Summary
The White House is taking steps to ensure that the shutdown lasts as long as needed for Republicans to emerge “the victor”, including the Office of Management and Budget finding ways to provide paychecks to federal law enforcement and active-duty military, and using tariff revenue to fund Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Additionally, the Trump Administration has begun mass layoffs, as threatened, with more than 1,300 Centers for Disease Control and Prevention (CDC) employees being fired on Friday (700 of which have been reportedly rescinded).
As the calendar inches closer to the beginning of ACA open enrollment, November 1, Republicans are beginning to develop a framework for a potential enhanced premium tax credit extension, including new income limits, new minimum out-of-pocket premiums, cutting off new enrollees and new abortion restrictions. However, Republicans will not engage in any negotiations on an extension unless the government is open. The Senate is set to vote on the House-passed continuing resolution (CR) for an eighth time, but will no longer allow votes on the Democrat version of the CR. Given that the current House CR provides funding through November 21, Sen. Markwayne Mullin (R-OK) has also floated an alternative CR that would provide funding through mid-December in order to avoid another shutdown in the near-term and allow more time for broader negotiations.
Nutrition Program Funding Update
The Department of Agriculture (USDA) Food and Nutrition Service (FNS) reportedly told congressional staff during a briefing that it will use $300 million in unused tariff funds leftover from child nutrition programs in the prior year to fund the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during the government shutdown. While the specifics have not been made public, a USDA spokesperson confirmed the Administration’s plans. States have already spent almost all of the $150 contingency fund to maintain benefits. However, the contingency fund cannot be spent on administration, which has already caused wait lists and other issues as states try to pay staff and continue to provide benefits. While the tariff funding can reportedly support benefits through October, a prolonged shutdown would force states to significantly revise their own budgets in the hopes of receiving reimbursement for federally funded benefits when the government reopens or reduce/pause benefits.
Additionally, USDA sent letters to states instructing Supplemental Nutrition Assistance Program (SNAP) directors to delay sending November funds to electronic benefits transfer (EBT) vendors in light of “operational issues and constraints.” SNAP is a mandatory program and is less vulnerable to shutdowns, but it is still on an annual funding cycle and the Administration is reportedly concerned that the program could run out of funding if the shutdown extends into November.
Vaccine Policy Update
The October meeting of the controversial Advisory Committee on Immunization Practices (ACIP) is postponed due to the government shutdown. ACIP also established a new working group to revisit the childhood and adolescent vaccination schedule and the use of aluminum adjuvants, which are used to boost immune response. Over the next several years, the workgroup will examine the timing and order of vaccines, concurrent administration, the safety of specific ingredients like aluminum adjuvants, and the efficacy of vaccine schedules in other countries. This work could then be used to justify changes to ACIP recommendations and federal vaccine policy.
Changes to the vaccine recommendations that are adopted by the Centers for Disease Control and Prevention (CDC) can impact access to and the cost of vaccines, and many public health leaders are concerned about the direction of ACIP work. The concurrent vaccine schedule, hepatitis B vaccine, and use of aluminum are common talking points among Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.’s allied vaccine skeptics, including President Trump. The President recently called for the measles, mumps, and rubella combined vaccine to be split (ACIP already voted to no longer recommend a version that also included varicella) during a press conference. Chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee Bill Cassidy (R-LA) is a hepatologist by practice and has been staunchly defending the hepatitis B birth dose in recent weeks as Kennedy allies and President Trump suggest delaying the initial dose to age four or even 12.
During the September meeting, ACIP voted to recommend “individual-based decision making” for the COVID-19 vaccine for all populations rather than a universal recommendation to be vaccinated. The decision may have increased access to the vaccine for pregnant women by undoing Secretary Kennedy’s earlier unilateral change to no longer recommend the vaccine at all during pregnancy. Neither ACIP nor Secretary Kennedy have commented on the implication of ACIP’s updated recommendation for pregnant women, but the September ACIP meeting demonstrated the members’ lack of understanding of the procedures and implications of ACIP recommendations.
Regulatory Update
The Office of Management and Budget (OMB) completed reviewing the following:
- Medicaid and Immigration Status. A final rule titled, “Medicaid Eligibility Changes Under the Affordable Care Act of 2010; Giving States Freedom to Use Immigration Information to Determine State Residency for Medicaid Eligibility.” The final rule is part of the Trump administration’s efforts to increase federal oversight on states using Federal Medicaid funding for the health care of undocumented immigrants.
OMB is also reviewing the following:
- Medicare:
- CY 2027 Medicare Advantage/Part D Policy. Proposed CY 2027 policy and technical changes to Medicare Advantage, Medicare Prescription Drug Benefit, Medicare Cost Plan, and PACE
- Medicare Payment Rules. The CY 2026 Physician Fee Schedule final rule, the CY 2026 Hospital Outpatient PPS final rule, and the CY 2026 ESRD final rule.
- Procurement of Domestic PPE. An advance notice of proposed rulemaking that would detail program incentives and requirements for Medicare providers and suppliers to invest and phase-in the procurement of American made personal protective equipment (PPE) and essential medicine to secure our nation’s health and safety.
- Medicaid:
- Gender-Affirming Care.
- A proposed rule titled, “Medicaid Program; Prohibition on Federal Medicaid Funding for Sex Trait Modification Procedures Furnished to Children and Youth.”
- A proposed rule titled, “Medicare and Medicaid Programs; Hospital Condition of Participation: Limiting Participation Based on the Performance of Sex Trait Modification Procedures on Children.”
- State Directed Payments. A proposed rule titled, “Medicaid Managed Care-State Directed Payments.” The proposed rule appears intended to advance a presidential memorandum released on June 6, which directs HHS to “eliminate waste, fraud, and abuse in Medicaid, including by ensuring Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law.”
- Gender-Affirming Care.
- Prescription Drugs:
- A proposed rule titled, “Improving Transparency into Pharmacy Benefit Manager Fee Disclosure” and a proposed rule addressing Transparency in Coverage requirements.
- CMMI Drug Pricing Models. A proposed rule for a Global Benchmark for Efficient Drug Pricing (GLOBE) Model and a proposed rule for Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model
- Nutrition:
- Head Start. A notice from the Administration for Children and Families titled, “Publish Request for Information: Nutrition Services in Head Start Programs
- Immigration:
- Unaccompanied Children. An interim final rule titled, “Unaccompanied Children Program Foundational Rule; Update to Include Proof of Identity and Income Verification Standards.”