Week of April 28–May 2, 2025

General Mental Health

• Gov. Kathy Hochul shored up her public safety agenda when state lawmakers agreed to loosen the legal standard for involuntary commitment of the mentally ill — a major victory for the Democrat and a sign that political winds on the issue are shifting to the center. Under the agreement, the state will fund pilot programs that dispatch unarmed first responders to mental health emergencies and will convene at least four panels to review incidents in which responders are accused of using excessive force, according to two people with direct knowledge of the matter who were granted anonymity to share details of the deal. Read more here.

Medicaid

• Rep. Don Bacon, a key GOP moderate, is drawing a red line on Medicaid cuts. The Nebraska Republican has privately told the White House he won’t accept more than $500 billion in reductions to the program, according to two people with direct knowledge of the matter. That could complicate the GOP’s effort to pass a domestic policy bill that is set to include an extension of President Donald Trump’s 2017 tax cuts. Read more here.
• A group of House conservatives is calling for significant “structural reforms” of Medicaid as part of the Republican reconciliation legislation, illustrating the seemingly intractable differences across GOP factions. In a “Dear Colleague” letter led by Rep. Chip Roy (R-Texas) and signed by 19 others, the lawmakers said the GOP conference must pursue “meaningful reforms” in reconciliation, including eliminating the enhanced federal matching funds for states that expanded Medicaid. Read more here.
• Congress is back in D.C. with plans to move forward on a budget framework that could include cuts to Medicaid. About one in three people with disabilities is enrolled in the program, which helps them access health care and live independently in their communities. Stephanie Sy reports, and we hear from people with disabilities and their caretakers about what Medicaid means to them. Read more here.
• New York Gov. Kathy Hochul is facing a threat of political backlash if the state is hit hard by looming federal cuts to Medicaid. With Congressional Republicans on the hook to realize $880 billion in savings by Sept. 30, the Democratic governor is now forced to look for ways to compensate for the anticipated hit to the state’s $124 billion Medicaid budget — one of the largest in the country. Hochul would be on the hook to contend with the fiscal fallout from the potential cuts, forcing her to consider contingencies that come with their own political risks. Read more here.

Federal Policy

• House Ways and Means Chair Jason Smith (R-Mo.) said President Trump “does not want” the “one big, beautiful bill” encompassing his agenda “to be a health care bill.” “Medicaid … all falls underneath the Energy and Commerce Committee, not Ways and Means,” Smith said when asked about cuts to Medicaid via the bill on “The Hill Sunday” by NewsNation’s Chris Stirewalt. Read more here.
• DOGE has cut a wide swath — shrinking the federal workforce to 1960s levels. However, its impact in other ways has been more narrow than both supporters and detractors might realize. Government spending is actually increasing amid all the DOGE cuts, with notable exceptions including foreign aid and education. “In a sense, it’s more successful than you might have thought, in a sense it’s less,” said an administration official close to DOGE who was granted anonymity to speak freely. Read more here.