ACADEMYHEALTH'S SITUATION REPORT: MEDICAID, CDC, FEDERAL HIRING, AND CHILDREN'S COVERAGE

The following information was released by AcademyHealth:

In this issue of AcademyHealth's Situation Report, we cover a Senate inquiry into flawed Medicaid eligibility systems, escalating instability at the CDC, and deep cuts to mental health services. We also highlight our concerns around cuts to nation's health data infrastructure.

Posted Oct 16, 2025

In this edition of AcademyHealth's Situation Report, AcademyHealth raises concerns over significant staff reductions at the National Center for Health Statistics (NCHS). We also examine mounting concerns over Medicaid eligibility system failures flagged by the Senate, major layoffs at the CDC and SAMHSA that threaten public health stability, and rising rates of uninsured children that could worsen under anticipated policy shifts. We also highlight the October 15 Executive Order consolidating political oversight of federal hiring, including in agencies central to health research. These developments signal growing strain on the systems that support vulnerable populations. Read on to learn how health services researchers can take action by helping shape our 2026 Annual Research Meeting (ARM) and continuing to use evidence when communicating about the impact of this rapidly changing landscape.

In today's issue:

Cuts to National Center for Health Statistics Threaten Nation's Health Evidence Infrastructure

Executive Order Expands Political Oversight of Federal Hiring

Senators Highlight Errors in Contractor Medicaid Eligibility Systems, Call for Improvements

Former CDC Official Raises Concerns Over Agency Stability

Mental Health and Substance Use Agencies Face Cuts amidst Government Shutdown

Rural Health Fund Seen as Historic but Insufficient to Offset Medicaid Cuts

Uninsured Rate Among Children Reaches 10-Year High

Use Your Expertise to Champion Evidence at the 2026 Annual Research Meeting

Cuts to National Center for Health Statistics Threaten Nation's Health Evidence Infrastructure

AcademyHealth israising concerns over significant staff reductions at the National Center for Health Statistics (NCHS), which threaten the integrity of the nation's health data infrastructure. NCHS collects vital statistics essential for informing public health and policy decisions, ranging from drug overdose trends and infant mortality to aging and nutrition. AcademyHealth President and CEO Aaron Carroll emphasized that "there is nothing partisan about collecting, maintaining, and disseminating health statistics," and warned that "without evidence, policymakers are flying blind." The loss of expert teams and decades of methodological knowledge risks creating lasting data gaps that could undermine health systems improvements and equitable policymaking. AcademyHealth urges swift action by Congress and the administration to preserve this critical nonpartisan resource.

Executive Order Expands Political Oversight of Federal Hiring

The latest Executive Order, issued October 15, 2025, further consolidates political oversight of the federal workforce, requiring agenciesincluding those central to health researchto form Strategic Hiring Committees led by senior political appointees. These committees will approve all new hires and staffing plans to ensure alignment with administration priorities.

While framed as an effort to improve efficiency and accountability, the order represents another shift in the balance between political control and professional expertise in federal agencies such as HHS, NIH, AHRQ, CDC, and CMS. For health services researchers, the implications may include staffing disruptions, reduced continuity in evidence-based programs, and potential impacts on research partnerships and data access.

This follows a series of policy changes that increase centralized political authority over research and grantmaking. Together, these actions underscore the need for researchers to stay informed, engaged, and ready to demonstrate the continued value of independent, evidence-driven science in guiding health policy and practice.

Senators Highlight Errors in Contractor Medicaid Eligibility Systems, Call for Improvements

The Senate Finance Committee haslaunched an inquiry into companies contracted with states to build Medicaid eligibility systems, spurred by aninvestigation that revealed widespread issues in states using Deloitte-run systems to assess Medicaid eligibility for millions of people. These system failures have resulted in the erroneous loss of coverage and other benefits for low-income people and can cost millions and take years to fix. In Florida, the eligibility system erroneouslycut benefits for new moms, while in Kentucky, an issue prevented coverage applications from getting through online, the resolution of which cost over $522 thousand and took 10 months.

In letters addressed to four companies, senators noted that states are preparing to institute work requirements mandated in the budget reconciliation bill, and that it is each company's responsibility to build functioning systems. Most states rely on such contractors to build and operate their Medicaid eligibility and enrollment systems, andexperts note that states in a "major sprint" to make the necessary changes by 2027 are being inundated with pitches by these contractors. These new contracts and systems present an additional opportunity for health services researchers looking to study the new federal Medicaid provisions a look at the efficiency, effectiveness, and cost of the systems designed to support such eligibility changes.

Former CDC Official Raises Concerns Over Agency Stability

The Centers for Disease Control and Prevention (CDC)fired over one thousand employees last week, before rehiring approximately half of them back over the weekend. Although the Department of Health and Human Services (HHS) has said the terminations were due to a technical coding error, the standing terminations, in addition to other recent staffing and budget cuts by Health Secretary Robert F. Kennedy Jr., ledformer CDC Chief Medical Officer Debra Houry to raise concern about the livelihood of the agency. Houry warns that with continued cuts to staff, the CDC will have fewer public health professionals to call on during times of need. "That is not going to allow scientific information to get to communities," she said. Dr. Houry adds that these changes are affecting an agency workforce with record-low morale. Unfortunately, amidst the government shutdown, additional federal layoffs could be imminent.

While the health and public health workforces experience rapid and drastic changes, it is imperative that health services researchers continue to monitor the data and help inform policy with evidence whenever and wherever possible.

Mental Health and Substance Use Agencies Face Cuts amidst Government Shutdown

The Substance Abuse and Mental Health Services Administration (SAMHSA), which oversees the 988 suicide prevention hotline, wasimpacted by recent layoffs last week amidst the government shutdown with alarge percentage of the staff that survivedspring Department of Government Efficiency (DOGE) layoffs being eliminated. Employees received a Reduction in Force notice stating they "were deemed non-essential by their respective division," highlighting the current administrations' effective defunding of mental health and substance use resources.

Daniel H. Gillison, Jr., the CEO at the National Alliance of Mental Illness (NAMI),responded to the cuts by emphasizing that, "The United States is in the midst of an ongoing mental health, suicide, and overdose crises, one of the most widespread and enduring public challenges of our time... we need to reinforce, not weaken, the agency dedicated to addressing mental health and substance use conditions."

Health services researchers working in the fields of substance use and mental health may expect to see trends of continued loss of federal funding. In response, researchers can emphasize that mental health and substance use conditions affect millions of children and adolescents and over 84 million adults across all backgrounds.

Rural Health Fund Seen as Historic but Insufficient to Offset Medicaid Cuts

The new Rural Health Transformation Program allocates $50 billion over five years to support rural health care systems. States can apply for funding to improve technology, expand access, and address workforce shortages, with proposals due November 5.

While the program represents a historic investment in rural health, experts caution that its impact may be limited. Givenhigh rates of Medicaid enrollment in rural areas, these facilities disproportionately rely on Medicaid reimbursement to keep their doors open. As a last-minute addition to the budget reconciliation bill passed in July, this program was positioned as funding that would save rural hospitals that would be deeply affected by the significant Medicaid cuts in order to sway the votes of hesitant Republicans representing rural states.

However, the fund's five-year investment just barely coversover a third of the expected loss of federal funding in rural areas that will be spread over 10 years, where rural areas are projected to lose over $137 billion Medicaid funds. While lauding the fund's intention to spur innovation to transform the rural health care system,experts also note that the program does little to provide continued funding to keep facilities open, meaning that any successful innovations that emerge may not occur in time to prevent the closing of several rural health entities. Notably,half of the $50 billion will be evenly divided among states whose applications are approved, regardless of their rural and overall populations, and states can directup to 15 percent of their program funding to non-rural areas.

This underscores the importance of researchers evaluating how temporary funding initiatives interact with the broader context of long-term federal spending reductions. So whileSecretary Kennedy's characterizations that this program is the largest cash infusion to rural health care may be accurate on the surface, a deeper analysis reveals that rural health systems are poised to face significant challenges over the next decade that could lead to service reductions or closures affecting millions of Americans.

Uninsured Rate Among Children Reaches 10-Year High

Newdata from the U.S. Census Bureau revealed that the national uninsured rate for children reached its highest point in the last decade, rising from 5.4 percent in 2023 to 6 percent in 2024. According to ananalysis by the Center for Children and Families at Georgetown University, 22 states experienced a "significant increase" in the rate of uninsured children from 2022 to 2024, with non-Medicaid expansion states experiencing greater overall rate increases.

Federal programs like the Children's Health Insurance Program (CHIP) and the Affordable Care Act (ACA) helped push the rate of uninsured children to a historical low (4.7 percent) in 2016, but several policies under the first Trump administration, such as the"public charge" rule, led to an increase in the rate in uninsured minors. Expertswarn that similar policies implemented under the second Trump administration will lead to even more uninsured children and an increased strain on the health care system. For example, if Congress allows ACA tax credits to expire, the Congressional Budget Officeestimated that rising premiums could lead to 3.8 million people, including children, losing coverage each year.

Coverage losses among children have wide-reaching effects. In 2023, more than one in four (27.4 percent) uninsured children reported not seeing a doctor in the past year, and uninsured children were much more likely than children with private or public insurance to forego needed care, citing high costs. Because uninsured populations, including children, often forego needed careand this leads to moresevere and costly health problemsa larger uninsured population means a less healthy nation and a strained health care system. Higher uninsured rates also contribute tohospital closures, hospital and patient financial strain, and stress on health care workers, especially forrural hospitals andemergency departments. These issues were alreadyexpected to worsen given the effect ofthe budget reconciliation bill on state budgets, the Supplemental Nutrition Assistance Program (SNAP), rural hospitals, and premium rates, but the impact may be compounded if more children continue to become uninsured each year.

For health services researchers, the growing number of uninsured children raises urgent questions about coverage continuity, access to care, and the broader system impacts of federal and state policy shifts areas where data and analysis will be critical to guide evidence-informed solutions.

Use Your Expertise to Champion Evidence at the 2026 Annual Research Meeting

At a time when the role of evidence in decision-making is being questioned and research budgets face increasing strain, the Annual Research Meeting (ARM) remains the nation's leading forum for showcasing how rigorous health services research improves health and health care. AcademyHealth is looking for volunteers to review abstracts and panels submitted to the 2026 ARM to determine which studies and ideas are featured on the national stage. We welcome reviewers who bring a variety of perspectives: researchers, patients, community voices, industry, government, health systems, payers, foundations, and others. Your expertise helps ensure that the research presented at ARM reflects the best of what evidence can offer: insight that informs policy, strengthens practice, and advances health outcomes. Volunteer to be an ARM reviewer by Monday, October 20th at 5:00 p.m. ET to help shape the conversation and reaffirm the value of evidence in a time when it matters most.