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New York City’s public health system is bracing for possible funding cuts from a federal budget rule change the Trump administration is considering
A proposed revision from the Office of Management and Budget would give the Trump administration broad discretion over how federal grants are awarded, managed, and terminated. Currently, such grants can’t be canceled without cause, but the new OMB rule would permit termination with minimal explanation or opportunities for appeal
Though a range of federal agencies could be potential targets of the revisions, known as “Uniform Guidance,” the city’s Department of Health and Mental Hygiene and community-based health centers are particularly vulnerable
Health officials say about $500 million, or 20% percent of the city’s budget for the Health Department, comes from the federal government. This money is earmarked for emergency preparedness and disease surveillance
The Health Department has already been a mark. Last year, the Trump administration tried to withhold funding across the United States, including some $100 million earmarked for the city’s Health Department, but a coalition of attorneys general sued. A federal judge halted the effort for now
“It would not necessarily completely disrupt what they’re doing, but it would maybe destabilize the core functions of the Health Department,” Dr. Oni Blackstock, a primary care physician based in New York City who specializes in HIV treatment, said of the proposed rule
Blackstock is also the founder and executive director of Health Justice, a consulting firm that aims to promote equity initiatives in healthcare and public health. She previously was an assistant commissioner at the New York City Health Department, leading the city’s response to the HIV epidemic
The OMB changes could be far-reaching, from the states to counties nationwide. According to the National Association of Counties, a nonprofit group advocating for county government across the United States, the proposed rule is the “most significant overhaul of federal grants regulations in more than a decade.” County programs such as transportation, public safety, housing, and disaster recovery could be affected
According to the department, “OMB is proposing revisions that would improve transparency, accountability, and oversight for Federal awards across the Federal Government.”
A spokesperson could not be reached for further comment
Russell Vought, the OMB director, is one of the main architects of Project 2025, the 900-page blueprint that articulated a broad conservative vision for the second Trump administration
The final version of the rule could take effect on Oct. 1. Until then, the OMB is required to consider every public comment it has received since the rule was announced in late May and address or respond to substantive critiques. The agency received nearly 500,000 comments until the comment period ended on July 13
The topic of the Trump administration possibly withholding funding from the city’s Health Department has come up before. At a March budget hearing, City Council Health Committee Chair Lynn Schulman asked about contingency plans
“We are currently in active discussions with (the city’s) OMB, with the law department in the mayor’s office, to come up with plans if there are cuts to specific activities,” Health Commissioner Dr. Alister Martin said at the March hearing. “We will assess and make decisions around what will protect New Yorkers’ health and safety the best.”
A Health Department spokesperson didn’t respond to questions about plans for potential cuts
Blackstock says the proposed OMB rule could target Health Department funding for outbreak responses, HIV prevention, substance use services, emergency preparedness, and chronic disease prevention
“All of these programs receive federal dollars through discretionary cooperative agreements,” she said
In the past, the Centers for Disease Control and Prevention or the U.S. Health Reons, but now political appointees will be making key decisions, she said
“They’re going to be using their own independent judgment and lack of knowledge and expertise to decide whether these discretionary federal awards are granted,” Blackstock said
Community-based groups that receive federal funds could also be affected. That means the pot of money will grow smaller, and nonprofits have cut back on hiring, reduced services, postponed raises, and resorted to layoffs. Nonprofits are also looking at ways to forge alliances and share re
A preview of the abrupt withdrawal of federal funding played out earlier this year. Community nonprofits working on substance abuse issues experienced the sudden loss of funding — and ensuing chaos — in January when an agency in the Department of Human and Health Services suddenly revoked roughly $2 billion in funding, only to restore the money the following day because of bipartisan lobbying
Given that the Trump administration has issued executive orders that target health care services for groups serving LGBTQ+ communities, some nonprofits may decide to pass on federal support
“If it’s a trans-led organization, they may be discouraged from actually applying for any federal funding because they don’t want to be a target of this administration and have their funds withdrawn,” Blackstock said
Trenton Danielis a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org oron the messaging appSignalat trentondaniel.88
