The White House Office of Management and Budget’s Office of Information and Regulatory Affairs has updated its regulatory agenda.

The Unified Agenda outlines key regulatory priorities in the near and long-term. It’s a key and oft-overlooked tool for policy engagement.

Key to Track

Several priorities, including the Administration’s plans to:

• Rescind the 2024 rule Designated Placements Requirements Under Titles IV-E and IV-B for LQBTQ+ Children, also known as the “Safe and Appropriate Placements Rule”

• Implementation of the child support data changes made as part of last year’s Supporting America’s Children and Families Act

• Implement anticipated changes to the TANF Work Participation Rate calculation, as outlined in the bipartisan Fiscal Responsibility Act

• Revisions to the Runaway and Homeless Youth Program

• New flexibilities in Head Start and child care

The agenda doesn’t give the full details of any particular regulatory action, but is a useful forecasting tool for tracking new developments.

On September 9, the House Appropriations Committee advanced a party-line Labor, Health and Human Services, Education, and Related Agencies spending bill for FY26.

It would make a 6% cut — $7B less than last year, far short of President Trump’s proposed $31B reduction, but with a $100M investment in the Make America Healthy Again initiative.

The bill would hold the National Institutes of Health flat at $48B but trim the U.S. Centers for Disease Control and Prevention nearly 20% ($1.7B), while zeroing out DEI initiatives and Planned Parenthood funding.

It also boosts rural hospitals and biodefense.

Why it Matters

Partisan appropriations bills are always aspirational.

This bill is not on its way to becoming law; it’s a signal of the direction the House majority wants health funding to go starting in October.

What’s not yet clear is whether and when a comprehensive FY26 bill can come together.

With funding expiring Sept. 30, shutdown risk is very much back in play, with implications for child and family policy.

The Trump Administration has finally unveiled the long-awaited Make America Healthy Again (MAHA) report and strategy, a sweeping strategy with 128 recommendations to address childhood chronic disease.

The report zeroes in on poor diet, chemical exposures, physical inactivity, chronic stress—and what it frames as the “overmedicalization” of children.

Recommendations of interest for child and family policy

• Nutrition and labeling rules could reshape school meals and SNAP choices.

• Vaccine recommendations will reignite debate on science, safety, and trust in public health.

• Prior authorization and prescribing safeguards that would reduce prescribing of psychotropic medication for kids, especially ADHD.

• ACF would be tasked with reviewing psychotropic prescribing patterns in foster care services, targeting overmedication risks.

• HHS and USDA would tighten nutrition standards in Head Start and child care, while promoting more physical activity in afterschool programs.

Takeaway

The MAHA report is a sprawling blueprint, and implementation will require sustained discipline.

This isn’t a straight-to-Federal-Register-release, but the full waterfront.

The signal to track is which recommendations agencies actually move on, and which remain rhetoric.

Savvy actors are already engaging relevant agencies and partners to see which to prioritize around.

Beyond the theatrics over HHS Secretary Robert F. Kennedy Jr.’s Senate hearing appearance last week, there are two things to watch:

1. A key upcoming CDC meeting; and

2. Shifting Senate support.

Key September Meeting to Monitor

September 18-19 brings a bellwether to watch; a key CDC Advisory Committee on Immunization Practices meeting on routine childhood vaccines.

Why it Matters: Secretary Kennedy eliminated all members of the ACIP earlier this year and added new members aligned with his skepticism over vaccines.

This upcoming meeting is on routine vaccinations, with implications for the Vaccines for Children program.

Major changes would lead to renewed pressure amid shifting support for the HHS Secretary.

Shifting Support in the Senate

Last week Secretary Kennedy faced Senators grilling him over policy and personnel changes with implications for vaccine approval and access, ousting the CDC director, and abruptly halting mRNA funding.

Noteworthy: Cassidy’s Warning Shot After Shots Warning

Sen. Bill Cassidy (R-LA), a physician and the top Republican on the HELP committee, was the critical confirmation vote for Kennedy earlier this year.

At the hearing, he signaled buyer’s remorse—pressing for oversight after Kennedy reversed on confirmation hearing commitments to Cassidy on vaccine access.

This pivot matters; the confirmation coalition is showing signs of stress.

Shifting Support Signals Unclear Path on Vaccine Changes

No GOP senator pulled support outright, but the shift is palpable.

Senator John Barrasso (R-WY) warned bluntly: “I’m a doctor. Vaccines work.”

Senator Ron Johnson (R-WI) went the other way, defending Kennedy and blasting colleagues for dodging blame on COVID.

In the context of the ACIP meeting, this eroding support will make major changes more likely to draw bipartisan challenges, and raise questions about HHS leadership.

Mississippi has declared a public health emergency in response to rising infant mortality rates. 

What’s not getting headlines is the parallel in foster care data that point to common connections. 

Why it Matters for Child Welfare

Infant mortality is closely tied to child maltreatment and child welfare system involvement; they share key social and family factors.

At the same time that Mississippi saw rising infant mortality rates, it saw rising infant placements into foster care, as you can see here:

Worth Tracking

Mississippi’s infant foster care rate is much higher than other age groups. That by itself isn’t unusual.

What sticks out is that while national foster care rates declined, Mississippi's rose every year starting in 2020 - with infant rates exceeding national averages even when they fell.

Strategic Implications

Marshaling a public health response alone without also tapping child welfare expertise could miss the common factors driving both.

From Our Radar to Yours

Forward guidance on what Wonks are tracking, week of 8/18.

• Return from Recess

  • Between now and the next session of Congress, we will see the shape of FY26 talks and how likely a shutdown is.

  • What to track

    • How many appropriations bills move, and how many get stuck

      • The more that advance, the greater the pressure for a deal.

    • Whether the White House proposes new rescissions packages or retains FY25 funds rather than releasing them.

• ACF Nominee Awaiting Confirmation

  • After his July 22nd confirmation hearing, Alex Adams is awaiting confirmation as Assistant Secretary for Family Support at the Administration for Children and Families.

  • His nomination appears likely to advance.

  • What to Track

    • How his priorities continue or change what acting Assistant Secretary Gradison has focused on.

    • Any early proposals that indicate where he is going to focus his time and attention.

Effective October 1, North Carolina is cutting Medicaid payment rates 3-10% across providers.

State leaders cited a budget shortfall and the recently enacted One Big Beautiful Bill Act.

The deepest cuts will impact autism and disability services.

Why it matters 

Medicaid already pays service providers rates far below those of Medicare. 

Budgetary pressures will increase that tension and raise questions about the sustainability of access to care.

Strategic implications

Anticipation of impacts like this was part of what led Senator Thom Tillis (R-NC) to oppose OBBBA and not seek re-election.

10% cuts to residential services and autism therapy are likely to impact already strained services.

What first movers are doing

Providers can prep to brief policymakers by stress-testing their payer mix to identify vulnerability and viability.

Forward-thinking Medicaid directors are contingency planning; child welfare agency leaders are already asking to be at that table.

What to watch

Whether this spreads beyond North Carolina and how rate reductions impact provider sustainability and patient access.

A newly leaked Make America Healthy Again (MAHA) commission report includes plans for a working group scrutinizing psychotropic medications for children, such as antidepressants and stimulants for ADHD.

Why it matters

Children in foster care have higher rates of both mental health conditions and prescription of these medications.Debates over appropriate prescribing are not new to child welfare policy. Foundational questions about the appropriateness of psychotropic medications for children have new momentum, and could augur larger policy changes than prescribing oversight.

Strategic implications

The working group aims to address the prescribing of these medications to children broadly. Will a broad policy address different needs for children in care?

What first movers are doing

Proactive child welfare agencies are auditing their psychotropic medication oversight protocols and preparing for MAHA questions. Residential treatment providers are preparing for Medicaid headwinds and impeded medication access.

What to watch

Whether child welfare gets a seat at the working group table. 

Significant new uncertainty for federal grants

On August 7, President Trump issued an Executive Order routing all federal discretionary grants through senior political appointees, with the power to kill them midstream if they stray from administration priorities.

The EO also bans funding tied to “anti-American values,” and aims to cap the amount of grant funds that go to overhead.

This also creates two major shifts to consider.

Lower Net Present Value

First, a long-term grant becomes worth less to you today.

If there’s a decent chance you might not actually receive every year of a grant that looks big on paper, it’s worth less to you in real life.

You plan like it’s smaller, spread funding across more sources, and front-load work.

Policy as Platform

Second, expansions of executive power persist.

Looking further into the future, presidents of both parties will have more tools to align the award of discretionary funding with their priorities.

Options for the Risk Exposed

Those with significant exposure to federal grant revenue have pivots to consider accelerating, including:

• Portfolio Prophylaxis. Limiting exposure to any single federal discretionary funding stream or agency, and to elevate state/local funds and private revenue.

• Show Your Work. Prospective grantees that have open protocols, clear replicability and auditable data processes are better positioned now.

• Armor Contracts. Language that seemed boilerplate will be a focal point for negotiating; step-down termination costs, IP retention, and more.

• FOA Fluency. Reading for screening words matters even more now.

• Staffing Stability. Tying FTEs to federal funds becomes riskier.

A new national survey by the National Organization of State Associations for Children and Association of Children’s Residential & Community Services shows child welfare service providers nationwide pointing to the potential liability insurance crisis we’ve previously elevated.

Here’s what they found:

• Rapidly Rising Premiums. Average premium increases were 163% since 2019, and about half of providers had premiums double.

• Market Instability. Nearly two-thirds of providers switched carriers in the last 5 years. Nearly two-thirds struggled to even get bids for coverage.

• Significant Spending. Just the 327 agencies that responded to the survey spent over $200M on annual premiums.

The math signals challenges for provider stability at a moment of significant fiscal and policy complexity.

Why This Matters

Insurance companies are pricing child welfare as inherently catastrophic risk, regardless of individual track records. This comes as jurisdictions face historic settlements over abuse claims.

Providers typically need coverage to operate, so this trend could signal disruptions to service availability or higher costs that will ultimately get passed on to public agencies.

What We Don’t Know

Whether this shift reflects consistent pricing in of new risks across all jurisdictions, or insurers spreading localized risks (like CA eliminating its statute of limitations on certain claims) across the county.

The Structural Fix

Providers have been arguing a federal fix is needed to stabilize the market. This survey will bolster that claim.

How the end of an era shapes what’s to come.

U.S. Representative Danny Davis (D-IL) will not seek re-election, retiring at the end of the 119th Congress after 15 terms.

Rep. Davis is the Ranking Member of the U.S. House Ways and Means subcommittee that oversees the child welfare system, safety net programs, and evidence-based home visiting.

Ending an Era

Throughout his career he has led and contributed to numerous significant bipartisan laws reforming child and family policy, including the:

• Supporting America’s Children and Families Act (P.L. 118-258)

• Jackie Walorski Maternal and Child Home Visiting Reauthorization Act of 2022 (P.L. 117-328)

• Supporting Foster Youth and Families Through the Pandemic Act (P.L. 116-260)

• Family First Transition Act (P.L. 116-94)

• Family First Prevention Services Act (P.L. 115-123)

• Fostering Connections to Success and Increasing Adoptions Act (P.L. 110-351)

Ranking Member Davis holds historical continuity from working on most major child and family legislation since the late 90s. This ends an era, not just a chapter.

Who Holds the Hammer?

This news also kicks off subcommittee succession scenario planning. Rep. Judy Chu (D-CA) is next in line of seniority, but that doesn’t automatically translate to a gavel.

Some of this will be a function of which way the midterms break; wins for Democrats would mean more seats (and maybe a Chair’s gavel), while the status quo or expanded seats for Republicans could remove another Democratic seat from the subcommittee.

New subcommittee leadership will matter for a variety of reasons.

It shapes which issues take priority, drives geographic and regional politics, and sets the tone for negotiations.

One Last Time

A leader with such a substantive record of leadership on a policy issue often translates that into a final bipartisan agreement.

It will be worth watching what issues Ranking Member Davis may raise as part of a final legislative legacy.

This could certainly be another reason to bet on the prospects for an older youth bill this Congress…

Movement on cross-partisan priorities, and how they’d impact child welfare.

Last week, the Senate Committee on Banking, Housing, and Urban Affairs unanimously voted to advance the Renewing Opportunity in the American Dream to Housing Act of 2025.

The committee’s first bipartisan housing markup in a decade targets the housing crisis by addressing the root causes of instability, not just adding more units.

Key provisions include:

• Addressing structural barriers to housing affordability, like the federal requirement for manufactured housing to have a permanent foundation;

• Reviewing federal construction financing barriers for modular housing;

• Expanding affordable housing through rental assistance programs like the Rental Assistance Demonstration (RAD) and public housing preservation;

• Strengthening tenant protections, including a Right to Counsel for eviction cases;

• Incentivizing zoning reform to increase affordable housing in high-demand areas; and

• Supporting home repairs through programs like the Whole-Home Repairs Act to ensure families can stay in their homes without displacement.

Housing’s Role in Child Welfare

The relevant impacts for child welfare policy are manifold.

Housing instability is a key driver of child welfare system involvement; homelessness and inadequate housing contributed to 13 percent of foster care entries in FY2023.1

Stable housing can also improve family reunification outcomes, giving parents the stability they need to meet reunification goals.

This matters given that 44 percent of foster care exits in FY 2023 were for reunification.2

And the expansion of homelessness prevention programs could serve as a lifeline for the over 15,000 youth aging out of foster care each year, who are disproportionately at risk for homelessness.

What Comes Next

Unanimous advancement out of committee isn’t just movement; it’s a signal of momentum.

Look for these policies to show up in future comprehensive legislative development.

Senate confirmation continues coming together for ACF nominee from Idaho.

On July 22nd, the U.S. Senate Finance Committee held a confirmation hearing for Alex Adams, the Trump Administration’s nominee for Assistant Secretary for Family Support at the Administration for Children and Families (ACF) in the Department of Health and Human Services (HHS).

What to Know

Alex Adams is currently Director of the Idaho Department of Health and Welfare.

In that role he has focused on child welfare policy, including extending foster care to 23 and implementing kin-specific licensing standards.

A pharmacist by training, he spent five years overseeing Idaho’s budget and regulatory process, during which time the state got its first-ever AAA bond rating.

If confirmed, Adams will oversee ACF’s $72 billion portfolio, including the:

• Child welfare programs of the Children’s Bureau;

• Temporary Assistance for Needy Families (TANF) block grant;

• Social Services Block Grant (SSBG), and

• Refugee resettlement, through the Office of Refugee Resettlement (ORR).

What SFC Asked

Adams’ nomination has the strong backing of Senate Finance Chair Mike Crapo (R-ID), which all but ensures confirmation.

We noted that confirmation hearings typically focus on securing policy commitments when the nominee is relatively non-controversial.

This hearing was light on child welfare policy details, with a larger focus on adjacent topics driving partisan divides.

Senators raised questions that ranged from the nominee’s views on HHS Secretary Kennedy’s views on vaccines to the the recent spending reductions to Medicaid in the One Big Beautiful Bill Act.

We saw some questions as expected on ACF staffing cuts and reconciliation, and a focus on Head Start and the Low Income Home Energy Assistance Program.

There were surprisingly few questions on the details of child welfare policy, including on the Family First Prevention Services Act or the recent Title IV-B reauthorization.

What Comes Next

ACF has not been idle without a Senate-confirmed Assistant Secretary, but acting leadership always comes with an asterisk.

Adams’ confirmation will bring new direction to an agency managing major personnel upheaval and ongoing funding uncertainty.

Expect a formal voting out of committee on a party-line vote, followed by Senate confirmation, likely before the end of the summer.

Cuts to PBS, NPR, and foreign aid augur funding deal turbulence; buckle up.

Congressional Republicans just pushed through a $9 billion rescission package on a party-line vote, with all 216 GOP House members and all but two GOP Senators voting yes.

The bill claws back previously approved funding for foreign assistance, including funds to the U.S. Agency for International Development (USAID) and Corporation for Public Broadcasting (CPB).

But the deeper story isn’t about the dollars—it’s about cross-partisan trust.

Signals of FY26 Turbulence

This was a key test case for FY26 appropriations, with Democrats watching to gauge whether it’s in their interest to come to the table to cut a deal.

That’s because while a rescissions package can erase funding by simple majority, an appropriations bill requires 60 votes to clear the Senate.

Reading the Room

Trust and predictability are essential ingredients for bipartisan cooperation.

The logic is simple: Why negotiate, offering needed votes in exchange for your funding priorities,if your counterpart can then unwind your deal via simple-majority?

Disrupting that procedural alchemy could poison the well for 60-vote cooperation in the Senate, all but guaranteeing a Continuing Resolution (CR) this fall.

Translation: we may already be on a glide path toward stalemate when funding expires on September 30.

As previously noted in Child Welfare Wonk’s reconciliation breakdown, rescissions as a tactic have downstream implications, including increased shutdown risk and CR lock-in.

For child welfare programs reliant on stable federal appropriations—especially discretionary Title IV-B and earmarks—this maneuvering creates ripple effects far beyond the Beltway.

Senate confirmation coming together for ACF nominee from Idaho.

On July 22nd, the U.S. Senate Finance Committee will hold a nomination hearing on Alex Adams, the Trump Administration’s nominee for Assistant Secretary for Family Support at the Administration for Children and Families (ACF) in the Department of Health and Human Services (HHS).

What to Know

Alex Adams is currently Director of the Idaho Department of Health and Welfare.

In that role he has focused on child welfare policy, including extending foster care to 23 and implementing kin-specific licensing standards.

A pharmacist by training, he spent five years overseeing Idaho’s budget and regulatory process, during which time the state got its first-ever AAA bond rating.

If confirmed, Adams will oversee ACF’s $72 billion portfolio, including the:

• Child welfare programs of the Children’s Bureau;

• Temporary Assistance for Needy Families (TANF) block grant;

• Social Services Block Grant (SSBG), and

• Refugee resettlement, through the Office of Refugee Resettlement (ORR).

What to Watch

Adams’ nomination has the strong backing of Senate Finance Chair Mike Crapo (R-ID), which all but ensures confirmation. Still, don’t expect a rubber stamp.

Senate hearings are less about outcome than orchestration: members will use the moment to publicly extract commitments and signal policy priorities.

Look for questions on everything from ACF staffing cuts and reconciliation plans, to how Adams might juggle the bandwidth-consuming oversight of ORR) with the traditional workhorses of child welfare and economic support.

ACF has not been idle without a Senate-confirmed Assistant Secretary, but acting leadership always comes with an asterisk.

Adams’ confirmation will bring new direction to an agency managing major personnel upheaval and ongoing funding uncertainty.

The ACF has released its FY 2026 Congressional Justification, the detailed version

What a CJ is: We previously highlighted the Trump Administration’s “skinny budget.” The CJ is where the details live.

What this CJ Proposes: Aligned with the broader budget, this proposes mostly level funding or slight reductions for child welfare programs, while reorganizing HHS more broadly around them.

• Child Abuse Prevention and Treatment Act

  • Title I State Grants– $105M, level with FY25

  • Title II Community-Based Child Abuse Prevention– $60.7M, a $10M cut from FY25

• Title IV-B

  • Subpart I Discretionary– $269M, level with FY25

  • Subpart II Discretionary– $63M, a $10M cut from FY25

• Chafee Education and Training Vouchers

  • $44M, level with FY25

What Comes Next: This is one part of the broader appropriations process. As Doug Steiger pointed out last week, it’s possible we may be facing a shutdown, so this is not yet settled.

According to the U.S. Congressional Budget Office, the House-passed budget reconciliation bill’s² net effect on families annual income differs significantly by income.

Those with the lowest incomes would see reduced annual income, while the highest income families would see a net increase.

Reminder on Reconciliation: Our reconciliation overview explains how this fast-track simple-majority legislative process works.

What’s New: CBO has a new analysis examining how the bill affects annual income, finding:

• The lowest income families would see $1,600 less, nearly 4 percent of their income.

  • Cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP) are the core explanatory drivers for this shift.

• The highest income families would see $12,000 more.

  • Tax policy changes are the core explanatory driver for this shift.

Why it Matters: Much media coverage is highlighting impacts on program access, the debt, and deficit. That excludes second-order economic shifts that could impact families and systems.

What it Means: Safety net policies typically counterbalance economic shock. Systems don’t typically plan to have fewer resources for struggling families right as economic risk rises.

What to Watch: This is a critical week in the Senate process, with likely text to drop later today.

The larger debt sustainability conversation is also deeply intertwined here. Wonks don’t just watch budgets; bond yields also signal trends that matter for child and family policy.

Warnings of a bond market crisis are no longer coming from the fringes.

Hedge fund giants, former budget directors, and green eyeshade types across the ideological spectrum are all pointing to the same thing: federal debt math is increasingly unsustainable.

What’s Happening: Interest payments on the debt are exceeding $1T annually; more than federal spending on Medicaid, SNAP, and disability insurance—combined.

What Happened Before: The U.S. has dodged enough fiscal cliffs to defy deficit doubts. Growth post Great Recession via low interest rate-fueled borrowing undermined concerns.

Because debt is central to policy-directed spending, deficits and debt are inherently political; those in power often dismiss deficits while those outside it decry them. That risks missing a shift.

What Could Be Different Now: The baseline debt level is higher, inflation is pushing interest rates higher, and geopolitical uncertainty is undermining long-held assumptions of U.S. finance.

If borrowing costs keep rising, the pressure will reach states. Flexible programs, like those serving children and families, will be the first to feel it.

Why it Matters: This isn't just budget theory. It’s a structural tension with real-world stakes.

This matters for child and family policy: economic growth matters both for families’ financial stability and the tax receipts that drive domestic spending. Now is a chance to think ahead.

As these pressures rise, discussions that start in Excel files on Wall Street will shift to those in state budget passbacks. That could translate to fewer staff serving fewer families.

At a June 12 hearing of the U.S. House Ways and Means Subcommittee on Work and Welfare, lawmakers examined how federal programs meant to support young people aging out of foster care often fall short.

Policy in Focus: the Chafee Program,¹ which funds independent living support, employment services, and Education and Training Vouchers (ETVs) for postsecondary costs.

What the Hearing Surfaced: Chronic underutilization. In FY22 alone, states returned $8.9 million in unused funds, largely due to administrative hurdles and low youth awareness.

Who Testified:

• Ramond Nelson– Lived Experience Leader, Foster Club

• Lisa Guillette– Executive Director, Foster Forward

• Maggie Stevens, Ed.D.– President and CEO, Foster Success

• Kimberely Webb– Youth in Foster Care in Farmington, Missouri

Wonk Out and Go Deeper: Catch the full hearing or dive into witness testimony here.

Following months of uncertainty, federal agencies are regaining control over the grantmaking process.

Role of Grants.gov

Overseen by the U.S. Department of Health and Human Services, Grants.gov is the key federal portal for soliciting applications for $500B+ in federal funds.

Shift to DOGE

DOGE became platform administrator this spring, centralizing review of every funding opportunity.

The result? Dozens of delayed grants and questions over the rules for grant decisions; everything from support for Alzheimer's caregivers to child and family programs.

This also happened in the context of the “Defend the Spend” initiative, which further delayed disbursement of funds for federal programs.

DOGE Denied

Now DOGE’s central gatekeeping role is out.

Agencies can post NOFOs directly — though political appointee sign-off requirements remain.

This shift follows changes in the role and influence of Elon Musk and DOGE.

It also occurs amidst contested legal questions about whether federal agencies must spend funds Congress appropriates.

Rerouting Red Tape

White House officials say DOGE still plays a “facilitator” role, with embedded staff at each agency.

It’s not yet clear whether the change will lead to revisiting delays and expirations of impacted grants.

The key question now is if decisional authority reverts to agency officials, or their DOGE teams.