September 19, 2025

Preparing Your Nonprofit for Immigration Enforcement –
Updated Guidance From the Lawyers Alliance  and NYLPI

Lawyers Alliance and New York Lawyers for the Public Interest are issuing an updated guidance for nonprofits, outlining best practices for preparing your organization for immigration enforcement actions at your site.

This piece, which has now been updated to reflect the current landscape of immigration enforcement, is intended to answer some of the most common yet complex legal questions that nonprofits and service providers have raised. This guide provides practical advice on how to deal with specific scenarios and background on key issue areas, along with an editable sample protocol for your organization.

Read the guidance here.
————
CONTINUING BUDGET RESOLUTION WRANGLING

Earlier today the House voted 217-212 to approve its continuing resolution, or CR.  Importantly, the House CR did NOT include an extension of the Medicare Telehealth flexibilities, it did NOT include an extension of the enhanced premium tax credits millions of Americans rely on to purchase health insurance through their state’s health insurance exchange, and it did NOT include an extension of the statute that authorizes the CCBHC Demonstration Program for an additional month (through 10/31/25).  The bill fell 44-48 in the Senate.  Senate Democrats proposed alternative legislation to maintain government operations until Oct. 31 and implement other policies, including a permanent extension of the enhanced health insurance exchange subsidies scheduled to sunset at the end of the year, and a reversal of the Medicaid cuts contained in Trump’s tax law. The bill also sought to extend the federal statute that authorizes the federal CCBHC Demo Program another month, or through 10/31.  That bill failed 47-45.

Implications of Expiring Medicare Telehealth Waivers (without Congressional action by 9/30/25 at 11:59):

• Beginning October 1, 2025, patients must have received a Medicare covered/Medicare eligible service mental health service in-person from the telehealth provider within six months prior to the first telehealth mental health service, and then at least once every 12 months thereafter.
  • CMS has provided some flexibility by allowing the required in-person service to be furnished by a colleague in the same subspecialty within the same group practice if the original practitioner is unavailable.   
  • The in-person service must be a Medicare-billable visit so that it is accurately recorded in CMS’s claims processing system.
• Exceptions to the in-person requirement include:
  • Patients located in a rural area and in an eligible originating site as defined under permanent law. 
  • If the risks and burdens of travel outweigh the benefits of an in-person encounter.
  • Patients receiving treatment for a substance use disorder (SUD) or a co-occurring mental health condition.  

Note:  Normally, government shutdowns don’t have immediate consequences for the healthcare sector because they don’t affect reimbursements from entitlement programs such as Medicare and Medicaid, which are not subject to annual appropriations.  But this year, policies enacted during the COVID-19 pandemic to expand access to telehealth and hospital-at-home services are also linked to the spending bill after Congress failed last year to enact more durable extensions. Community health centers, which have been operating under stopgap funding and reauthorizations for two years, could face a funding crunch in short order.

Lawmakers swiftly departed Washington after the Senate vote for the Rosh Hashanah recess. The House is slated to be gone until Oct. 1, although Majority Whip Tom Emmer (R-Minn.) advised members Friday that they may need to return sooner.  The Senate plans to back in session Sept. 29.  If Congress sticks to that schedule, it would leave less than two days to negotiate a compromise by midnight on Sept. 30.  Note: In the event of a shutdown, the Health and Human Services Department would be required to continue offering many essential services, such as operating Medicare and Medicaid.———————-

OMH Notice, 9/19 to the field:

We are pleased to announce recent changes to both Mental Hygiene Law and Public Health Law, increasing access to care and the ability to consent for a new added group of youth under the age of 18, who can now consent to treatment without parental consent.  Please refer to the attached letter from our State Agency Commissioners for more information, as well as our updated memo from OMH for additional guidance on Mental Hygiene Law here: https://omh.ny.gov/omhweb/guidance/omh-minors-rights-memo.pdf.

Thank you,

NYS Office of Mental Health

Division of Integrated Community Services for Children and Families

Shannon Fortran, MA, MHC, IMH-E® (she/her/hers)

Director, Youth/Families Clinic, School-Based & Integrated Services Unit

Office of Mental Health

Central Office | Division of Integrated Community Services for Children and Families – Bureau of Clinic Services

44 Holland Ave. Albany, NY 12229

518-486-1106 | shannon.fortran@omh.ny.gov

omh.ny.gov
————————–
RURAL HEALTH TRANSFORMATION PROGRAM
One of the two docs I sent all members this morning with our proposals to NYS re: the Rural Health Care Transformation Fund, still showed a watermark when I shared it with you.  My apologies!  See clean copy attached.  
————————–

Medicaid Cuts Kick in Quickly and Quietly in Idaho

Source:  Georgetown Center for Children and Families, 9/17/25

In a quick move right before Labor Day, the Idaho Department of Health and Welfare announced plans to cut reimbursement rates for Medicaid providers by 4%. The Department, which is currently accepting public comment on the proposed cuts, cites rising health care expenses as its justification for the cuts. Health leaders in the state are already saying these cuts could push some doctors’ offices to stop accepting Medicaid and some are saying this will cause them to close their doors altogether.

These cuts, which follow Governor Brad Little’s executive order that all state agencies reduce their budgets, illustrate the intense pressure that state budgets are already facing and is only going to get worse. As readers of the Say Ahhh! blog know, deep, damaging cuts to Medicaid in the budget reconciliation law (H.R.1) of $990 billion are on the way. In fact, Idaho’s senior Senator Mark Crapo is the Chair of the Senate Finance Committee, which has jurisdiction over Medicaid and played a key role in getting these cuts through Congress. Shifting costs away from the federal government and to state budgets was an intentional aim of H.R. 1, and states are already reacting. Idaho is at least the second state to announce Medicaid provider rate cuts since H.R.1 was signed into law. North Carolina announced its plans to cut Medicaid provider rates by 3%, which the North Carolina Department of Health and Human Services directly attributed to these impending cuts.

Of course, Idaho’s health care providers face rising costs too, but only tribal providers, federally qualified health centers, and rural health centers are exempt from the reimbursement rate cuts. Idaho is a very rural state and is already suffering from acute provider shortages, as we discuss below.

The notice of reimbursement cuts come after a presentation from the Department on impacts to the state from H.R. 1, where the message was largely that Idaho was unaffected. This provider rate cut is also at odds with Senator Crapo’s repeated statements that HR1 targets “waste, fraud, and abuse” in Medicaid, including this post just days after Idaho announced these cuts. A 4% across the board cut to providers has nothing to do with targeting fraudulent activity. Our colleague Andy Schneider has debunked the claims that Medicaid cuts in HR1 are targeting waste, fraud, and abuse in a blog here.

What these cuts will do is exacerbate Idaho’s healthcare provider shortage, which plagues nearly every county in the state and is particularly acute in rural communities. Individuals living in rural communities, and particularly children and women of childbearing age, are more likely than those living in metro areas to rely on Medicaid for their health coverage.

Medicaid is a lifeline for kids and their families throughout Idaho, such as the Daniels family in Caldwell, Idaho. When Amber Daniels was 20 weeks pregnant with her youngest of four children, the baby tried to come early—too early for survival. With the help of Medicaid, the doctors were able to help Amber keep the baby in utero until he reached a viable gestational age of 32 weeks. Aleister had to spend the first month of his life in the NICU and Amber and her husband, Darrell, are grateful that Medicaid helped him survive. Amber remembers the days before she had Medicaid when she went without insurance because she couldn’t afford it. She had to either get her health care needs met or feed the family, and she always chose to feed the family. Now that she has Medicaid, she can ensure that she is in good health so that she can be there for her kids. She loves being a stay-at-home mom and because her husband has a job and the family qualifies for Medicaid, she can focus on being the best mom to her children. 

Idaho, along with just about every other state, has seen increased spending for its Medicaid program. But 97% of this growth is from the “traditional” Medicaid population, not the expansion group that continues to face attacks from the state legislature and was heavily targeted in H.R. 1. (The Idaho legislature has attempted to repeal Medicaid expansion year after year, with the latest failed attempt happening in the most recent legislative session.) Medicaid is the largest payor of long-term care services, which account for 23% of spending in the state. Individuals with disabilities and individuals 65+, while only making up 21% of Idaho’s Medicaid enrollment, account for half of Medicaid spending. These provider cuts will only hurt the “most vulnerable” individuals enrolled in Medicaid – the exact groups Senator Crapo and his colleagues who passed the cuts have promised to protect and serve.

Idaho may be one of the first states to announce these drastic cuts to their Medicaid program, but it certainly won’t be the last. As new, burdensome restrictions and requirements from H.R. 1 start to take effect, such as mandatory work reporting requirements, all states will have to reckon with the impact of H.R. 1 on their budgets in upcoming legislative sessions and for years to come.
——————-

Trump Administration Cannot Proceed with Overhaul of US Health Agencies, Court Rules

By Nate Raymond, Daniel Wiessner | Reuters News Service| 9/17 

Summary

• Court will not lift block on agency cuts pending appeal
• States sued over cuts at food and drug, disease control agencies
• Plans include cutting 10,000 jobs

A federal appeals court on Wednesday refused for now to allow U.S. President Donald Trump’s administration to proceed with a planned overhaul of the U.S. Department of Health and Human Services, which would involve reorganizing several agencies and firing thousands of employees.

A three-judge panel of the Boston-based 1st U.S. Circuit Court of Appeals declined to lift a federal judge’s injunction secured by several Democratic-led states. They had challenged a plan U.S. Health Secretary Robert F. Kennedy Jr announced in March to carry out a large-scale reorganization of the department.

The 1st Circuit rejected the Trump administration’s claims that the states could not show they would be immediately harmed if the injunction is lifted pending an appeal. The panel noted that the lower court relied on hundreds of pages of testimony from state officials.

“The government does not explain how the district court clearly erred in crediting these uncontroverted facts,” the court said in an unsigned order. All three judges were appointed by former President Joe Biden, a Democrat.

HHS did not immediately respond to a request for comment. The office of New York Attorney General Letitia James, which is spearheading the lawsuit, declined to comment.

Kennedy’s plan to reshape the department involved cutting 10,000 employees and centralizing some functions of the U.S. Food and Drug Administration, Centers for Disease Control and Prevention and other agencies under his purview.

The 19 states that sued, along with the District of Columbia, challenged HHS’ implementation of its restructuring plan, which also called for collapsing 28 divisions into 15 and closing half of its 10 regional offices.

While the states argued that the entire plan was unlawful, they only asked a judge to block firings and restructurings at four agencies within HHS, including the U.S. Centers for Disease Control and Prevention and the Office of Head Start.

The states said the cuts led to infectious disease lab closures, research being abandoned and partnerships being suspended, rendering the CDC unable to meet statutory mandates to investigate diseases and threatening Head Start centers that support early childhood programs.

In July, U.S. District Judge Melissa DuBose, a Biden appointee in Providence, Rhode Island, agreed, saying the administration “does not have the authority to order, organize, or implement wholesale changes to the structure and function of the agencies created by Congress.”

She ordered HHS to halt mass job cuts and restructurings at the four agencies, which also included the FDA’s Center for Tobacco Products and the Office of the Assistant Secretary for Planning and Evaluation.

The administration appealed, saying DuBose’s ruling should be set aside as the lawsuit was functionally identical to two earlier cases in which the 6-3 conservative majority U.S. Supreme Court lifted orders requiring it to reinstate employees let go en masse at other agencies by the administration.

The Trump administration had argued that the states’ case rests on speculation about what harms they would suffer as a result of changes to department services, and that any challenges to the firings had to be pursued by the federal employees themselves before the Merit Systems Protection Board.

But the 1st Circuit on Wednesday said that states rely on HHS for an array of services, such as infectious disease testing and data on maternal and infant mortality and health, and so had a stake in the dispute.