Last month, I joined hundreds of lawyers and advocates in Charlotte, North Carolina, for the American Bar Association/National Legal Aid & Defender Association Equal Justice Conference. Our team was there to discuss two of the most urgent threats facing Medicaid today: the trillion-dollar cuts in the so-called One Big Beautiful Bill Act and automated eligibility systems that are denying eligible people the coverage they deserve.
The energy in that room is something I will carry with me, a reminder that we know what is at stake, and that we will not back down.
Earlier this month, the Centers for Medicare & Medicaid Services released an Interim Final Rule implementing the Medicaid work requirement provisions of the One Big Beautiful Bill Act. These provisions require people to repeatedly document work hours or exemptions to keep their Medicaid, a reporting burden that causes even eligible people to lose coverage over paperwork, not eligibility. Nebraska already began implementing work requirements on May 1st. Montana follows on July 1st. The rest of the forty-one states that expanded Medicaid are required to implement these harmful requirements by early 2027.
This is the moment we have been fighting to prevent. It is also the moment we are prepared for.
When the rule was released, NHeLP’s legal and policy teams immediately got to work fighting back. Staff across the organization analyzed hundreds of pages of regulatory text, identified key threats and vulnerabilities, briefed advocates and journalists, and began helping partners understand what the new requirements will mean for the people they serve. At the same time, we launched a new national hub where advocates can share information, strategies, and resources in real time, strengthening our collective ability to protect access to health care in every state.
This is what NHeLP was built to do: connect legal expertise, policy analysis, communications, and state-based advocacy to meet emerging threats quickly and effectively.
The urgency of that work reflects a simple reality: the harm is not hypothetical. Millions of people who are entitled to health care, even people who meet every one of the new eligibility requirements, are now at risk of losing it. Not because they do not qualify, but because of red tape, system failures, and paperwork burdens that create barriers where none should exist. A missed notice, a confusing portal message, or a form sent to the wrong address can mean the difference between having coverage and losing it.
In Nebraska, we are already in court challenging the state’s use of an automated assessment tool that drastically cuts benefits for people with intellectual and developmental disabilities, even when their conditions have not changed. This is what happens when automated systems make life-altering decisions without meaningful accountability.
We know from the history of Medicaid work requirement experiments that these policies do not help people find work. They punish people who cannot work, denying them the care that keeps them healthy and making it even harder to work. They take health care away from people who are already working, caregiving, managing illnesses, or simply trying to navigate a system that was never built with them in mind. The result is health care that remains available on paper but is lost in practice.
As we approach Juneteenth, the holiday marking the day in 1865 when enslaved people in Texas finally learned they were free – more than two years after the Emancipation Proclamation – it carries a particular weight this summer. Juneteenth reminds us that the promise of freedom, like the promise of health care, did not arrive all at once, and did not reach everyone equally.
There has always been a gap between what people are legally entitled to and what they can actually access, and NHeLP has fought to close that divide for nearly 60 years.
There has always been a gap between what people are legally entitled to and what they can actually access, and NHeLP has fought to close that divide for nearly 60 years.
I want to be honest about this moment: it is incredibly challenging. Trillion-dollar cut to Medicaid. Work requirements. Attacks on immigrant coverage. All of it is landing at once, and it is landing hardest on people who already face the greatest barriers to care.
And yet, what stayed with me in Charlotte was not only the urgency in the room. It was the specificity of the work. Advocates had come not just to resist, but to strategize. Courts are issuing important victories. Partners are finding new approaches. People are showing up for one another and for the communities they serve.
That is what I see at NHeLP too.
Even in the face of unprecedented challenges, our work continues to make a tangible difference in communities across the country.
This spring, states continued advancing policies to expand access to contraception. In Virginia, our model Contraceptive Equity Act was signed into law after years of technical assistance and coalition work. In Tennessee, we helped advocates secure a new law allowing people to obtain a full year’s supply of contraceptives at once, making it easier for people to access the care they need.
In Florida, a federal court ordered the state to halt Medicaid coverage terminations it found to be “incomprehensible” and constitutionally deficient. Across the country, more than half of all states and Washington, D.C. now reimburse doulas through Medicaid, up from just two states when NHeLP began this advocacy in 2018.
And in Georgia, our partnership with state advocates this spring helped secure the release of a 21-year-old man with autism who had been confined for months in a locked psychiatric unit, long after his doctors determined he could be released to a community placement.
He is living in the community now.
This work cannot be done alone. Our Health Law Partnerships, now approaching 26, including the first Medicaid-focused legal aid clinic in Puerto Rico, make this kind of coordinated advocacy possible. We will be announcing more soon.
None of these wins arrived easily or quickly. They are the result of years of sustained effort by advocates who stayed in the fight long after it would have been reasonable to walk away.
Because of your support, NHeLP can respond on multiple fronts at once: supporting advocates in the states, challenging unlawful actions in court, helping shape policy, and ensuring that people facing barriers to care are not left to navigate these challenges alone.
Your support also allows us to build the long-term partnerships and legal strategies that make lasting change possible.
A few months into this role, I have never been more confident in NHeLP’s ability to meet this moment.
One of NHeLP’s great state partners, Michele Johnson of the Tennessee Justice Center, said something to me during my very first week on the job that I keep coming back to: we are made for this moment.
Health care access, like freedom, is never secured by promise alone. It must be fought for, enforced, and protected, case by case, state by state, person by person.
Thank you, as always, for making it possible.
Warmly,
Jen
Jennifer Cannistra
Executive Director
National Health Law Program
