New Shifts in Medicaid, HIV Funding, and NIH Research

In this edition of AcademyHealth’s Situation Report, we examine how Medicaid waiver restrictions could affect states’ ability to expand coverage and test innovative approaches, proposed changes to childhood vaccination policy, as well as changes to HIV prevention funding and growing state oversight of private equity investments in health care. Furthermore, NIH restrictions on research examining the health effects of public policy underscore broader concerns about the role of evidence in informing policy decisions and evaluating what works. Together, these developments illustrate the importance of understanding the effects of rapidly changing policies and ensuring that decisions about health care are grounded in evidence

In Today’s Issue:

• NIH Restricts Funding for Policy-Focused Research

• New CMS Waiver Rules Could Reshape Medicaid Coverage and State Innovation

• Vaccine-Makers Unlikely to Split MMR Shots Despite Trump’s Push

• HIV Prevention Funding Cuts Create Uncertainty for Florida Clinics

• Stricter State Laws Slow Health Care Private Equity Deals

  Share

NIH Restricts Funding for Policy-Focused Research

The U.S. National Institutes of Health (NIH) is removing policy-focused grant projects from the agency’s portfolio because the agency claims that “policymakers are not considered a stakeholder group within the scope of NIH’s mission.” For decades, the NIH has invested in many projects examining the health impacts of policies to help policymakers make informed decisions. Freezing policy-focused grant applications would limit evidence that shape policy decisions.

According to NIH officials, many grant applicants have been instructed to remove the word ‘policy’ from their applications. NIH leadership also described certain flagged proposals as lobbying, which is prohibited under NIH rules. This change may be the result of major budget cuts under the Trump administration that may have forced the agency to shift funds away from policy-related research. Although it is normal for agency priorities to shift and evolve under different presidential administrations, excluding policymakers from “NIH mission-relevant stakeholder groups” hinders the translation of evidence into policies that could improve health care access and quality. Given the potential growing influence of political appointees in the grantmaking process, this change could further politicize NIH funding decisions especially if policy-related research conflicts with the Trump administration’s agenda.

New CMS Waiver Rules Could Reshape Medicaid Coverage and State Innovation

A new dispute over Arkansas’ Medicaid expansion waiver is raising broader questions about how the administration plans to implement new Medicaid budget-neutrality requirements established under H.R.1. According to KFF Health News, CMS recently informed Arkansas that it would not approve the state’s requested five-year waiver renewal because the program does not meet the administration’s revised interpretation of budget neutrality rules, meaning they cannot cost the federal government more than the state would have spent under standard Medicaid rules.

Medicaid waivers are designed to give states flexibility to test new approaches to coverage and care delivery, often serving as policy laboratories for innovations that federal law would not otherwise permit. States have used waivers to expand coverage, provide housing and nutrition support, purchase private insurance for Medicaid beneficiaries, create behavioral health and substance use treatment programs, and test new payment and delivery models. The decision could affect roughly 200,000 Arkansans and may foreshadow challenges for other states relying on long-standing Medicaid waivers to expand coverage, test new delivery models, or provide services beyond traditional Medicaid benefits.

The issue extends beyond Arkansas. Nearly every state operates at least one Medicaid waiver, and several states, including California and Georgia, have major waivers scheduled for renewal this year. CMS argues the new policy simply enforces statutory requirements that federal waivers not increase program costs. Critics, however, contend that the administration is using a technical budget rule to limit coverage expansions and reduce federal Medicaid spending. Hospitals and policy experts have also expressed concern that additional waiver restrictions could discourage innovation, jeopardize funding streams that support care for vulnerable populations, and create new administrative hurdles for states.

For decades, Medicaid waivers have allowed researchers to study how different approaches affect coverage, access, costs, and health outcomes. As states prepare to implement Medicaid work requirements beginning in 2027, Georgia’s Pathways program and Arkansas’ private option model are already attracting national attention as evidence for what may happen elsewhere. Changes to waiver approval and renewal processes could influence not only coverage and benefits, but also the ability of policymakers and researchers to evaluate new approaches to improving care for Medicaid beneficiaries.

Vaccine-Makers Unlikely to Split MMR Shots Despite Trump’s Push

President Trump signed an executive order directing federal officials to develop plans within 90 days to separate combination vaccines, including the measles, mumps and rubella (MMR) vaccine, into individual shots and to consider spacing out other childhood vaccinations. Implementing the changes would require manufacturers to develop and seek FDA approval for vaccines that have not been widely used individually in the U.S. for decades, potentially requiring new studies, manufacturing capacity and regulatory review. For families and providers, separating the two-dose MMR series alone could mean six office visits instead of two because spacing out additional vaccines could further increase the number of appointments needed.

For health services researchers, the proposed changes raise important questions about access, care delivery, and implementation. More required appointments could increase costs and administrative demands for health systems and pediatric practices while creating additional barriers for families trying to complete recommended vaccinations. Researchers will have an important role in evaluating how changes to vaccine delivery affect vaccination completion, access to care, provider capacity, costs and disparities across patient populations. The executive order itself does not require manufacturers to develop individual vaccines or states to change school vaccination requirements, so its ultimate impact will depend on how federal agencies, manufacturers and states respond.

HIV Prevention Funding Cuts Create Uncertainty for Florida Clinics

Community-based HIV prevention organizations in Florida are preparing to lose direct federal funding after the Trump administration announced that the Centers for Disease Control and Prevention (CDC) will not renew a grant program supporting 96 HIV-focused community organizations nationwide. According to reporting from Central Florida Public Media, the funding has supported HIV testing, outreach, education, and access to prevention medications such as PrEP, particularly in communities with high rates of new HIV diagnoses.

The decision could have significant implications for Florida, which recorded more than 4,400 new HIV diagnoses in 2024 and receives the second-largest amount of CDC HIV prevention funding nationwide. Orange County, one of the CDC’s 48 priority jurisdictions for HIV prevention, reported 423 new HIV diagnoses in 2024 and currently receives approximately $5 million annually for HIV testing and prevention efforts. While CDC has established a temporary supplemental funding stream for state health departments through May 2027, community organizations will no longer receive funding directly and instead may need to compete for state-administered grants. Advocates warn that the transition could create funding gaps and service disruptions for organizations that provide frontline prevention and testing services. The policy shift also marks a notable departure from the first Trump administration’s 2019 “Ending the HIV Epidemic” initiative, which set a goal of reducing new HIV infections by 90 percent by 2030.

The funding changes raise important questions about how public health programs are structured, delivered, and evaluated. Community-based organizations have long served as a key component of HIV prevention efforts, especially in high-incidence areas. As funding responsibility shifts from direct federal support to state-administered programs, researchers and policymakers will be watching closely to understand how the change affects access to prevention services.

Stricter State Laws Slow Health Care Private Equity Deals

Private health equity investments in health care services have been declining in recent years due to state laws imposing stricter oversight on private equity deals. The number of private equity deals dropped from 1,312 deals in 2021 to just 337 deals in the first half of 2026. A new report suggests that increased regulations and oversight discourage private equity dealmaking. For example, a new California law requires private equity firms to provide 90 days’ advance notice of proposed deals, which increases the state’s oversight on these transactions. Another law in Oregon, Senate Bill 951, restricts private equity involvement in physician practices by banning the management structures that private equity firms rely on to own and manage them. These laws could make it harder and longer for private equity firms to complete deals.

Concerns about the impact of private health equity investments on health care costs and quality have fueled increased regulatory oversight. There is a growing body of research that suggests private health equity investments can increase costs and lower quality of care. This is a pivotal example of how health services research can provide evidence to inform policy and regulations. The debate surrounding private equity in health care will continue to gain attention in the upcoming elections, and policymakers will need to lean on evidence to support their positions and determine the appropriate level of oversight.