The Trump administration has withheld billions of dollars Congress appropriated for health programs, while a new law puts hundreds of thousands of immigrants with legal status at risk of losing Medicaid coverage starting Oct. 1. Some of the money could expire Wednesday, when the fiscal year ends. Democratic and some Republican lawmakers say the administration’s actions are illegal.
Appropriated funds left idle
Congress appropriated $9.4 billion for global health programs for fiscal 2026, including funding for the President’s Emergency Plan for AIDS Relief, the Global Fund to Fight TB, AIDS and Malaria, and HIV/AIDS programs previously administered through the U.S. Agency for International Development. 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 are concerned the administration is diverting $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 would expire Wednesday rather than be spent. Collins didn’t appear to have received a response to her questions about how officials would use the money.
The White House also canceled nearly $1 billion in funding Congress had appropriated late last week. Under the 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.
Congress passed $101 million for the Teen Pregnancy Prevention program, but the Department of Health and Human Services has spent only about $500,000. Created in 2010, the national, evidence-based program funds organizations that help young people make healthy decisions, reduce sexual risk behavior, and decrease sexually transmitted infections and unintended teen pregnancy.
In June, HHS terminated 53 grants to nonprofits, universities and health departments worth about $67 million, two years before they were due to expire. The agency said the grants no longer aligned with its priorities and that it wanted to reshape the program 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.
Cuts reach local programs and research
In August, a federal judge blocked the administration’s changes to the teen pregnancy program while a lawsuit proceeds. U.S. District Judge Christopher Cooper said he wasn’t sure he had authority to reinstate the canceled grants, and a decision on that question is pending. A letter to HHS from 92 House and Senate Democrats led by the Democratic Women’s Caucus said grant recipients hadn’t received any restored funding. Local programs working to reduce teen pregnancy, sexually transmitted infections and other health risks for young people 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. President Trump’s 2027 budget request proposed eliminating the program, calling it leftist and ineffective, although he signed the fiscal 2026 budget with its funding included.
Congress appropriated about $345 million for the Agency for Healthcare Research and Quality this year. The agency works to make health care safer, more affordable and more effective; research it funded is estimated to have saved thousands of lives and billions of dollars over the past 27 years. In July, AHRQ told researchers it would halt 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 told them it planned to award just 90 grants this year and sought to transfer $100 million specifically appropriated for AHRQ to other agencies. At his confirmation hearing on Sept. 16, Chris Klomp, nominee for HHS deputy secretary, told senators AHRQ was “on track to expend 97 percent of its appropriated funds by the end of the fiscal year.” The article said that figure apparently didn’t include research grants.
“We’ve seen almost no money go out the door, and so unless they actually somehow manage to ship it all out today or tomorrow, there’s going to be a massive impoundment at AHRQ, and likely the result will be lawsuits or hopefully further congressional action,” said Aaron Carroll, chief executive of AcademyHealth, a health services research group that supports AHRQ’s work. The White House had also failed to spend AHRQ funding before, impounding $80 million after it didn’t award grants from fiscal 2025.
Medicaid eligibility narrowed
State data shows hundreds of thousands of immigrants with legal status are at risk of losing government health coverage starting Oct. 1. The One Big Beautiful Bill ends Medicaid eligibility for refugees, asylees, trafficking victims and others, and the effect may exceed initial predictions.
President Donald Trump signed the law on July 4, 2025. It cuts more than $900 billion in Medicaid spending through 2034. The coverage loss and the funding left unspent affect different programs, but both put public health resources and access to care at stake as the fiscal year ends.