President Donald Trump’s bid to remake the federal government is already affecting some vulnerable populations in the United States, according to nonprofits and health care providers who are grappling with delays in federal funding, new rules and changed guidance.
A 19-year-old West Virginia resident with intellectual disabilities, for example, was not able to start a job at Goodwill on Monday because a nonprofit group that facilitates employment had not received the federal grant money it requested last week.
It was a result of one of the broadest and most head-spinning moves of the second Trump administration’s early days: a sweeping Office of Management and Budget memo ordering a pause on trillions in federal grants, loans and financial assistance.
It was quickly rescinded by the administration, and federal judges have since blocked that funding freeze from taking effect. But some organizations say despite the court rulings, they are still unable to access funding. And administration lawyers have also effectively given federal agencies the green light to slash payments on their own.
The delay in receiving its federal funds forced the Appalachian Center for Independent Living, which has operated in the Charleston, West Virginia, area for four decades, to lay off its employment training specialist – one of its five staffers – and halt its job placement services.
The center, which helps West Virginians with disabilities live in their own homes, also had to initially lay off its transportation coordinator and independent living skills trainer but was able to bring them back after receiving funding from state grants. The infusion will allow the center to continue serving more of its customers, including taking an 86-year-old woman to her dialysis treatments this week.
Still, the center likely can only operate for up to two more months without access to its federal funding, said Meredith Pride, its executive director, noting that the state has the highest share of residents with disabilities in the US. The center already had to cancel its February order to stock its food pantry because of its general financial uncertainty.
“We are in dire straits,” she said, noting that the center is checking its bank account at least every half hour to see if the federal funding has been deposited. “Our biggest concern is we do not want our consumers to have to go into institutionalized settings, group homes, or even worse, end up homeless if they don’t receive our services.”
As of late Wednesday afternoon, Pride said the money had not been deposited. She said she spoke to an official with the Department of Health and Human Services’ grant payments portal on Monday, who told her that the government is inundated with funding requests and is working through them.
HHS acknowledged in a statement to CNN that some users of its payments system “may be experiencing lags due to the high volume of requests.” The department is working to “help expedite resolution as quickly as possible,” it said.
Pride is confident that the center will receive the funds but hopes it will be before the end of the week to alleviate the financial uncertainty.
Administration lawyers indicated in a court filing Monday morning that federal agencies led by Trump appointees will argue against the court orders. And Elon Musk, the billionaire tapped by Trump to helm a new department tasked with deeply slashing spending across the federal government, indicated on social media over the weekend that his Department of Government Efficiency is “shutting down” government payments he considers illegal.
Trump campaigned on promises of massive disruption, and voters handed him a Republican-led House and Senate that largely appears eager to fall in line – though his earliest moves also face challenges in courts. But the localized impacts, large and small, will also serve as the earliest tangible effects many Americans feel of Trump’s second term in office.
Some Head Start programs shut down amid funding confusion
Multiple Head Start programs were briefly denied access to their federal funds last week right after the Trump administration announced the funding freeze. Many were able to log in later the same day – but not all.
Roughly 40 Head Start programs across about 20 states have not regained access to their funds, forcing at least two to shut down, Tommy Sheridan, deputy director of the National Head Start Association, told CNN Tuesday.
The others have been able to remain open by accessing state, local or other funds or by seeking loans or lines of credit. But at least one program told Sheridan it only has enough money to stay open the rest of this week.
The association has reached out to HHS, which oversees Head Start and operates the payments portal, and other agencies about the issue but has yet to receive a response, Sheridan said. Head Start serves nearly 800,000 low-income children from birth to age 5 and their families.
“The funding needs to be moving or children and families will get hurt,” Sheridan said.
Trans youth care suspensions
It’s not just delayed access to funding that’s affecting what services are available to Americans.
Hospitals in several major US cities – including those once considered a haven for gender-affirming care – have suspended some medical treatments for transgender youth as they evaluate Trump’s executive order that would block federal support for some medical treatment of trans people under the age of 19.
In part, the order directs federal agencies to ensure that medical institutions that receive federal grant funding are not providing trans youth with puberty blockers, hormone therapy or surgery to aid in their gender transition. It also directs the Department of Justice to help draft legislation that could allow providers to be sued for giving gender-affirming care and prioritize investigations into parents who seek the care for their children.
Denver Health in Colorado said it is complying with the executive order, pointing to what it said were the federal funding repercussions of noncompliance, but said it is “deeply concerned for the health and safety of our gender diverse patients under the age of 19.”
Children’s National Hospital in Washington, DC, said in a statement it has paused all puberty blockers and hormone therapy prescriptions for trans youth patients but will continue providing mental health counseling. Like many providers, the hospital does not offer gender-affirming surgery to trans minors.
Similarly, VCU Children’s Hospital of Richmond in Virginia announced it has suspended gender-affirming medication and surgical procedures for those under 19.
Within the practice of gender-affirming care, medical and surgical interventions are typically reserved for adults. International guidelines do not recommend medical or surgical intervention before transgender children reach puberty. Even for older teens and adults, surgery is relatively rare, research shows.
Refugees in limbo
The administration’s pause on most foreign aid – which is intensifying humanitarian crises around the world – is also being felt at home.
Global Refuge, which helps refugees resettle in the US, said it was told by the State Department in late January to halt its work as part of that freeze. It has not received any reimbursement for its services from the department for several weeks, said Timothy Young, spokesman for the nonprofit, formerly known as Lutheran Immigration and Refugee Service, which he said has left in limbo just under 6,000 newly arrived refugees from Afghanistan, Ukraine, Venezuela and elsewhere.
Global Refuge is working with church groups, civic organizations and volunteers to attempt to fill the void and help the new residents. The State Department did not respond to CNN’s request for comment on the payments.
Global Refuge said it has also had trouble accessing additional funding from HHS for services it provides to refugees beyond the initial 90-day resettlement window. The assistance includes securing housing for refugees, connecting them with health care and English lessons, helping them find jobs and other aid.
“There’s so much confusion that it’s unclear when or if we’ll continue to receive the federal funding that’s critical for the wellbeing of refugee children and families,” Young said.
Global Refuge was among the organizations included in a post on X last week from Michael Flynn, who briefly served as Trump’s national security adviser in his first term. In the post, Flynn listed HHS grants the groups received, accused them of money laundering and questioned who is benefiting from the taxpayer funds.
Musk responded to Flynn with a post declaring “The @DOGE team is rapidly shutting down these illegal payments.”
The nonprofit issued a statement condemning “in the strongest possible terms, the false accusations lodged against our humanitarian work.”
Anxiety over possible future spending freezes
Much of the nonprofits’ anxiety is about whether funding could be halted in the future.
The Trump administration has told federal employees spending freezes at agencies still might be able to take place, even after the OMB freeze was blocked in court.
“Agencies may exercise their own authority to pause awards or obligations, provided agencies do so purely based on their own discretion—not as a result of the OMB Memo or the President’s Executive Orders—and provided the pause complies with all notice and procedural requirements in the award, agreement, or other instrument relating to such a pause,” reads a notice of compliance the administration sent to agencies Monday morning, which was also made public in a court filing.
The fight over the disbursement of federal funds – and whether Trump and his top delegates, including Musk, can pick and choose what the government pays out – is one of the most volatile legal situations so far for the new administration.
So far, two courts have told the administration they can’t freeze outgoing payments following the OMB announcement.
But Musk and others appear to still be interested in doing so – with the world’s richest man announcing on social media over the weekend he wanted to shut down payments the federal government is obligated to make, if he thought they were illegal.
Potential future reductions in federal funding are already worrying groups like Hope’s Door in Hawthorne, New York, which provides services, shelter and support to victims of domestic violence. The group depends on that funding for well over half of its $3.5 million annual budget, much of which is spent on staffing its round-the-clock operations.
“If they do what they said they wanted to do, people could die,” executive director CarlLa Horton told CNN. “Our work is hard enough – trying to keep people alive. To be distracted by the chaos coming out of Washington is disgraceful.”
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