The city Health Department is looking at how to preserve its “core” functions as it enters an expected federal funding downturn five years after the pandemic and new threats to support from Washington under President Donald Trump and Republican control of Congress.
The city is at the nadir of the “boom and bust” cycle of federal aid, in which dollars pour in during public health emergencies and quickly dry up afterward, leaving the city and state to cover the gaps, said Interim Health Commissioner Michelle Morse at a City Council oversight hearing on Monday. While it contends with the winding-down of what was once hundreds of millions of dollars a year in federal Covid-19 aid, the Department of Health and Mental Hygiene is “actively planning” for how to maintain infectious disease services in the face of deep federal cuts, Morse said.
Roughly $600 million of the department’s budget comes from the federal government, accounting for more than a quarter of its $2.1 billion preliminary spending plan. Most of that funding goes to emergency preparedness and infectious disease control.
Morse told the Council’s health and mental health committees that she sent a letter to Health and Human Services Secretary Robert F. Kennedy, Jr. and Acting CDC Director Susan Monarez, urging them to maintain national public health infrastructure, but has not gotten a response.
While the exact extent to which $880 billion in cuts to Medicaid would fall on the city, “there will be significant impacts” on both health care and social services if they come to fruition, Morse said. The city received around $60 million a year from Medicaid for school health programs, early intervention and other services, and a few million in reimbursements to clients at the city’s public sexual health clinics.
Reports that the Trump administration was eyeing cuts to HIV prevention funding through the Centers for Disease Control and Prevention has raised alarm at the Health Department.
The city has seen a 71% reduction in HIV cases over the last two decades specifically due to that funding, Morse said. The department currently receives $36 million from that pot, much of which goes to community-based organizations running HIV prevention and treatment programs.
Infectious disease coffers are padded by an extension the city received to continue using federal Covid-19 funding through next fiscal year, worth a total of $200 million between fiscal year 2025 and 2026, said the department’s Chief Financial Officer, Aaron Anderson. A bulk of that funding goes to expanding lab capacity, which will sunset in July of 2026. Other funding for vaccination and immunization will end in June 2027, he said.
That funding has helped reduce racial disparities in Covid-19 illnesses that killed Black and Latino residents in much greater numbers. The reduction in Covid-related deaths has been a major driver in increasing life expectancy in recent years, while disparities particularly in drug overdose, maternal mortality, and chronic disease persist. As a result, life expectancy in Brownsville is 12 years shorter than in SoHo.
“In a society stratified by race, class, geography, and more, we are facing vast inequities in time that mirror historic inequities in resources,” Morse said.
The city is looking for alternative funding sources, particularly from the state, which along with other grant sources, makes up about $1 billion of the agency’s budget. Morse, in particular, is pushing for the restoration of an estimated $60 million in state funds for public health services that were cut in 2019. That funding, known as Article 6, was not included in the governor or legislature’s budget proposals this year, though public support, including in the City Council is growing. At a state budget hearing in February, state Health Commissioner James McDonald said the cuts to the city created a disparity with the rest of the state.
