The current federal government shutdown is driven by failure of the Congress to finalize this year’s federal budget appropriations or adopt a Continuing Resolution (CR). The shutdown is already impacting the Supplemental Nutrition Assistance Program (SNAP), Head Start programs and other family supports, as Congress remains in a stand-still over extending ACA marketplace enhanced premium tax credits. But lost in the debate include pending appropriations bills that seek to zero out funding for key programs such as Healthy Start. Whether the shutdown ends with a CR or with passage of appropriations bills, successful maternal and child health programs are threatened. As we contemplate major H.R. 1 cuts to the health system, simultaneously cutting back these maternal and child health programs will rob communities of targeted investments that extend the utility of Medicaid and other health insurance programs. It’s worth reminding some of the public health programs at stake.
Healthy Start
The Healthy Start program was established in 1991 by President George H. W. Bush to support communities with infant mortality rates at least 1.5 times the national average. By 2024, Healthy Start was funded in 115 communities in 37 states, the District of Columbia, and Puerto Rico. Distinct from other care coordination and home visiting programs, it is the only federal program specifically designed to both engage community members and provide services to reduce maternal and infant mortality. Healthy Start sites are reducing infant mortality and improving access to care. The most recent data (2021) show program performance above the national average for key measures, among participants: 85% received early prenatal care compared to 78% for all US pregnant mothers, and 93% received well-child visits compared to an average of 56% for infants and toddlers enrolled in Medicaid that year.
President Trump’s FY26 budget proposed to eliminate Healthy Start. On July 31, 2025 the Senate Committee on Appropriations approved the Labor, Health, and Human Services, and Education, and Related Agencies Appropriations Act, which provides level funding at $145,250,000 for Healthy Start. On September 5, 2025, the House Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education and Related Agencies approved its FY26 bill, with no Healthy Start funds appropriated.
Maternal and child health advocates have strongly urged bipartisan Congressional action to maintain funding for the Healthy Start program at $145 million in FY2026 and support reauthorization in of the Healthy Start program in 2025.
Title X Family Planning
Created in 1970 under President Richard Nixon, Title X was designed as a cornerstone of preventive public health with bipartisan support. Title X provides federal funding to support clinics across the country to provide comprehensive family planning services to low-income and uninsured individuals. Federal support assists nearly 4,000 clinics across the country to provide services to 2.8 million clients in all 50 states, D.C. and U.S. territories.
Funding for the Title X Family Planning program is also threatened. On March 31, 2025, about one in five Title X grantees received notification that their year 4 funding of a 5-year project period would be temporarily withheld. KFF estimates that 24% of all Title X clinics across 23 states were affected by the funding freeze.
While the Continuing Appropriations and Extensions Act, 2025 (P.L. 119-4) provided $286.5 million for Title X in FY25, the President’s budget proposal and the House Labor-HHS appropriations bill zeroed out FY2026 funding. Title X cuts would exacerbate the H.R. 1 limits on Medicaid financing for Planned Parenthood sites and further starve family planning clinics that provide comprehensive health services to women across the lifespan.
Other Maternal and Child Health Programs at HHS’s Health Resources and Services Administration (HRSA)
For HRSA’s Maternal and Child Health Bureau (MCHB), the Senate LHHS bill provides $799.7 million for the MCH Block Grant and $196 million for Special Projects of Regional and National Significance (SPRANS). Unfortunately, the proposed spending levels make cuts from FY24 & FY25 funding ($813.7 million and $212 million, respectively). Within SPRANS, the bill provides $55 million forState Maternal Health Innovation Grants to improve maternal health outcomes and address disparities in maternal health. It also includes $17 million to continue implementation of the Alliance for Innovation on Maternal Health (AIM) program nationwide.
The House Labor-HHS appropriations bill includes $985.4 million for Title V MCH, with no more than $163.6 million for SPRANS and $10.2 million for Community Integrated Service Systems (CISS) projects. No further details were provided.
Both the Senate and House bills provide level funding or small increases for maternal health programs activities and grants such as Maternal Mental Health Hotline, Screening and Treatment for Maternal Mental Health and Substance Use Disorders, Rural Maternity and Obstetrics Management Strategies (RMOMS), and Integrated Services for Pregnant and Postpartum Women.
As shown in the table, both the Senate and House bills provide level funding or small increases for child health program activities and grants related to autism, developmental disabilities, heritable disorders (newborn screening), and early childhood development grants.
Maternal and Child Health at the Centers for Disease Control and Prevention
The Senate bill includes $113.5 million—a $3 million increase—for CDC’s Safe Motherhood and Infant Health portfolio. In Senate report language, CDC is directed to maintain the same level of staff in the Safe Motherhood Office as were in place on March 31, 2025. They also encouraged CDC to use the funding increase to expand support for Maternal Mortality Review Committees [MMRCs], Perinatal Quality Collaboratives [PQCs], and other programs, as well as funding to continue data collection under the Pregnancy Risk Assessment Monitoring System [PRAMS]. This Senate-proposed increase is a bright spot in the appropriations as we observe states like North Carolina pulling back their own funding for such efforts.
The House LHHS appropriations FY26 bill does not mention these CDC programs but provides level funding for the Safe Motherhood and Infant Health portfolio.
The House LHHS appropriations bill also provides $208 million (a $2 million increase) for CDC work
on birth defects, developmental disabilities, disabilities and health. The Senate bill reduces funding by $1 million.
H.R. 1 Cuts Already Threaten the Health of Millions of Women, Children, and Families
H.R. 1, the One Big Beautiful Bill Act (OBBBA, P.L. 119-21), includes dramatic cuts to Medicaid, changes in Affordable Care Act Marketplace coverage, constraints on SNAP, and more. Together, these policies threaten overall coverage as well as the health and well-being of mothers, children and families.
Access to coverage and care for mothers is threatened. Interruptions in coverage as a result of Medicaid work reporting requirements are anticipated, even for those exempt from requirements. And children’s health coverage will be at risk as their parents and caregivers lose their coverage – the recent unwinding shows the ways children can lose coverage even as they remain eligible. In addition to the loss of coverage for eligible people unable to successfully navigate the red-tape created by work reporting requirements, the massive cost-shift from the federal government to states will have a major impact on people covered by Medicaid. State lawmakers may be forced consider scaling back provider rates (impacting access to care), benefits, or even income eligibility levels as they are forced to grapple with federal Medicaid budget cuts that will increase each year. This may include opting out of the optional extended postpartum coverage reducing it from 12 months. Or rethinking income or waiver eligibility for the one in five children covered by Medicaid in optional coverage categories. Or cutting other state-funded programs families rely on to meet their needs.
Looming coverage losses from work requirements or state rollbacks are likely to compound recent declines in child health coverage. From 2022 to 2024 the rate of uninsured children increased from 5.1% to 6.0%—the highest rate of uninsured children in nearly a decade. As Joan Alker explained recently, this is a dramatic reversal on the progress our nation had made improving child health coverage.
What Will Funding Levels Be?
The small but mighty public health and maternal and child health programs, like those being negotiated in the budget, help to invest in community solutions and provide the infrastructure that makes Medicaid and other insurance plans work better. While the Senate bill maintains funding levels for key maternal and child health initiatives, Congress has yet to act. Whether this session of Congress ends with a continuing resolution or passage of final appropriations bills, women, children and families are likely to be impacted even more. The propose funding reductions— on top of massive H.R. 1 cuts—come at a time when American families continue to face unacceptable infant and maternal mortality rates, rising health coverage costs, and increased costs for food, utilities, housing and more.