Bringing you the latest news impacting our network from Congress and the Administration.
In this Edition
Medicaid: The Latest - including LSA Network in Action
Housing Bill in Limbo
Federal Actions Raise New Questions for People with Disabilities
States' First Ever SNAP 'Bill' to Cost Billions
SCOTUS Ruling Terminates TPS for Haitian and Syrian Nationals; and Related Workforce Implications
Available Funding Opportunities
Join us in August for "Capitol Conversations"
What Are We Reading?
Medicaid: Our Network in Action
Chris Tonniges, President & CEO of Lutheran Family Services, built on his prior media engagement leveraging our Here We Stand. messaging with an interview with the Public News Service, which was syndicated to 4 additional news outlets:
After leveraging Here We Stand. resources to publish an op-ed on Medicaid's impact on rural nursing homes, Jason Cronk, President and CEO of Immanuel Living helped spark federal engagement. Our advocacy team shared the piece with Senator Tim Sheehy's (R-MT) staff, leading to a follow-up meeting that reinforced concerns and elevated local insight to the federal level.
MEDICAID: The Latest
States Scramble on Work Requirements
The recent CMS’s interim final rule marked a significant shift from policy to rapid implementation. States are now racing toward a January 1, 2027 deadline to operationalize new work reporting requirements that condition eligibility on 80 hours /month of employment, education, or community engagement. Recent analysis underscores just how complex this will be: states must build new verification systems, conduct frequent eligibility checks, and align outreach, all while managing tight timelines and limited administrative capacity.
25 States File Lawsuit….
On Tuesday, officials from 25 states and the District of Columbia filed suit to block the rule, arguing CMS bypassed proper rulemaking procedures, departed from prior guidance, and left states too little time to meet the deadlines set by the new tax law. The plaintiffs are asking the U.S. District Court for the District of Massachusetts to stay the regulation while the case proceeds.
Medical Frailty and Behavioral Health
A central — and increasingly contested — piece of this framework is the “medical frailty” exemption. While statute explicitly protects individuals with serious mental illness, substance use disorders (SUD), and other complex conditions, the rule narrows how those protections are applied by tying eligibility to functional limitations rather than diagnosis alone.
Tell me more!
For individuals with SUD and behavioral health needs, this approach is particularly problematic: clinical evidence shows these conditions are often episodic and non-linear, making standardized, repeated certification poorly aligned with treatment and recovery. At the same time, providers are being asked to supply detailed documentation and make eligibility determinations without clear, consistent guidance—placing new administrative burdens on already strained systems. This approach risks disrupting continuity of care and creating gaps in coverage for populations the exemption was intended to protect. You can learn more by reviewing recent analysis.
More on Waste, Fraud, & Abuse
DOJ Enforcement
Policymakers are intensifying focus on “waste, fraud, and abuse,” with major enforcement actions helping drive the narrative. In June, the Department of Justice announced a nationwide crackdown charging 455 defendants in schemes involving more than $6.5 billion in fraudulent claims, including significant Medicaid-related cases.
State Efforts
States continue to step-up enforcement efforts, with Ohio indicting multiple providers accused of billing for services not rendered and falsifying records.
Potential Fallout
These recent developments continue to shape policy discussions, including continuing Congressional budget discussions and the midterm elections. The immediate looming question is whether these enforcement efforts will successfully be used to justify even stricter eligibility rules and additional program cuts as Congress continues its work. And the challenge remains balancing between ensuring efforts to address bad actors does not further jeopardize care for eligible individuals.
3.0? - to be or not to be? – that is the question!
All of this is unfolding alongside renewed momentum—and uncertainty—around a potential “Reconciliation 3.0” package. Congressional leaders are exploring a sweeping, party-line bill that could include new spending alongside offsetting cuts -- once again with Medicaid at the center of the debate. At the same time, significant divisions within the majority party and a compressed legislative calendar raise real questions about whether such a package can advance before the midterms.
Where does this leave us?
For providers and advocates, the takeaway is clear: decisions being made now, especially at the state level on work requirements that will determine eligibility, will further shape the landscape regardless of what happens in Congress. Ensuring those decisions reflect the realities of patient care and provider capacity remains more important than ever.
Schedule a one-on-one consultation for assistance using Here We Stand. messaging and resources into action: please contactKylie Bowldsto set up a time.
Take Actionusing our turn-key advocacy tool and send messages to your lawmakers urging them not to make further harmful cuts to Medicaid funding.
HOUSING BILL IN LIMBO
Despite overwhelming bipartisan support and final passage in Congress, the 21st Century ROAD to Housing Act remains in limbo after President Trump abruptly declined to sign the bill into law.
What happened?
After much debate over many months, ROAD to Housing cleared significant hurdles with both the Senate and House passing the bill with wide margins given the urgency lawmakers feel to address the shortage of affordable housing supply. Instead of anticipated and immediate signing ceremony, President Trump unexpectedly announced he will withhold his signature until Congress passes a separate, unrelated measure—the SAVE America Act.
SAVE America Act?
From previous editions, you may know the SAVE America Act would essentially impose nationwide voter ID requirements and additional proof-of-citizenship rules for federal elections. This act continues to lack sufficient support in the Senate.
Now what?
This unexpected move has stalled one of the only and most significant bipartisan legislative efforts to address housing affordability and supply challenges. With the bill now awaiting presidential action, several outcomes are possible:
Signed into law: Trump could still sign the bill within the constitutional 10-day window.
Becomes law without signature: If he takes no action and Congress remains in session, the bill automatically becomes law after 10 days (excluding Sundays).
Pocket veto: If Congress adjourns before that deadline and the president has not signed it, the bill could be effectively vetoed without formal action.
Gets rolled up into Reconciliation 3.0:Advocates are also speculating that the Road to Housing Act could get rolled into reconciliation 3.0 – which may put more wind behind the back of a third budget bill.
Bottom line!
What had been a rare moment of bipartisan momentum on housing policy is now tied up in unrelated political negotiations—leaving the bill’s fate uncertain even after Congress has done its work.
FEDERAL ACTIONS RAISE NEW QUESTIONS FOR PEOPLE WITH DISABILITIES
Recent DOJ Memo Casts Uncertainly on Olmstead Protections
A recent Department of Justice legal opinion has sparked significant concern across the disability community by questioning decades of precedent under the landmark Olmstead v. Curtis decision -- which essentially guarantees the right of people with disabilities to receive services in home and community settings (HCBS).The memo argues that federal law may not actually require states to prioritize community-based care over institutional settings. While the memo does not change existing law, in concert with recent Medicaid actions questioning HCBS, it signals a shift in federal policy away from actively promoting integration and community living.
DOE Moves Special Education to HHS
At the same time, the Department of Education (DOE) has announced plans to move key special education functions to the Department of Health and Human Services (HHS), with civil rights enforcement shifting to the Department of Justice. These moves are part of broader efforts to downsize the DOE. Supporters argue the changes could better align services and reduce fragmentation for families, but many advocates worry the shift may blur accountability and move disability services toward a more medicalized model, potentially undermining inclusive, school-based supports guaranteed under federal law.
What It Means Right Now?
Taken together, these developments introduce new uncertainty about how federal agencies will support—and enforce—the rights of people with disabilities to live, work, and engage in integrated settings.Lutheran Services in America and LSA-DN released a statement last week to address the DOJ memo and to send a strong message of support as part of our on-going commitment to ensure all that all people live and work in the community of their choice with dignity and independence. We will continue to follow and engage in these efforts.
STATES' FIRST EVER SNAP 'BILL' TO COST BILLIONS
New Analysis from the Center on Budget and Policy Priorities (CBPP) on State Costs for SNAP: The 2025 reconciliation law (H.R. 1) made the deepest cuts in history to food assistance through SNAP, in part by slashing federal funding and imposing those costs onto states. Based on new Department of Agriculture data, our estimates show that states may soon face a collective bill of roughly $9 billion, threatening benefits for millions of SNAP households, 79 percent of which include a child, a senior, or a person with a disability, who count on SNAP to help them meet their basic needs. Without immediate congressional action to delay this cost shift for all states, the unfolding emergency will only worsen as more people lose the SNAP benefits they need to afford groceries.
SCOTUS RULING TERMINATES TPS FOR HAITIAN AND SYRIAN NATIONALS; AND RELATED WORKORCE IMPLICATIONS
Last week, the U.S. Supreme Court (SCOTUS) ruled in favor of the Trump administration in a 6-3 decision in Mullin v. Doe et al, the consolidated cases challenging the administration’s termination of Temporary Protected Status (TPS) for Haitian and Syrian nationals. As LeadingAge reported, Justice Alito, writing for the majority, held that federal law generally bars judicial review of TPS designation and termination decisions, and rejected arguments that Haiti’s termination was unconstitutionally motivated by racial animus. The 6-3 decision removes the legal backstop advocates have relied on for protecting 350,000 Haitian and Syrian TPS holders.
What’s Next?
We expect the Department of Homeland Security (DHS) to issue implementation guidance on work authorization, document validity, and compliance timing for the roughly 350,000 Haitian and 6,000 Syrian nationals with TPS protections who are affected by the decision.
What Now?
By holding that TPS termination decisions are largely unreviewable by the courts, the Supreme Court has removed the primary legal backstop on which advocates and providers had relied to protect TPS holders across the board. Up to 1.3 million TPS holders are now at risk.
And workforce implications with it…
Given the existing workforce shortages across member service lines, providers will be faced with even tougher choices. Calls for immigration reform are starting to echo. We will continue to monitor and share updates.
AVAILABLE FUNDING AND TRAINING OPPORTUNITIES
The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced new Notices of Funding Opportunity (NOFOs) for behavioral health programs. Faith-based organizations are eligible to apply to several of the opportunities, including the Strategic Prevention Framework and Treatment and Recovery Services for Youth, Young Adults, and Families. Two related videos can help potential applicants prepare:
Preparing to Apply for a SAMHSA Grant: Thiswebinarwalked participants through everything they need to know beforesubmittinga SAMHSA grant application
Best Practices for Writing a SAMHSA Grant Application:Thiswebinarbroke down the grant narrative section by section, using real application examples to show the difference between an adequate response and a competitive one.
SAMHSA also supports a wide range of Training and Technical Assistance (TTA) Centers that can help faith-based entities, community organizations, and houses of worship with free, practical resources to strengthen your behavioral health work.
Join Us: August 20, 1 P.M. ET for the Next Capitol Conversations
Reminder: Capitol Conversations is moving to an every-other-month format. Our next webinaronAugust 20will cover housing issues and key Medicaid updates.
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.
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