The Trump administration has withheld billions of dollars Congress appropriated for health programs, while a law President Donald Trump signed will end Medicaid eligibility for some immigrants with legal status starting Oct. 1. The dispute puts federal spending decisions at odds with congressional appropriations, and state data shows the coverage change could affect hundreds of thousands of people.
Congressional funding at risk
Congress appropriated $9.4 billion for global health programs for fiscal 2026, preserving the President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight TB, AIDS and Malaria, and HIV/AIDS programs previously administered through the U.S. Agency for International Development (USAID). The administration hasn't spent $1.3 billion intended to protect maternal and child health and counter infectious diseases including HIV/AIDS, malaria and tuberculosis.
Sen. Susan Collins (R-Maine), chair of the Senate Appropriations Committee, urged administration officials last week to spend the money as Congress intended. Collins and top Democrats said they were concerned that the administration was diverting the $1.3 billion for global health programs, along with $1.2 billion for development assistance, to pay for shutting down USAID. Lawmakers said another $725 million was due to expire Wednesday rather than be spent. Officials hadn't made clear whether Collins received a response after she asked how they would use the funds.
Under the Trump administration’s “America First” foreign aid program, the United States is entering bilateral agreements with individual countries so they can eventually rely less on U.S. funding. The administration's withholding of appropriated money follows the White House's unilateral cancellation late last week of nearly $1 billion in congressionally appropriated funding. Democratic and some Republican lawmakers say the move is illegal.
Programs and grants curtailed
Congress also passed $101 million for the Teen Pregnancy Prevention (TPP) program, but the Department of Health and Human Services (HHS) has spent only about $500,000. Created in 2010, TPP funds organizations that help young people make healthy decisions, reduce sexual risk behavior, and decrease sexually transmitted infections and unintended teen pregnancy.
HHS terminated 53 grants to nonprofits, universities and health departments worth about $67 million in June, two years before they were due to expire. HHS said the grants no longer aligned with agency priorities, and the administration wanted to reshape TPP into abstinence-only curricula. A list The Hill saw said HHS terminated most grants because it said they normalized or promoted sexual activity for minors.
A federal judge blocked the administration’s changes to TPP in August while a lawsuit proceeds. A letter to HHS from 92 House and Senate Democrats led by the Democratic Women’s Caucus said none of the funding had been restored and local programs had halted work. “HHS’s only options are to either return the funding to the communities and teens who rely on it or let it go to waste,” the lawmakers wrote.
Congress appropriated about $345 million for the Agency for Healthcare Research and Quality (AHRQ) this year. In July, the agency told researchers it was halting at least 104 grants across 32 states, many aimed at improving patient safety. Sens. Patty Murray (Wash.) and Tammy Baldwin (Wis.), top Democratic appropriators, said HHS planned to award just 90 grants this year and sought to transfer $100 million specifically appropriated for AHRQ to other agencies.
Medicaid eligibility changes
The One Big Beautiful Bill ends Medicaid eligibility for refugees, asylees, trafficking victims and others. State data shows hundreds of thousands of immigrants with legal status risk losing government health coverage starting Oct. 1, and the effect may be greater than initially predicted. President Donald Trump signed the law on July 4, 2025. It cuts more than $900 billion in Medicaid spending through 2034.