Updated: April 4 at 11:20 a.m. ET
A federal judge said she will grant a request from 23 states to issue an emergency block on the federal government's rescindment of billions in public health funds to states, cities and organizations.
The states' complaint, filed April 1 in the U.S. District Court for the District of Rhode Island, concerns roughly $11 billion awarded by the Department of Health and Human Services (HHS) near the end of the COVID-19 emergency related to efforts on pandemic preparedness, mental health, overdose prevention, community health programs and public health infrastructure.
Judge Mary S. McElroy, of the U.S. District Court for the District of Rhode Island, told government lawyers during a Thursday afternoon hearing that she is "going to grant the temporary restraining order" sought by states.
She said the likelihood states' arguments would succeed on the merits was "extremely strong" and noted the "voluminous" evidence that the department's action would cause irreparable harm.
The judge said the written temporary restraining order would be coming shortly, though it has not yet been officially granted as of Friday morning.
Leslie Kane, the attorney who represented the federal government, objected to the impending temporary restraining order, but acknowledged that her office wasn't able to make a detailed argument against the plaintiffs because they had not yet had time to fully review the case.
Sarah Rice, who argued on behalf of the Rhode Island Attorney General's Office, said the plaintiffs intend to file for a preliminary injunction—a longer emergency block with a higher bar to clear. McElroy also said she would grant an expedited briefing schedule and hearing.
HHS sent out the grant termination notices on March 24. At the time, an HHS spokesperson said "the COVID-19 pandemic is over, and HHS will no longer waste billions of taxpayer dollars responding to a non-existent pandemic that Americans moved on from years ago. HHS is prioritizing funding projects that will deliver on President Trump’s mandate to address our chronic disease epidemic and Make America Healthy Again."
The attorneys general wrote in their initial complaint that the department decision to "abruptly and arbitrarily" pull back those funds will lead to the dissolution of programs addressing ongoing and emerging public health needs within their states, as well as widespread public health worker and contractor dismissals. Some of those harms have already occurred due to the "substantial confusion" caused by the decision, they wrote.
"The result of these massive, unexpected funding terminations is serious harm to public health, leaving Plaintiff States at greater risk for future pandemics and the spread of otherwise preventable disease and cutting off vital public health services," they wrote in the complaint.
The attorneys general argue that the terminations exceeded HHS' statutory authority and are unlawful under the Administrative Procedure Act, writing that the end of a pandemic "is not a lawful basis to terminate 'for cause.'" They also noted that Congress—which authorized the funding during the pandemic—has since rescinded a separate $27 billion when reviewing laws related to the pandemic but "determined not to rescind any of the funding at issue here."
The predominantly blue state plaintiffs asked the court to vacate the grant terminations, declare them a violation of the Administrative Procedures Act, and preliminarily and permanently enjoin the administration from implementing or enforcing the terminations.
How much was cut
An exact $11.4 billion figure for the grant rescindments was first reported by NBC News and confirmed by a government spokesperson, but it also directionally aligns with an avalanche of grant terminations on doge.gov, where the Department of Government Efficiency posts its “wall of receipts” of savings across the federal government. Doge.gov was updated March 24 with approximately 1,285 grant terminations under the Department of Health and Human Services (HHS), dated March 23.
Although some cancelled grants did not scratch seven figures, other cancellations listed are valued up to $877 million, like one at the Texas Department of State Health Services. Funds also went toward the Community Health Workers for COVID Response and Resilient Communities program and a program designed to address COVID-19-related "health disparities."
Fierce Healthcare sifted through grant cuts, keeping track of all terminations totaling $10 million or more. These showed $7.5 billion in cancelled grants going to states and major cities. No information is provided on the doge.com postings besides a description that says “No description available.”
A message, obtained by Fierce Healthcare, went out to HHS employees the morning of March 26, telling them to urgently identify contracts that may lead to censorship or cause someone to hold value certain ideas more than others. Examples given included COVID-19 vaccine usage, masking and education and outreach advertisements.
It also said contracts or grants aimed at fighting misinformation or disinformation should be pinpointed, telling workers to scan for keywords including lockdown, media literacy, social media and more. The contents of this message were first reported by STAT News.
States feeling the impact
States and local communities are not affected by monetary value equally, but most states have grants that are now terminated, as a result of this action.
California lost five grants for more than $700 million. These grants are used for COVID-19-related efforts and other outbreak responses, states say.
“The California Department of Public Health (CDPH) has received notice from the CDC that it intends to immediately end state and local public health funding awarded during COVID-19 that supports respiratory virus monitoring, testing and response, immunizations and vaccines for children, and health disparities efforts,” said CDPH Director and State Public Health Officer Erica Pan, M.D., in a provided statement. “This funding supports the public health work and data systems improved during the pandemic that helped California fill gaps in its existing public health infrastructure, including ongoing response to COVID-19 disease and other respiratory and vaccine-preventable diseases that require similar resources. We are working to evaluate the impact of these actions.”
“Though the affected grants include non-expended and unobligated funds, there will be impacts to current staffing and ongoing projects that these grants currently fund,” said the Virginia Department of Health in an email. “VDH is working to assess the exact impacts that these changes will have and will be communicating to affected staff and partner organizations.”
Washington state confirmed to Fierce Healthcare that $125 million in COVID-related funding was immediately terminated. Connecticut will see more than $150 million in cuts. Rhode Island had four grants cancelled, with unspent amounts totaling $31 million.
The Alabama Department of Public Health said they were expecting more reduced or discontinued funding through COVID-19, and had already made "staffing and budget adjustments" in anticipation. North Carolina's health department says the cuts will directly lead to 80 layoffs and $100 million in less funding.
New York City Health Department Acting Commissioner Michelle Morse, M.D., will also see $100 million in cuts. Some of their grants for infectious disease prevention and surveillance, as well as supporting flu and RSV vaccination education outreach, had recently been extended by the CDC until 2026 and 2027.
In Los Angeles County, the public health department received notices rescinding Epidemiology and Laboratory Capacity (ELC) COVID-associated funding, the department said. The CDC told them grants for vaccination services will likely be terminated as well.
"In total, these actions to rescind ELC COVID-associated funding will impact more than $45 million in core LA County Public Health funding," a spokesperson said over email. "Much of this funding supports disease surveillance, public health lab services, outbreak investigations, infection control activities at healthcare facilities, and data transparency."
Universities and research centers continue to see grant cuts as well, following in the footsteps of research cuts at Columbia University, which have already spurred legal challenges.
The latest cuts to these entities total more than $1 billion, according to DOGE, and target the nonprofit Research Triangle Institute, the International Fertility Research Program, Duke University, UCLA and the Fred Hutchinson Cancer Center. But some of these cancellations are misleading, if not outright incorrect.
Fred Hutchinson had seven grants listed on the DOGE website, but just two of them were active at the time of cancellation. Five of the grants expired Nov. 30, a spokesperson said.
Other behavioral health programs in states are seeing reductions in grant awards as well. This includes $46 million to the Arizona Health Care Cost Containment System, $38 million to the Georgia Department of Behavioral Health, $24 million to the Indiana Department of Mental Health, $42 million to the New York Office of Alcoholism and Substance Abuse Services and $29 million to the Office of Mental Health, $32 million to the Ohio Department of Alcohol and Drug Addiction Services and more.
The federal Substance Abuse and Mental Health Services Administration (SAMHSA) terminated awards to the Massachusetts Department of Mental Health, confirmed the state in a press release. Attorney General Maura Healey said the Trump administration is moving to claim back unobligated funds from mental health and COVID-19 programs.
"This funding is used to support the core functions of the State Public Health Laboratory, including treatment and testing for respiratory diseases, like bird flu," the news release said. "Much of the funding goes directly to the community, including to community heath centers across the state to support workforce and community investments."
The Connecticut Department of Health is canceling 48 contracts with local health departments and providers for immunization services, a news release March 27 said. Housing and employment services, regional suicide advisory boards, perinatal screening and medication-assisted treatment will be impacted by grant cuts to the Connecticut Department of Mental Health and Addiction Services.
In North Carolina, cancelled grants will impact the statewide immunization registry, substance use disorder services and more.
"Some of the impacted funding supports work that is completed by local health departments, universities, hospitals and local departments of social services," the department explained in a message to Fierce Healthcare. "The department is putting impacted vendors on notice for them to pause work supported by these funds, until we learn more from the federal government."
The Colorado Department of Public Health and Environment said government officials are worried the four grants cut will diminish the effectiveness of its state lab, which was the first in the country to detect the initial SARS-CoV-2 variant in late 2020.
"Abrupt terminations of grants and contracts is unprecedented and will impact our work and that of our partners," said Minnesota Commissioner of Health Brooke Cunningham, M.D., in a news bulletin. "Every dollar rescinded had been thoroughly reviewed and approved for its intended purpose by the federal government. In the past we could count on the federal government to uphold its commitments and obligations."
Cuts from these grants total $226 million and account to 25% of the Minnesota Department of Health's budget, reported local news KARE11. The department expects 150 to 200 employees will be laid off, in addition to closing five vaccine clinics.
The Trump administration is canceling huge numbers of grants. This month, the government axed grants to research institutions studying health equity and LGBTQ issues, including research focused on HIV research. It's expected $120 million in family-planning grants—involving pregnancy testing, STI treatment and infertility counseling—could be frozen soon, which would impact progressively coded groups like Planned Parenthood, reported the Wall Street Journal.
HHS also closed the Office of Long COVID Research and Practice this week and there are reports the Agency for Healthcare Research and Quality is not far behind.