Trump Administration & 119th Congressional Update

Through our partnership and membership with The National Council for Mental Wellbeing, Ohio Council members have access to important and timely information occurring at the federal level. With the transition to a new White House administration and Congressional leadership, the National Council staff have developed an informational briefing that includes key developments, appointments, and policy initiatives underway. Ohio Council members can sign up to receive this federal policy and regulatory newsletter. If you’re not already signed up to receive we highly recommend you subscribe here.

Accordingly, please see this recent update on the first 100 days of the 119th Congress and the Trump-Vance administration.

Inauguration and Executive Orders:

• President Trump officially sworn in: On Monday, Jan. 20, Donald Trump was sworn in as the 47th president. His address did not go into detail on health care-related policy positions.
• President Trump Executive Orders: President Trump signed dozens of executive orders since his inauguration, many of which reversed executive orders from the Biden-Harris administration. See a full list with summaries of each order here.

Potential Proposed Cuts to Medicaid:

• House “Menu of Options” to reduce deficit circulates, includes proposed Medicaid cuts: As lawmakers look to reconciliation, House Budget Chair Jodey Arrington (R-Texas) shared a list of potential spending cuts with House Republicans that include several proposals that if pursued and passed, could result in over $2 trillion in Medicaid cuts. While these proposals have not been incorporated into legislation at this time, it is important lawmakers understand the significant impact cuts to the Medicaid program could have on lifesaving access to mental health and substance use care. The proposed cuts included:
• Per capita caps: Per capita caps establish a limit at which the federal government will pay for Medicaid services on a per-beneficiary basis over states’ actual costs. A per capita proposal would reduce Medicaid over growing amounts over time and shift costs to states with varying impact. Some states noted as especially vulnerable to a per capita cap include: AK, NV, WY, ID, SC, GA, FL, AL, TX, MS.
• Reduced expansion match rate: Eliminating the 90% matching rate and instead applying the regular federal Medicaid Assistance Percentage (FMAP) apply, on average is 57%, would also shift costs to states. This could mean that expansion states may drop their expansions over time, and it would immediately implicate the states that have trigger laws to drop their expansion if the expansion FMAP is lowered. States that have automatic trigger laws if the expansion FMAP is lowered are: AZ, AR, IL, IN, MT, NH, NC, UT, and VA. States that have trigger laws authorizing the state Medicaid agency to drop the expansion or requiring state legislative reconsideration: ID, IA, and NM.
• Lower minimum Medicaid match rate: A state’s regular Medicaid match rate could be dropped below the current 50% minimum, but a new minimum threshold has not been specified. For states that currently have a minimum 50% matching rate – CA, CO, CT, MD, MA, NH, NJ, NY, WA, and WY – this proposal would shift substantial costs to states.
• Restricted the use of provider taxes: All states except Alaska count on provider taxes as a part of financing their Medicaid programs. Restrictions on such taxes could impact states’ ability to raise revenue to finance the program and could therefore reduce coverage through the program, lowering federal Medicaid spending. Details of such restrictions have not yet been specified.
• Of note: Some political reporters stated that several Republican House members disagreeing internally with Rep. Arrington’s approach.
• Slim majority = opportunity for advocacy: Republicans currently have a two-vote majority in the House, at least until special elections in Florida and New York later this spring. Those elections are likely to increase the Republican majority.In other words, right now, if Republicans wanted to pass a reconciliation bill reforming Medicaid, they essentially have no margin to allow any of their members to vote no.Thus, connecting with your lawmaker now is an opportunity to educate and raise awareness of the impact Medicaid has in your community – see our advocacy opportunity below.
• Where is the Senate on this? So far, there are no known comparable proposals from the Senate to reduce Medicaid spending. Attempts to reform Medicaid have generally been perceived by voters as unpopular. After Republicans’ failed attempt to roll back large swaths of the Affordable Care Act in 2017, the 2018 midterm elections resulted in Democrats regaining control of the House for the final two years of President Trump’s first term. Republicans in general would not want a similar outcome in 2026, which underscores the opportunity for education and awareness efforts around the impact these cuts would have on people.

Advocacy Opportunity:

• Considering this recent news, the National Council is initiating an outreach campaign to share with lawmakers how these proposed cuts would negatively impact access to care. See the link below to send an initial letter to your lawmakers on how important Medicaid is to providing mental health and substance use services across the country. 
• Use this link to customize and send a letter to your elected officials 
  • Sharing your story moves and impacts lawmakers! In doing so, staying focused on the ask, sharing a concise anecdote, and using respectful language goes a long way in your story’s efficacy.
  • Lawmakers need to hear from their constituents that any proposal to significantly cut Medicaid should be considered a non-starter in legislative negotiations.

• HHS Secretary nomination hearing set: Robert F. Kennedy Jr. (HHS Secretary nominee) will appear before the Senate Finance Committee on Wednesday, Jan. 29. He is expected to appear before the Senate HELP Committee the following day. 
  • Hearings forDr. Mehmet Oz (CMS Administrator nominee) have not been set.
  • The Trump administration named Dorothy Fink as Acting HHS secretary in the meantime. Fink was previously director of the Office on Women’s Health in HHS’ Office of Assistant Secretary for Health.
• What about SAMHSA? No news yet on who may replace Dr. Miriam Delphin-Rittmon. This too is a Senate-confirmed position.
• VA secretary hearing: On Jan. 21, the U.S. Department of Veterans Affairs held a confirmation hearing for former Congressman Doug Collins to be Secretary of Veterans Affairs.

• March 14th: Government funding will again face a funding deadline, as per the continuing resolution passed at the end of 2024.
• March 31st: Medicare telehealth flexibilities will expire unless Congress passes another extension.