In this edition of AcademyHealth’s Situation Report, we highlight our ongoing advocacy for the Agency for Healthcare Resaerch and Quality as well as update readers on the ongoing, 35-day government shutdown, including court orders that the administration must use contingency funds for partial SNAP benefits after 42 million Americans who did not receive their benefits on November 1. Funding and access to other critical health services is also at risk as the administration directs states reverify citizenship of Medicaid enrollees, which could cause eligible individuals to lose their coverage unnecessarily, as well as substantial cuts to HIV/AIDS treatment as a result of a House bill. Former CDC advisors release new analysis critical of CDC vaccine policymaking. As these policy changes unfold, they have direct implications for health services researchers tracking how federal decisions affect access, quality, and equity in care.
In today’s issue:
- AcademyHealth’s AHRQ Analysis Spurs National Attention
- Federal Government Ordered to Use Contingency Funds for Partial SNAP Benefits
- Federal Order for States to Reverify Medicaid Enrollees Raises Coverage Concerns
- Medicare Finalizes Rule to Reduce Payments for Certain Specialist Services
- HIV Services Funding At Risk Amid Budget Negotiations
- Experts Give CDC’s Vaccine Advisory Panel an F Score for Maturity in Policymaking
AcademyHealth’s AHRQ Analysis Spurs National Attention
Following AcademyHealth’s recent blog on AHRQ’s collapsing grant function, POLITICO published an article today amplifying our analysis and featuring the voices of our community whose work has been directly affected by AHRQ’s operational crisis.
The article spotlights the consequences of deep staff cuts at AHRQ, which have frozen new research grants and stalled critical projects to expand behavioral health and post-critical illness care. Citing AcademyHealth’s data that AHRQ staffing has dropped by at least 65 percent since January, CEO Aaron Carroll told POLITICO, “Even if AHRQ wanted to award new grants, there simply isn’t enough staff to do so.” He warned that the consequences are especially severe for rural communities, where proposals to improve mental health access are “languishing because AHRQ doesn’t have staff to review them.”
Two researchers also brought vital, human context to the story. Dr. Leslie Scheunemann, a geriatrician at the University of Pittsburgh, described how her study to help survivors of serious illness reintegrate into their communities had to be paused after expected AHRQ funding did not come through: “We were basically helping patients and families learn adaptive coping skills… It’s been devastating to think about what all the staff members have been going through there.”
Dr. David Mandell, a professor of psychiatry at the University of Pennsylvania, shared that his proposal to expand evidence-based mental health care in rural areas has been stalled since early this year. He recalled receiving a message from AHRQ saying, “I’m the only person here. Everybody has been fired. We have no way of reviewing these grant proposals.”
These stories vividly demonstrate what we have been warning: the collapse of AHRQ’s grant function has real-world consequences for patients, providers, and researchers across the country. AcademyHealth continues to call for urgent congressional oversight and restoration of AHRQ’s capacity to carry out its mission.
Read the POLITICO article here and our original analysis here.
Federal Government Ordered to Use Contingency Funds for Partial SNAP Benefits
The White House confirmed that the administration will comply with federal court orders and use contingency funds to provide food benefits to tens of millions of Americans who use the Supplemental Nutrition Assistance Program (SNAP). The announcement came after President Trump raised skepticism as to whether the administration would comply with the court orders through a social media post in which he announced that SNAP benefits would only be dispersed when the government shutdown ends.
The court orders come from two federal judges, from Massachusetts and Rhode Island, respectively, who ruled that the Trump administration must continue to fund SNAP either partially or fully through November. This decision impacts up to 42 million Americans who did not receive their benefits on November 1 as they normally would on the first of the month. Although benefits will be distributed, Americans in some states may experience significant delays due to process errors and challenges given the disruption, and benefits in all states will be reduced.
These court orders came about following two different lawsuits from coalitions of several states, municipalities, and non-profit organizations that claimed the administration's decision to stop SNAP funds was illegal. While advocates call for the Rhode Island Judge to order the administration to provide full SNAP benefits, researchers have the ongoing opportunity to inform the evolving conversation through reliable data. Researchers studying social determinants of health and nutrition assistance programs can provide data on how disruptions to SNAP benefits influence health outcomes and healthcare utilization.
Federal Order for States to Reverify Medicaid Enrollees Raises Coverage Concerns
The administration has ordered states to investigate individuals enrolled in Medicaid to ascertain their eligibility based on their immigration status, an unprecedented step by the federal government to use the state-run federal health program for low-income and disabled individuals to verify eligibility based on immigration status. KFF Health News reports that five states have received more than 170,000 names to investigate, as CMS Administrator Oz stated on X that more than $1 billion “of federal taxpayer dollars were being spent on funding Medicaid for illegal immigrants,” in five states and Washington, D.C. Only U.S. citizens and some lawfully present immigrants are eligible for Medicaid, while unauthorized immigrants are ineligible for federally funded health coverage, including Medicaid, Medicare, and plans through the ACA marketplaces.
This federal order follows a similar one issued by CMS in August, demanding that state Medicaid agencies check the immigration status of those on a list of individuals enrolled in Medicaid. Similarly, in June, HHS Secretary Kennedy ordered CMS to share information about Medicaid enrollees with the Department of Homeland Security (DHS), which drew a lawsuit in which a federal judge ordered HHS to stop sharing such information. States use databases maintained by the Social Security Administration and DHS to verify enrollees’ immigration status, and experts note that requiring states to reverify citizenship could cause eligible individuals to lose their coverage unnecessarily. Experts also note that the inability to verify certain individuals’ immigration status at the federal level could be caused by something as simple as misspelled or misattributed names. Health services researchers can help quantify the potential loss of coverage among eligible populations and its impact on health care systems.
Medicare Finalizes Rule to Reduce Payments for Certain Specialist Services
On Friday, Medicare issued a final rule announcing policy changes for Medicare payments under the Physician Fee Schedule (PFS). In alignment with the proposed rule released in July, this “efficiency adjustment” reduced payment for surgeries, outpatient procedures, and other procedures the agency believes can be done more efficiently, reflecting the belief that technological advancements and standardized workflows have decreased the associated time and costs of these services. Beginning January 1, 2026, these select services will see a 2.5 percent cut to reimbursement rate.
This decision has elicited mixed reactions among stakeholders because it conflicts with the rates recommended by the American Medical Association, the industry’s main lobbying group. The AMA convenes the Relative Value Scale Update Committee, which advises Medicare on how to assign values to codes based on estimates of time and overhead costs. Specialists and hospitals express concern that these reimbursement cuts are a risk to their financial stability and could limit patient access to essential surgical services. Meanwhile among primary care providers, this policy and its subsequent ability to reallocate resources toward time-based services is viewed as an opportunity to strengthen the primary care infrastructure and promote a more balanced health care system. These shifts also present opportunities for researchers to evaluate the downstream effects of payment changes on access, cost, and provider behavior.
HIV Services Funding At Risk Amid Budget Negotiations
HIV advocates, researchers, and policymakers are concerned as the budget bill passed by the House includes proposals to eliminate over $1.5 billion in life-saving HIV and AIDS services for people living with HIV (PLHIV) in the U.S., which poses a dramatic increase from the cuts originally proposed by the Senate and White House. Over $1 billion in U.S. HIV/AIDS prevention and research could be eliminated if passed with an additional $525 million in cuts to the Ryan White HIV/AIDS program, which provides lifesaving treatment to PLHIV. The bill also would cut nearly $2 billion in global HIV initiatives, including life-saving medication millions rely on. While it remains uncertain whether the White House or Senate will sign off on the bill after the government shutdown, advocates argue that said cuts will result in decreased HIV testing, later diagnoses, and ultimately greater cases of AIDS and death. The bill would maintain a $505 million budget for the Housing Opportunities for Persons with AIDS (HOPWA) program, despite the Trump administration’s proposal to eliminate the program.
The Senate has been more reluctant to eliminate HIV/ AIDs programs, with Senate Republicans such as Susan Collins calling the President's Emergency Plan for AIDS Relief (PEPFAR) an “enormous success,” arguing that she “can’t imagine why we would want to terminate that program.” While a Department of Health and Human Services (HHS) spokesperson said that essential domestic HIV/AIDS programs will “continue through the Administration for a Healthy America,” advocates and researchers warn that these cuts could reverse decades of progress in HIV prevention and treatment.
The Office of Infectious Disease and HIV/ AIDS Policy, along with several other HHS divisions for HIV services, were eliminated during HHS layoffs. Over 1.2 million PLHIV, or about 40 percent of adults needing HIV treatment, rely on Medicaid which covers costs such as pre-exposure prophlyxasis (PrEP) and lenacopavir. Lenacopavir costs about $28,000 per year with other HIV medication costing thousands of dollars. Recent Medicaid cuts authorized by the budget reconciliation act will result in PLHIV, and those at risk of acquiring HIV, losing access to any treatment. Collectively, these proposed reductions could undermine progress and will dramatically increase the number of new cases of HIV as well as the number of people who will die unnecessarily from HIV progressing to AIDS.
Health services researchers working with HIV can emphasize the importance of life-saving medications to preventing the spread of HIV and to the overall health of the nation to policymakers, highlighting that there are PLHIV who were born with HIV and cases such as Ryan White who acquired HIV through a blood transfusion. This messaging is especially critical as policymakers have historically responded to these approaches while largely ignoring the HIV epidemic before Ryan White. Moreover, researchers can begin educating state policymakers about the importance of these programs and HIV prevention as the future of federal HIV/ AIDS programs remains unclear.
Experts Give CDC’s Vaccine Advisory Panel an F Score
The Immunization Scientific Advisory Collaborative (ISAC)—partially comprised of the fired members of the Advisory Committee on Immunization Practices (ACIP) at the Center for Disease Control and Prevention (CDC)—reported that ACIP’s September meeting failed in its maturity of policymaking. The September meeting received a score of 58 percent, marking a significant drop from ACIP’s April meeting maturity in policymaking score of 100 percent. Assessing seven key indicators of policymaking expertise, ISAC attributed the failed score to ACIP’s inadequacies in systematic review, how carefully evidence was considered, and concerns regarding transparency and conflicts of interest. ISAC explained that ACIP “shifted” the committee’s “standard for evidence” by increasingly considering vaccine-skeptical evidence and minimizing “standard, high-quality evidence” around vaccines. Moreover, ACIP is taking on tasks outside the scope of its mission, such as in its recommendation for hepatitis B testing for pregnant women. Such recommendations are tasked to the U.S. Preventive Service Task Force (USPSTF), which faces similar threats to those faced by ACIP, such as its members being removed and replaced with members whose beliefs are more aligned with those of Secretary Kennedy. AcademyHealth has taken efforts to champion the task force after the most recent meeting was cancelled. Experts worry that immaturity in policymaking and providing recommendations outside of its scope will cost ACIP its expertise and lead to “greater sorrow” caused by the reemergence of preventable diseases.
Previous Editions
This is the latest in a series of Situation Report updates from AcademyHealth. You can find prior issues here.
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