Twenty-three states and the District of Columbia are involved in a lawsuit against the Trump administration, as many state departments are concerned that an $11 billion loss in funding would be devastating for the health of nursing home residents as well as community health. 

The Department of Health and Human Services (HHS) last week announced its plans to pull $11 billion in Covid-era grants from the Centers for Disease Control and Prevention (CDC) for infectious disease research. Another $1 billion in cuts was slated for federal grants in mental health and substance abuse, HHS said.

The attorneys general, co-led by Rhode Island Attorney General Peter Neronha, requested the judge to reinstate the funding, noting that the budget cuts were unlawful and would cause “irreparable harm” to state constituents. Moreover, the states argue that rescinding these grants violates the Administrative Procedure Act (APA) because it is “arbitrary and capricious,” according to the lawsuit.

Toby Pearson, president and CEO of Care Providers of Minnesota, which is one of the states named in the lawsuit, told Skilled Nursing News that the cuts would have “real, tangible” impacts on state skilled nursing and assisted living facilities.

“We have made real progress to improve the safety of our facilities with staff training, HVAC upgrades and shared best practices to keep our residents safe,” Pearson said. “We have no interest in seeing that go backwards and these cuts jeopardize all progress that has been made.”

‘Massive and egregiously irresponsible’ cuts

Neronha, in a statement, said the cuts were “massive and egregiously irresponsible,” and that the decision to cut funding should put the country on high alert for the “depths this administration is willing to go.”

Funding terminations leaves states “at greater risk for future pandemics and the spread of otherwise preventable disease and cutting off of vital public health services,” according to the lawsuit.

The pandemic had a disproportionate impact on the country’s nursing home residents, despite this population making up less than 1% of the population, according to a December 2023 study published by the AARP Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio.

With more than 185,000 nursing home residents having died from Covid, this constitutes roughly one-sixth of the nation’s total death toll, the study found. And, Covid cases and death rose once again in the winter months of 2023 as vaccination rates at the time hit new lows.

The attorneys general filed the lawsuit on April 1 in the U.S. District Court for the District of Rhode Island. The latest states to join the lawsuit include Maine and New Mexico.

“Americans expect their government to protect them from harm. By eliminating billions in critical funding for essential public health initiatives, the Administration is effectively telling the American people to fend for themselves,” added Neronha.

The funding provides essential support for identifying, tracking, and addressing infectious diseases, and also ensuring access to immunizations, and fortifying emergency preparedness, among other public health needs.

Cuts put nursing home at risk for future health crises

In issuing the funding cuts, HHS told states that the infectious disease grants were no longer needed “now that the pandemic is over.” Some of the grants were supposed to extend into 2027, state departments said, and the announcement ran concurrently with the agency’s firing of 10,000 federal public health employees.

The agency is assuming, without legal or factual support, that the grants were only intended for use during the pandemic when relevant statutes indicate the opposite, attorneys general said in the lawsuit.

HHS also fails to undertake any individualized assessments of grants or cooperative agreements, and analysis of benefits of the public health funding – or the “dire consequences of termination,” attorneys general said.

Congress made wide-ranging public health investments intended to extend beyond the pandemic, according to the lawsuit.

“After the pandemic was declared over, Congress reviewed the Covid-19 related laws, rescinded $27 billion in funds, but determined not to rescind any of the funding at issue here,” the attorneys general said.

Public health emergency funds came to an end on May 11 2023, which included a wide array of policy changes, waivers and funding support for nursing homes. With the loss of these funds alone, nursing homes face challenges to long-term financial viability, with sub-par funds to cover existing staffing levels let alone federal staffing mandate levels, industry researchers said last November.