April 21, 2026

Bringing you the latest news impacting our network from Congress and the Administration.

In this Edition: 

• Senate Unveils "Skinny" Budget Reconciliation 2.0 Blueprint 
• "Here We Stand." Campaign Continues with Coordinated Advocacy, Hill Day This Week
• Join Us Next Week for Capitol Conversations
  • April 30, 1PM ET: The Next Phase of "Here We Stand."

• What We Are Reading

Senate Unveils "Skinny" Budget Reconciliation 2.0 Blueprint

Today, Senate Budget Committee Chair Lindsey Graham (R‑SC) formally kicked off the second phase of Republicans’ reconciliation strategy—designed as a three-part effort—by releasing a narrow budget resolution. The resolution is designed to fund Immigration and Customs Enforcement (ICE) and other immigration enforcement activities at the Department of Homeland Security (DHS). The aim is to break the ongoing partial shutdown at DHS by bypassing the Senate filibuster.  Republicans plan to move as quickly as possible to deliver the bill to the President by his self-imposed June 1 deadline. 

Narrow Approach on Immigration and Border Enforcement 

As Republicans have been signaling recently, the resolution gives reconciliation instructions only to the panels with jurisdiction over immigration and border enforcement policy including the Senate Judiciary Committee and the Senate Homeland Security and Governmental Affairs Committee, and the House Homeland Security Committee and the House Judiciary Committee. Under the blueprint, these committees are directed to produce legislation by May 15. The package could provide up to roughly $140 billion total in immigration enforcement funding, which Republican leaders say would sustain ICE, Border Patrol, and related activities for several years.

Broader Implications? 

At this time, no instructions are included in the budget resolution for committees overseeing Medicaid, including Senate Finance and House Energy and Commerce.  Because reconciliation bills may only include provisions within the jurisdiction of committees named in the instructions, at present we do not expect Medicaid provisions to be included in this bill.

Outlook for Medicaid

As Republican leaders continue to signal interest in a larger, third reconciliation bill later this year, which could include defense spending, the war in Iran, tax policy, or broader deficit reduction goals, threats to Medicaid are still looming. As outside analysts and Congressional aides have noted, any future reconciliation package that includes instructions to committees with Medicaid jurisdiction could once again put “fraud prevention” policies, eligibility restrictions, or financing changes back on the table.  

Now What?

For now, the immediate focus is on whether Senate Republicans can keep this second reconciliation bill narrow enough to move quickly—and whether House leaders will proceed with reopening the rest of DHS once the process is underway. Senate Republicans are aiming to adopt the budget resolution this week. Senate Majority Leader John Thune can lose only as many as three GOP members so long as Vice President JD Vance is available to break ties. 

We will continue to monitor developments closely, including potential future cuts to Medicaid in a third reconciliation bill.

"Here We Stand." Campaign Continues with Coordinated Advocacy, Hill Day This Week

This Thursday, Lutheran Services in America network members from our Policy and Advocacy Committee, the Disability Network, and the Board of Directors will convene in Washington, D.C. for a day of meetings with Congressional offices.  This marks the next phase of our continuing unified effort in the Here We Stand (HWS) campaign to protect Medicaid integrity while ensuring continued access to care.   

What Are Our Asks?

No more cuts to Medicaid

This is a pivotal moment as new federal changes stemming from H.R. 1 take hold and scrutiny of Medicaid intensifies.  As Congress considers next steps through reconciliation and the budget process, it’s important to make one point clear: cutting Medicaid doesn’t reduce demand for care. It shifts costs to providers and communities and often drives higher long-term costs and reduced access.  

Participants in Thursday’s Hill Day will raise concerns about any additional cuts to Medicaid through ongoing budget reconciliation efforts, noting that existing changes under H.R. 1, such as broad funding deferrals and blanket moratoria, are already disrupting access to critical care.  

And workforce and housing…

Our new Here We Stand. Medicaid one-pager includes a key focus on workforce, including strengthening support for the Healthcare Workforce Innovation Act. Specific to housing, meetings will include strengthening support to pass the 21st Century ROAD to Housing Act and the Yes in God’s Backyard Act.

What’s Ahead and What You Can Do:

• Join us on April 30 at 1 p.m. ET for Capitol Conversations: Here We Stand for Medicaid Messaging & Advocacy Tools—a chance to walk through these resources together and for the debut of our new resources for state-level efforts. MORE DETAILS BELOW

• Read our new Medicaid Brief: Supporting the Integrity of Medicaid and the People it Serves which provides an overview related to state fiscal challenges and also important resources related to confronting waste, fraud and abuse.

• Take Action: Use our new Action Guide to engage with your federal and state policymakers. 

Join Us Next Week for the Next Phase of Here We Stand.

Capitol Conversations Series: The Next Phase of "Here We Stand." 

April 30, 2026, 1:00 p.m. ET 

REMINDER: you must register for each Capitol Conversations webinar individually, and can register for up to three at a time.

For more information, please contact Sarah Dobson. 

What We Are Reading: 

 Medicaid Program Integrity 

• Limiting Medicaid Waste, Fraud, and Abuse: A Checklist for States to Protect Medicaid for the Vulnerable and the Taxpayers Who Finance It 

• Beyond Minnesota: Four Medicaid Services Vulnerable to Fraud and the Case for Stronger CMS Enforcement 

• Attacks on Medicaid Aging & Disability Care Are Cover for Cuts 

• CMS Issues Guidance to Implement New Limits on Federal Medicaid and CHIP Funding for Certain Noncitizens 

Medicaid Work Reporting Requirements: 

• ‘A crisis in the making’: Nebraska races to impose work requirements on Medicaid 

• As States Implement Medicaid Community Engagement Requirements, Due Process Safeguards Loom Large      

• Insurers ramp up marketing as Medicaid losses loom 

• Providers fret over Nebraska’s May 1 Medicaid work requirements 

Medicare:  

• Why a new Medicare ACO model is exciting value-based care groups 

HCBS: 

• Medicaid Home and Community-Based Services Initiation and Acute Services Use 

SNAP:  

• SNAP Cuts Mitigation Hub: Responding to H.R. 1 

For more information, please contact Sarah Dobson, Senior Director of Public Policy and Advocacy.

Lutheran Services in America is one of the nation’s largest national networks of health and human service providers with a mission to cultivate caring communities that advance health and opportunity for all. With 300 nonprofit organizations across 1,400 U.S. communities and more than $26 billion in combined annual services, the Lutheran Services in America network advances equitable outcomes for children, youth and families, improves independence and choice for older adults, champions meaningful services and support for people with intellectual and developmental disabilities, and strengthens stability and purpose for veterans and others. Formed in 1997, Lutheran Services in America brings together a network of leaders, partners and funders to catalyze innovation, strengthen organizational capacity and advance public policy.