of the case.

On Sept. 17, some of those plaintiffs are scheduled to appear in federal court to request that U.S. District Judge Dana Christensen block a series of President Donald Trump’s executive orders on energy issues. They argue the orders violate their Fifth Amendment rights and will cause nearly 200,000 additional deaths over the next 25 years and lead to more heart, respiratory, and other health problems. They are joined by other plaintiffs ages 7 to 24 from California, Florida, Hawaii, and Oregon, and are backed by the climate-focused nonprofit Our Children’s Trust.

“Trump’s fossil fuel orders are a death sentence for my generation,” Eva Lighthiser, a 19-year-old resident of Livingston, Montana, wrote in the complaint filed on May 29. “I am not suing because I want to, I am suing because I have to. My health, my future and my right to speak the truth are all on the line.”

She added that a warming climate has led to an increase in summer wildfire smoke and contributed to the flooding of the Yellowstone River (a warmer atmosphere holds more precipitation). At the heart of the case, Lighthiser v. Trump, is the claim that young people are being denied their Fifth Amendment rights under the U.S. Constitution — life, liberty, and the pursuit of happiness — because of the health effects of fossil fuel development and climate change. And they say the Montana Supreme Court’s decision in December to uphold their right to a clean and healthful environment buttresses their claim.

Montana Attorney General Austin Knudsen, a Republican, along with 18 other states and Guam, a U.S. territory, have sided with the Trump administration, filing a motion supporting the government’s request to dismiss the case. They argue the plaintiffs do not have standing to file the lawsuit, and that there is no constitutional right to a specific energy policy. “The state of Montana has an interest in this case because it will directly impact the business done in the energy sector within its borders,” Knudsen argued in his motion.

A hearing on the motion to dismiss, as well as the plaintiffs’ call for a stay of the executive orders, is scheduled for next week in federal court in Missoula.

Olivia Vesovich, 21, one of the plaintiffs, who is in her senior year at the University of Montana in Missoula, told KFF Health News she struggles with severe spring pollen allergies, which research shows are exacerbated by climate warming and will likely worsen.

“My eyes were swollen shut every single day, every single night,” Vesovich said. “When I wake up in the morning, I couldn’t open my eyes for 10 minutes. It’s not fun at all, and it’s exacerbated by climate change and by the fossil fuel industry.”

She also has exercise-induced asthma as well as feelings of suffocation from the smoke-filled skies during wildfire season — the intensity and frequency of which are magnified by climate change. And Trump’s executive orders are already being implemented and causing harm, Vesovich said.

“We are making an argument that Olivia’s state constitutional right to a safe climate system should also be protected under the federal Fifth Amendment as part of her liberty right,” said Andrea Rodgers, a senior attorney for Our Children’s Trust.

Our Children’s Trust was also behind the climate change case Juliana v. the United States, filed in 2015 by 21 young plaintiffs who argued their rights had been violated. In 2024, the 9th U.S. Circuit Court of Appeals ordered the federal district court to dismiss the case, ruling that the courts were not the appropriate venue for climate policy.

They believe the victory in Held v. Montana gives American youth more standing this time. If they prevail, the result would be more far-reaching than the Montana case, creating a national precedent.

The plaintiffs are asking the court to declare Trump’s three related executive orders — “Unleashing American Energy,” “Declaring a National Energy Emergency,” and “Reinvigorating America’s Beautiful Clean Coal Industry” — unconstitutional and to block their implementation. They also claim that Trump has overstepped his authority by attempting to undo laws such as the Clean Air Act. A coalition of 14 states’ attorneys general has also filed a lawsuit against the order that declares an energy emergency.

Trump came into office in January primed to support traditional energy sources and to back off efforts to usher in an era of renewable energy, which he claims are not viable. He has also issued orders rolling back environmental regulations. “We are driving a dagger into the heart of the climate change religion to drive down the cost of living for American families, unleash American energy, bring auto jobs back to the U.S., and more,” Environmental Protection Agency Administrator Lee Zeldin said in a March news release.

In July, the EPA proposed repealing its 2009 “endangerment finding” that concluded climate-warming gases “endanger both the public health and the public welfare of current and future generations.”

The finding established that greenhouse gases are a pollutant and create adverse effects, such as extreme weather and risks to human health and ecosystems. And it created a foundation to regulate automobiles and the energy sector to address climate change.

Zeldin said that eliminating the rule would save Americans “$1 trillion or more in hidden taxes.”

Unleashing fossil fuels will come with costs, as well. The health effects of a warming world are thoroughly established in scientific literature, said Kristie Ebi, a University of Washington professor of global health and an expert in the health risks of climate variability. Mosquito-borne diseases such as dengue, chikungunya, and malaria are spreading, and flooding, droughts, and wildfire, exacerbated by climate change, pose threats. And research has shown an increase in deaths.

“There’s a long list of adverse health outcomes” from a warming world, she said. “The data are clear.”

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Hasta este año.

El plan de la administración Trump de retirar más de $550 millones en fondos federales para salud pública y pandemias en Texas hizo que se cancelara el evento, justo antes de su inicio programado para el 21 de julio.

“Hay personas que vienen todos los años y dependen de este evento”, dijo Dairen Sarmiento Rangel, directora del Departamento de Salud y Servicios Humanos del condado de Hidalgo. “Algunas personas incluso acampan afuera de Operación Salud Fronteriza para ser las primeras en recibir servicios. Este evento es muy importante para nuestra comunidad”.

Los gobiernos estatales y locales ya han tenido que hacer dolorosos recortes a sus programas, luego de importantes reducciones en la financiación federal para salud que ya han entrado en vigor. Ahora, se preparan para enfrentar los golpes financieros que están por venir —algunos no ocurrirán hasta finales del próximo año o incluso después— como resultado de la ley fiscal y de gasto aprobada por los republicanos en el Congreso en julio, conocida como la One Big Beautiful Bill, que pone en marcha gran parte de la agenda nacional del presidente Donald Trump.

Texas, por ejemplo, anticipa una reducción de hasta $39.000 millones en fondos federales para Medicaid durante los próximos 10 años debido a nuevas barreras para la inscripción, como revisiones de elegibilidad más frecuentes, según un análisis publicado en julio por KFF.

En conjunto, estas reducciones representan un cambio radical en la forma en que se financian y se ofrecen los programas estatales de salud. En la práctica, la administración está trasladando una parte importante de los costos de salud a los estados. Esto obligará a sus líderes a tomar decisiones difíciles, ya que muchos presupuestos estatales ya están presionados por la disminución en la recaudación de impuestos, la desaceleración del gasto federal por covid y la incertidumbre económica.

Más de una docena de estados han bajado sus proyecciones de ingresos para el año próximo, según un informe publicado en junio por Pew.

“Es casi inevitable que los estados recorten varios servicios de salud debido a la presión fiscal”, dijo Wesley Tharpe, asesor principal en política fiscal estatal del Centro para Prioridades Presupuestarias y Políticas (CBPP), una organización de tendencia progresista.

Algunos estados tratan de suavizar el impacto de forma proactiva.

En Hawaii, los legisladores se han propuesto ayudar a organizaciones sin fines de lucro que ya enfrentan disminución en fondos federales. Repartirán $50 millones en subvenciones a organizaciones de salud, servicios sociales y otras que hayan sufrido recortes. Para acceder a los fondos, deben demostrar que su financiación fue eliminada, reducida o afectada por los recortes.

“No es justo que organizaciones dedicadas a ayudar al pueblo de Hawaii se vean obligadas a reducir sus servicios por los recortes federales”, declaró el gobernador demócrata Josh Green en un comunicado.

Otros estados recortan proyectos para enfrentar la situación.

El gobernador de Delaware, Matt Meyer, demócrata, supo en marzo que la administración Trump retiraría $38 millones en fondos de salud pública al estado. Como consecuencia, un mes después, los líderes legislativos estatales frenaron un proyecto para renovar y ampliar el complejo del Capitolio estatal.

“Reconocimos que los recortes federales irresponsables a la red de protección social de miles de habitantes de Delaware nos obligaban a ahorrar recursos para proteger a los más vulnerables”, dijo David Sokola, presidente temporal del Senado estatal.

En Nuevo México, el estado con el mayor porcentaje de residentes inscritos en Medicaid, un grupo bipartidista de legisladores votó a favor de crear un fondo fiduciario para reforzar el financiamiento del programa. Según algunas estimaciones, aproximadamente el 10% de los más de 800.000 residentes que están cubiertos por Medicaid y el Programa de Seguro Médico para Niños (CHIP, en inglés) podrían perder su cobertura bajo esta nueva ley federal.

Algunos líderes estatales advierten a sus comunidades que lo peor está por venir.

En un evento realizado el 18 de agosto en un hospital del sur del Bronx, en la ciudad de Nueva York, la gobernadora demócrata Kathy Hochul subió al escenario junto a trabajadores de salud para criticar la nueva ley de Trump.

“Lo que los republicanos en Washington han hecho con la ‘Ley Más Horrible’ que he visto es, literalmente, perjudicar a los neoyorquinos”, dijo. El sistema de salud del estado se prepara para enfrentar recortes cercanos a los $13.000 millones al año.

En California, los legisladores analizaron el impacto de los recortes en una audiencia del comité de la Asamblea General el 20 de agosto, donde algunos legisladores demócratas señalaron que programas estatales como los de salud reproductiva estaban en peligro.

“Nos hemos preparado para esta realidad: la llamada ‘Big Beautiful Bill’ del presidente Trump ahora es ley”, dijo el legislador demócrata Gregg Hart durante la audiencia, calificándola como “un ataque directo a los programas fundamentales de California y a nuestros valores”.

“Lamentablemente, la realidad es que el estado no tiene la capacidad para compensar todos estos recortes federales draconianos con el presupuesto actual”, agregó. “No podemos simplemente firmar un cheque y hacer que esto desaparezca”.

La radical ley presupuestaria, que fue aprobada sin apoyo demócrata, reducirá el gasto federal en Medicaid en aproximadamen $1.000 millones durante la próxima década, según estimaciones de la Oficina de Presupuesto del Congreso (CBO). Las reducciones en el gasto vienen en gran medida de la imposición de un requisito laboral para las personas que obtuvieron Medicaid con la expansión promovida por la Ley de Cuidado de Salud a Bajo Precio (ACA), además de otras nuevas barreras para acceder a la cobertura.

Según la CBO, más de 7,5 millones de personas perderán la cobertura de Medicaid y quedarán sin seguro, mientras se extienden recortes fiscales para personas ricas que, según los demócratas, no los necesitan.

Por su parte, los republicanos y el presidente Trump afirman que el paquete fiscal y los recortes en los programas son necesarios para evitar el fraude y el despilfarro, y para garantizar la sostenibilidad de Medicaid, un programa federal-estatal que brinda cobertura a personas con discapacidades y de bajos ingresos.

“La One Big Beautiful Bill elimina a los inmigrantes ilegales, aplica requisitos laborales y protege a Medicaid para los verdaderamente vulnerables”, anunció la Casa Blanca en un comunicado del 29 de junio.

Los recortes a Medicaid no comenzarán hasta después de las elecciones legislativas de mitad de mandato en noviembre de 2026, pero ya se han aplicado otros recortes.

La administración Trump ha intentado recuperar $11.000 millones en fondos federales de salud pública destinados a los estados durante la pandemia, lo que provocó una batalla legal con una coalición de estados gobernados por demócratas. También recortó unos $1.000 millones en subvenciones federales para servicios de salud mental en las escuelas y detuvo los fondos de los Institutos Nacionales de Salud (NIH) que financiaban a más de 90 universidades públicas.

Un análisis de KFF Health News demuestra que las cancelaciones han afectado a todo el país, sin importar la afiliación política o la ubicación geográfica. De las organizaciones que sufrieron recortes en el primer mes, aproximadamente el 40% se encuentran en estados que Trump ganó en noviembre.

La secretaria de prensa del Departamento de Salud y Servicios Humanos (HHS), Emily Hilliard, dijo que la agencia prioriza las inversiones que respalden el mandato de Trump de enfrentar las enfermedades crónicas. Defendió algunos de los recortes y afirmó, erróneamente, que la nueva ley no reduce Medicaid.

“La pandemia de covid-19 ya terminó, y el HHS no seguirá desperdiciando miles de millones de dólares de los contribuyentes en una crisis que los estadounidenses superaron hace años”, dijo.

Líderes estatales señalan que los fondos federales por la pandemia, que la administración busca recuperar, se habían destinado a otras medidas de salud pública, como la vigilancia de enfermedades emergentes, la respuesta ante brotes y la contratación de personal. En mayo, fiscales estatales ganaron una orden de restricción temporal contra la administración.

“Lo que estamos viendo ahora es que los estados anticipan grandes recortes a Medicaid, pero también enfrentan una serie de recortes federales más pequeños, pero significativos, en programas de salud pública”, dijo Larry Levitt, vicepresidente ejecutivo de políticas de salud en KFF. (KFF Health News es uno de los programas de KFF)

Parte del desafío para los estados es simplemente entender los cambios.

“Creo que es justo decir que hay preocupación, confusión e incertidumbre”, afirmó Kathryn Costanza, experta en Medicaid en la Conferencia Nacional de Legislaturas Estatales.

Los estados intentan entenderlo todo, creando grupos asesores para seguir los cambios federales, presentando demandas para intentar bloquear los recortes y reasignando fondos.

En Colorado, los legisladores aprobaron una ley que permite que fondos estatales de Medicaid se usen para servicios de salud —excluyendo abortos— en clínicas de Planned Parenthood of America, después de que la nueva ley de Trump prohibiera la financiación federal para este tipo de atención. Aún está por verse si esa prohibición se mantiene en los tribunales.

La legislatura de Louisiana asignó $7,5 millones a universidades estatales para compensar los recortes en financiación federal para la investigación, gran parte de ella relacionada con temas de salud.

Y en Dakota del Sur, el banco de alimentos más grande del estado pidió a los legisladores que destinen $3 millones para compensar recortes en fondos del Departamento de Agricultura de Estados Unidos.

Los estados deben equilibrar sus presupuestos cada año, por lo que los recortes ponen en riesgo muchos servicios si los legisladores no están dispuestos a aumentar impuestos. El trabajo comenzará en serio en enero, cuando muchos estados inicien sus nuevas sesiones legislativas.

Y es probable que las decisiones difíciles continúen. Los republicanos en la Cámara de Representantes del Congreso consideran nuevas leyes que podrían traer más recortes, como la reducción al generoso financiamiento federal que actualmente reciben 20 millones de adultos inscritos en Medicaid gracias a la expansión de ACA.

Como resultado, algunos estados revertirán sus expansiones de Medicaid y recortarán aún más programas de salud.

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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Until this year. The Trump administration’s plan to strip more than $550 million in federal public health and pandemic funds from Texas helped prompt cancellation of the event just before its scheduled July 21 start.

“Some people come every year and rely on it,” said Hidalgo County Health and Human Services Director Dairen Sarmiento Rangel. “Some people even camp out outside of Border Health so they can be the first in line to receive services. This event is very important to our community.”

States and local governments have made painful program cuts in the wake of major reductions in federal health funding that have already taken effect. Now, they’re sizing up the financial hits to come — some not until late next year or beyond — from the “One Big Beautiful Bill Act,” the tax and spending law congressional Republicans passed in July that enacts much of President Donald Trump’s domestic agenda.

Texas, for instance, expects to see its federal Medicaid funds reduced by as much as $39 billion over 10 years due to new barriers for enrollment, such as more frequent eligibility checks, according to a July analysis by KFF.

Taken together, the reductions amount to a seismic shift in how state health programs are provided and paid for. The administration is, in effect, pushing a significant amount of health costs to states. That will force their leaders to make difficult choices, as many state budgets are already strained by declining tax revenues, a slowdown in federal pandemic spending, and economic uncertainty.

Revenue forecasters in more than a dozen states have lowered expectations for the coming year, according to a June report by Pew.

“It’s almost inevitable that states will enact a number of cuts to health services because of the fiscal pressure,” said Wesley Tharpe, senior adviser for state tax policy at the left-leaning Center on Budget and Policy Priorities.

Some are proactively trying to stanch the impact.

Hawaii lawmakers are looking to aid nonprofits that are already contending with federal funding cuts. They’re doling out $50 million in grants to health, social service, and other nonprofits hit by federal funding cuts. To get the money, nonprofits must show a termination or drop in funding, or that they have otherwise been harmed by the cuts.

“It is not fair that organizations dedicated to supporting the people of Hawaii are being forced to scale back due to federal funding cuts,” Democratic Gov. Josh Green said in a statement.

Other states are scaling back projects to contend with cuts. Delaware Gov. Matt Meyer, a Democrat, received notice in March that the Trump administration was cutting $38 million in public health funding from the state. The next month, state legislative leaders halted a planned project to upgrade and expand the Capitol complex as a result.

“We recognized that the reckless federal cuts to the social safety nets of thousands of Delawareans called for us to hold back resources to protect our most vulnerable,” said David Sokola, president pro tempore of the Delaware Senate.

In New Mexico, the state with the highest percentage of residents enrolled in Medicaid, a bipartisan group of lawmakers voted to create a trust fund to boost funding for the program. About 10% of the more than 800,000 state residents covered by Medicaid and the related Children’s Health Insurance Program could lose their health coverage under the federal spending law, based on some estimates.

Some state leaders are warning constituents that the worst may be yet to come.

At an Aug. 18 event at a hospital in the South Bronx section of New York City, New York Gov. Kathy Hochul, a Democrat, stood on stage among health care workers in white coats to skewer Trump’s new law.

“What Republicans in Washington have done through the ‘Big Ugliest Bill’ I’ve ever seen is literally screwing New Yorkers,” she said. The state’s health system is bracing for nearly $13 billion in annual cuts.

And in California, lawmakers weighed the impact of the coming cuts from the federal law at a general assembly committee hearing on Aug. 20, where some Democratic legislators said state efforts to protect reproductive health services and other programs were in jeopardy.

“We’ve been bracing for this reality: President Trump’s so-called ‘Big, Beautiful Bill’ is now law,” Democratic lawmaker Gregg Hart said at the hearing, calling it a “direct assault on California’s core programs and our values.”

“Sadly, the reality is, the state does not have the capacity to backfill all of these draconian federal funding cuts in the current budget,” Hart said. “We cannot simply write a check and make this go away.”

The sweeping budget law, which passed without any Democratic support, will reduce federal spending on Medicaid by about $1 trillion over the next decade, based on estimates from the Congressional Budget Office. The spending reductions largely come from the imposition of a work requirement on people who’ve obtained Medicaid under the Affordable Care Act’s expansion, as well as other new barriers to coverage.

The law will mean more than 7.5 million people will lose Medicaid coverage and become uninsured, according to the Congressional Budget Office, while extending tax cuts for wealthy people who, Democrats say, don’t need them. Republicans and Trump have said the spending package and its accompanying program cuts were necessary to prevent fraud and waste, and to sustain Medicaid, a state-federal program for people with disabilities and lower incomes.

“The One Big Beautiful Bill removes illegal aliens, enforces work requirements, and protects Medicaid for the truly vulnerable,” the White House said in a June 29 statement.

The Medicaid cuts won’t begin until after the midterm elections in November 2026, but other cuts have already hit.

The Trump administration has sought to claw back $11 billion in federal public health funds earmarked to states because of the pandemic, spurring a legal fight with a coalition of Democratic-led states. It also cut about $1 billion in federal grants for mental health services in schools, and halted grants from the National Institutes of Health that provided money to more than 90 public universities.

HHS press secretary Emily Hilliard said the agency is prioritizing investments that advance Trump’s mandate to confront chronic disease. She defended some of the cuts and said, erroneously, that the spending law doesn’t cut Medicaid.

“The covid-19 pandemic is over, and HHS will no longer waste billions of taxpayer dollars responding to a crisis that Americans moved on from years ago,” she said.

State leaders say the pandemic funding the administration wants returned was earmarked for other public health measures, such as tracking emerging diseases, outbreak responses, and staffing. State attorneys general in May won a temporary restraining order against the administration.

“What we’re seeing now is states anticipating big cuts in Medicaid coming, but they’re also dealing with a whole variety of federal cutbacks in public health programs that are smaller but still quite meaningful,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News.

Part of the challenge for states is simply understanding the changes.

“I think it’s fair to say there is concern, confusion, and uncertainty,” said Kathryn Costanza, a Medicaid expert at the National Conference of State Legislatures.

States are struggling to sort it all out, forming advisory groups that are tracking federal changes, suing to try to block the cuts, and reallocating funding.

In Colorado, lawmakers passed a bill to let state Medicaid dollars pay for non-abortion care at Planned Parenthood of America clinics after Trump’s law banned federal funding for such care. Whether the ban holds up in court remains to be seen.

The Louisiana Legislature sent $7.5 million to state universities to make up for cuts to federal research funding, much of which goes to health-related research.

And in South Dakota, the state’s largest food bank has asked lawmakers to spend $3 million to make up for funding cuts to the U.S. Department of Agriculture.

States must balance their budgets every year, so cuts put many services at risk if state lawmakers are unwilling to raise taxes. The work will begin in earnest in January, when many states begin new legislative sessions.

And the tough choices are likely to continue. Congressional House Republicans are considering legislation that could bring more cuts, including by slashing the generous cost sharing the federal government provides for 20 million adults who enrolled in Medicaid under the ACA’s Medicaid expansion.

Some states will roll back their Medicaid expansions and cut more health programs as a result.

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For more than a decade, the University of California-San Francisco researcher relied on federal grants without incident. But Thakur, a doctor and a scientist, suddenly found herself leading the charge for public health science against President Donald Trump’s political ideology.

Thakur, 45, a pulmonologist who also is medical director of the Zuckerberg San Francisco General Hospital Chest Clinic, is the lead plaintiff among six UC researchers who in June won a class-action preliminary injunction against the efforts of several federal agencies to carry out Trump’s executive orders seeking to eliminate research grants deemed to focus on areas of diversity, equity, and inclusion. The administration has filed a notice of appeal, and the outcome, whether or not she and her colleagues prevail, could influence both the future of academic research and the health of those she’s spent her life trying to help.

“When this moment hit us, where science was really under attack and lives are at stake, it doesn’t surprise me that she stepped up,” said Margot Kushel, who directs the UCSF Action Research Center for Health Equity and has known Thakur for more than a decade through their work at the center and San Francisco General, the public county hospital.

“We don’t think our work should be political, to be honest,” Kushel said. “Saving people’s lives and making sure people don’t die doesn’t seem to me that it should be a partisan issue.”

Thakur said that after the abrupt funding cuts, she and the other researchers “felt pretty powerless and found that the class-action lawsuit was a way for us to join together and sort of take a stance.”

The suit was filed independently by the researchers and allowed them to show the harm inflicted not just on their own work “but more broadly on public health and public health research,” she said.

Thakur’s study, which received more than $1.3 million in funding from the Environmental Protection Agency and was set to run through November, explores the impact of increased wildfire smoke on low-income communities and communities of color, populations that already experience heightened pollution and other environmental health disparities. The goal is to find ways to help residents limit their smoke exposure, Thakur said, adding that the results could help people no matter their circumstances.

Preliminary findings show that smoke can trigger breathing emergencies among children days after exposure, knowledge that could lead to better treatment, and that smoke intensity may peak during just a few hours when protection is most needed, indicating the need for more precise and timely safety messaging.

Thakur said her studies on health equity and health disparities saw growing federal support during the covid pandemic and a national focus on racism spurred by the murder of George Floyd. The EPA had solicited the grant in 2021 for her and her team to research how climate change affects underserved communities.

Trump, in one of several executive orders blocking federal funding for DEI programs, said they “use dangerous, demeaning, and immoral race- and sex-based preferences” that he said have “prioritized how people were born instead of what they were capable of doing.”

EPA Administrator Lee Zeldin said in March that, in cooperation with the Department of Government Efficiency, the administration had canceled more than 400 grants topping $2 billion “to rein in wasteful federal spending.”

The order by U.S. District Judge Rita Lin in San Francisco temporarily blocking the grant terminations covered the EPA, as well as grants by the National Endowment for the Humanities and the National Science Foundation. Lin’s ruling was not a nationwide injunction of the sort restricted by the U.S. Supreme Court in a June decision.

The Trump administration agencies affected by the order have reinstated the UC grants as the lawsuit proceeds. The government filed a motion for a temporary stay on the order pending the outcome of its appeal, but a decision had not been issued as of publication.

The EPA declined to comment on the judge’s order blocking the attempted cancellation of the research funding, citing the ongoing litigation, and attorneys representing the government did not respond to requests for comment.

Thakur defends the need for research that spotlights disadvantaged communities. Her interest in health equity stems from childhood experiences. The daughter of immigrants from India, with a physician and an engineer as parents, she grew up relatively well-off in a mixed-income neighborhood in Phoenix. While she prospered, however, she had friends who couldn’t afford college or became pregnant as teenagers.

“I see my research being directed towards trying to understand how where you live and what you experience impacts your health,” Thakur said.

When the grants were suspended in April, the researchers were unable to finish identifying ways to help protect communities from wildfire smoke. Thakur had to dismiss a student intern and dip into discretionary funds to pay her postdoctoral fellow. At least three research papers that could have directly affected public health were in danger of going unpublished without the funding, she said.

The government reinstated her team’s grants about three weeks after the judge’s order, and Thakur is in the process of picking up the pieces. She’s hopeful that researchers can publish two of the three studies they were working on.

Thakur said she is now cautiously optimistic after experiencing “a roller coaster of emotions.” Putting together a project and conducting the research takes years, she said, so “to have all of that end suddenly, it brought me a range of emotions one thinks about when folks are experiencing grief. There’s denial, anger.”

But the Trump administration’s actions have already sapped morale in the field. Rebecca Sugrue, Thakur’s postdoctoral fellow and an expert in health equity and climate change, is rethinking her entire career path.

“I kind of came to the realization that all the expertise I had built up were the kind of things that were being deprioritized,” Sugrue said. She said she and other postdoctoral students and more junior members of the research team even had discussions about leaving academia: “‘Unstable’ and ‘uncertain’ were words that were used a lot.”

The lasting damage is not lost on Thakur. If the grants ultimately disappear, universities won’t have the typical programs to train students or to support academic research, she said, adding that, “I think there are concerns that the sort of divestment from science and research in these particular areas will cause generations of impact.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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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