Since early 2025, several large federal health grants to states have been suspended and then restored after legal challenges. On Feb. 13, 2026, for example, the federal government moved to suspend about US$600 million in public health grants to four states before a federal court temporarily blocked the action. Hundreds of millions of dollars that had already been allocated by Congress were briefly put on hold before the court intervened.
Author
- Max Crowley
Professor of Human Development, Family Studies and Public Policy, Penn State
From the outside, these episodes may look like routine disputes between states and the federal government, as such cancellations do happen. But inside state agencies and in communities, they create something more consequential: uncertainty that interrupts crucial public health programs - even if states ultimately get the money.
As a scholar who studies how to build infrastructure for preventing human suffering , I've seen how instability - even when temporary - changes how agencies and the communities they serve plan, hire and invest.
Even when funding is eventually restored, repeated cycles in which funding is frozen and then temporarily reinstated, pending lawsuits, can disrupt how public health systems operate. This, in turn, erodes the public health infrastructure that federal funding helps build and maintain.
That infrastructure includes vaccination clinics, restaurant sanitation inspections, opioid response teams, school violence prevention, maternal health programs and disease surveillance systems, to name a few. Programs like this play a critical role in public health, but because they focus on preventing problems before they occur, many people aren't away of the critical need for them until something goes wrong.
Most disruptions never make headlines, but they affect services communities rely on.
Public health depends on continuity
Despite the heavy media focus on emergency response during crises such as the COVID-19 pandemic, most public health work is long-term planning built around multiyear prevention strategies .
Federal grants support epidemiologists, prevention specialists, behavioral health providers and data analysts. They fund disease surveillance systems, maternal and child health initiatives, substance use prevention programs and partnerships with community organizations. These efforts operate on multiyear timelines. Each one requires hiring staff, bringing on outside contractors and service providers, and setting up systems to track outcomes.
When funding is suddenly paused or regulatory environments change, agencies cannot simply wait for clarity. Hiring slows. Leaders draft contingency plans in case the suspension becomes permanent. Many state and local employees begin exploring more stable employment opportunities.
National workforce surveys show that roughly 1 in 4 state public health employees report considering leaving their job within a year . In 2023, local health departments lost an average of 19% of their staff , reflecting how the COVID-19 pandemic strained the public health workforce. In a small county health department, where the entire staff may consist of only four to seven people, losing even a single nurse or disease investigator can significantly disrupt services.
If funding is later restored, as has occurred in several cases in 2025 and early 2026, agencies must reverse course. They reissue guidance, renegotiate contracts and reassure partners. But the disruption has already consumed time and public resources.
Some projects and communities may not fully recover. Volatility creates costs even when the money returns.
The financial and administrative cost of legal battles
Suing the federal government over funding suspensions is expensive. When states challenge federal decisions, state attorneys general devote staff time and legal resources. Health departments must coordinate with lawyers, compile documentation and model alternative budget scenarios. Senior leaders shift attention from program oversight to legal and fiscal risk management.
Those administrative hours are funded by taxpayers. They represent real expenditures, though they rarely appear in public debate. And while litigation proceeds - often for months - agencies must prepare for multiple possible outcomes.
The uncertainty itself shapes planning . Agencies may hesitate to launch new initiatives if funding could disappear midstream. They may shorten contracts, delay hiring or scale back expansion plans to reduce exposure. Over time, that caution can slow implementation and limit innovation.
Instability extends beyond grant dollars
Suspended funding is not the only source of instability. The federal government has also announced structural changes within some health agencies, starting with a major reorganization of the Department of Health and Human Services in March 2025. These changes, too, inject uncertainty into how public health systems operate.
For example, federal health officials recently indicated they plan to significantly scale back the Office of Planning, Research and Evaluation within the Administration for Children and Families.
Since 1995, that office has studied the impact of programs serving families and children , including Head Start, the foster care system and Temporary Assistance for Needy Families. Independent research and policy organizations, including the Data Foundation and Results for America , warn that interrupting those studies could undermine states' ability to assess and improve these programs .
Similarly, recent grant terminations and restructuring within the Substance Abuse and Mental Health Services Administration , which administers major behavioral health grants to states, have introduced uncertainty. When staff supported by grants are cut or funding terms shift abruptly, payments can be delayed, reporting guidance becomes unclear, and local treatment providers may struggle to plan. For communities trying to prevent opioid overdoses or rising mental health needs, even short-term disruption can be a matter of life or death.
Pausing or reorganizing such studies midstream disrupts the ability to understand what works and what doesn't. Experienced staff may leave. Rebuilding that expertise can take years.
Prevention is especially vulnerable
Almost by definition, people take prevention for granted. If programs focused on vaccination, substance use treatment and youth mental health are effective, many people never experience the crises that might have occurred without them.
But prevention depends on continuity: sustained staffing, stable partnerships and consistent data collection. The effects of disruption are difficult to measure in a single budget cycle, but they influence how confidently agencies invest in long-term strategies. In that sense, funding instability can become a public health issue of its own.
Policy priorities will always evolve. Courts review executive actions. Congress revisits allocations. Change is part of governance. But if policymakers want stronger, more resilient public health infrastructure, stability is not simply administrative convenience. It is part of the foundation that makes prevention and preparedness possible.
Max Crowley does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
