The Trump Administration abruptly canceling – then reinstating – federal health grants is creating overall “funding volatility” in state and local public health programs, officials told state lawmakers this week.
The ongoing cuts and constant back-and-forth policy changes have confounded efforts to maintain state and local programs as well as retain staff, they say.
“Funding volatility is probably the most painful part of our jobs right now,” said Julia Peek, deputy administrator for the state Division of Public and Behavioral Health, adding it’s “hard to recruit staff in federally funded programs when we don’t entirely know that it will continue.”
State lawmakers were updated on the state of public health and impact of federal policy changes under Trump during Tuesday’s meeting of the Interim Committee on Health and Human Services.
State Sen. Fabian Doñate (D-Las Vegas), who chairs the committee, asked state officials to provide a master list of the displaced workforce and grants that have been cut within the last two years.
Though the state has compiled overviews of federal funding changes, Peek said tracking the entirety of the volatility’s impact in detail is compromised by the volatility itself.
For instance, some cuts are in limbo while awaiting outcomes of ongoing litigation.
The Trump Administration has slashed a plethora of federal grants over the last year, including funding of disease prevention and treatment programs and federal support for behavioral and mental health systems.
There have been numerous times, Peek said, when without warning states are told the administration would immediately cut a major federal grant, sending health officials into a panic.
Such was the case in January of this year when the administration announced it would cancel billions of dollars in mental health grants.
“Typically, we hear it in the news first, that unfortunately the federal government has chosen to eliminate some grants,” Peek said. “We have to scramble so incredibly much to figure out how that looks, and then often there’s reinstatement of that funding almost immediately.”
As was the case with the mental health grants.
The constant whiplash makes it “really, really challenging to run a government agency,” Peek told the lawmakers.
Scant or extremely last-minute notice about changes to grant requirements have also been chaotic for agencies.
More recently, Nevada health officials, along with health agencies across the country, didn’t know until late last month if the administration would renew federal funding for a long standing Title X family planning grant, which provides reproductive health services.
Though the grant typically renews April 1, agencies were only given a couple days notice that they could reapply, Peek said.
The state was told “you have a couple days to do your application,” she said. “That was every state and our local partners as well. It’s really hard to run a program if we don’t know the funding is going to be there.”
State lawmakers passed Senate Bill 118 in 2023 which allocated $15 million for local health authorities to help identify and fund health care needs of the community.
The idea with those dollars was to expand local health initiatives, but “more volatility than expected” at the federal level has driven agencies to use money to fill gaps created by federal funding cuts and uncertainty.
“We were really hoping that this funding would help us build out more foundational public health services statewide,” Peek said.
A grant from the Centers for Disease Control and Prevention to help with disease monitoring and prevention helped fund a 40-person staff in Southern Nevada, said William Bendick, the public health laboratory manager with SNHD.
“Without that state public health funding, we would more than likely have to cut 25% of our staffing who are directly responsible for performing surveillance testing for our local jurisdiction,” he said.
Even if state funds are able to patch budget holes left by federal cuts, the federal funding instability is making it hard to keep and hire staff.
“Because of the insecurity associated with federal funding, we’ve had a lot of staff that have chosen to leave for other positions where they might have more stability when it comes to their salaries,” Jeanne Freeman with Carson City’s Health and Human Services told lawmakers.
“’I currently have five staff that have left to go to other positions, and I do not have the ability to fill those positions due to that lack of funding,” she said, adding that state funding under SB118 only covers the cost of less than one full-time equivalent position of the of the five she has lost.
Officials agreed there are no signs that this year will be less volatile than last year when it comes to federal funding.