Federal grant freeze: what you can do

It has been a week of chaos in the world of health and science, to put it mildly.
Multiple executive orders have shut down the day-to-day functions of US health agencies, causing confusion, fear, and for many Americans, the question of whether their next paycheck will arrive. While some pauses are normal during administration transitions, the scope of freezes and changes that have occurred over the last week is unprecedented.
Here's a quick recap:
- Communication from US federal health agencies stopped - with a few exceptions, last week federal health agencies including the CDC, NIH, FDA were instructed to stop communicating with the public until Feb 1. This includes public health guidance, press releases, social media posts, the CDC's weekly MMWR report (the first time in decades it has not been published), and website updates. Some respiratory virus and H5 flu data was provided last week, while many other data dashboards were not updated.
- Elimination of anything related to "diversity" – Federal organizations and organizations receiving federal money (universities, nonprofits) have been instructed to remove any programs and projects related to promotion of diversity or DEI. What counts as "related" is somewhat vague, and the effects have been far reaching beyond DEI offices and hiring practices – for example the FDA removed information from its website on enrolling patients from diverse backgrounds in clinical trials, which has been historically done to ensure women and minority groups are adequately represented when new drugs are tested for safety and efficacy.
- NIH work and travel stopped - many regular NIH activities were stopped in their tracks, including workshops that were cancelled the same day, study sections which review new grant proposals, and travel to conferences. Advisory gatherings like the National Vaccine Advisory Committee and the Presidential Advisory Council for Combating Antibiotic Resistance were also called off. Two days ago, it was clarified that critical functions as well as clinical trials already in progress and purchasing of supplies for ongoing experiments can continue.
- US foreign aid put on hold – nearly all US foreign aid has been frozen for 90 days, leading to job losses and halting of international programs that provide medicines and clean water to impoverished children, work to eradicate malaria and other tropical diseases, provide aid for refugee camps, and many other international efforts. The stop work order is effective immediately: for example, George W. Bush's President's Emergency Plan for AIDS Relief (PEPFAR) program is one of many international health programs affected, and HIV medications this program provided that are already purchased and stocked in international clinics are not allowed to be distributed.
- US withdraws from the World Health Organization – the CDC has been instructed to stop working with the WHO immediately, even though the WHO withdrawal requires congressional approval and the US is required to provide one-year notice before withdrawing. This significantly limits international coordination for addressing emerging threats, like marbung virus (a cousin of ebola) and bird flu.
Federal grant freeze
On Monday, an Office of Management and Budget (OMB) memo announced that federal agencies needed to "temporarily pause all activities related to obligation or disbursement of all federal financial assistance" by Tuesday at 5 pm so that grants and funds can be reviewed to decide if funded activities are consistent with recent executive orders.
Federal financial aid includes trillions of dollars in grants that fund scientific research, disaster relief, education, healthcare, housing, and many other community efforts. A extensive funding freeze puts hundreds of thousands of American's paychecks at risk, as these grants employ university professors, nonprofit workers, trainees, community health staff, and many more.
It was not immediately clear on Monday which programs would be affected, causing widespread confusion and panic. Payments "directly to individuals" including Medicare (a federal program that provides health insurance for adults over 65 and others with certain conditions) and social security benefits were explicitly exempt.
However, on Tuesday reports started emerging that states were unable access the online portal used to process Medicaid payments. Medicaid provides health insurance for 72 million low income Americans. The payment portal, which is also used by community health centers and childhood education programs, is now working again for many states, but currently displays a new warning:
PAYMENT DELAYS: Due to Executive Orders regarding potentially unallowable grant payments, PMS is taking additional measures to process payments. Reviews of applicable programs and payments will result in delays and/or rejections of payments.
A second OMB memo was released on Tuesday which provided some additional clarity on the funding freeze. It stated the pause is not to be applied across the board and is "limited to programs, projects, and activities implicated by the President's Executive Orders, such as ending DEI, the green new deal, and funding nongovernmental organizations that undermine the national interest." It also noted that medicaid and SNAP funds would not be interrupted.
Given how broad and vague these directions are (what counts as promoting "diversity?") as well as the warning listed on the HHS payment portal, it is still unclear how much federal aid and grants will be impacted or delayed.
Just before the 5:00 pm deadline on Tuesday, a DC federal judged temporarily blocked the federal grant freeze until next Monday, at which point the court will hear additional arguments from nonprofit groups who argue the freeze will cause irreparable harm to their organizations.
What you can do
This situation will unfold over the next few weeks, and it will become more clear who is and isn't impacted by the grant freeze and other federal funding changes. A team of public health reachers and community leaders lead by Your Local Epidemiologist has put together a survey to help assess what is actually happening on the ground.
If you or someone you know has had funding cut or projects cancelled, fill out this anonymous survey to share the impact of that funding and what losing it has meant for you and your work. If you haven't been impacted personally, share it with those in your networks who may have been impacted.
I will post updates as these events continue to unfold and as we get data back from the survey. For many folks in public health and medicine, this past week and a half has felt like a rollercoaster, even reminiscent of the first weeks of March 2020 when everything felt chaotic and uncertain.
But we will get through this. To quote my good friend Katelyn Jetelina, "Power also comes from the bottom up – don't forget that you have it."
Kristen Panthagani, MD, PhD, is a resident physician and Yale Emergency Scholar, completing a combined Emergency Medicine residency and research fellowship focusing on health literacy and communication. In her free time, she is the creator of the medical blog You Can Know Things and author of Your Local Epidemiologist’s section on Health (Mis)communication. You can subscribe to her website below or find her on Substack, Instagram, or Bluesky. Views expressed belong to KP, not her employer.