Molly Pofahl had big plans for the $370,000 in federal money awarded to the East Central District Health Department in March. 

They would use the money to provide cleanup for homes with high lead levels in Boone, Colfax, Nance and Platte counties, said Pofahl, the department’s chief public health officer. They could make it easier for people living in the district’s rural areas to get vaccinated. She planned to get training for her staff to better teach central Nebraskans about preventing infections.

Lessons learned during COVID-19 informed their plans for the money – it showed them areas, she said, where they could improve before the next crisis.

The local health department had barely started to use the money when Pofahl received word that the grant was canceled. 

“...It felt defeating,” Pofahl said. “Now we can’t do all this work, and so we’re just going to almost be stuck in the same spot we were during COVID because we can’t expand our capacity.”

The department, and many other public health providers in Nebraska, are staring down a shifting reality in Washington, D.C.

Nearly $100 million in funding already disbursed to Nebraska is being clawed back, according to a list of canceled grants published by the U.S. Department of Health and Human Services.

Nationally, it’s part of an HHS overhaul that will cut roughly 20,000 employees – nearly a quarter of the department’s workforce – and cancel billions of dollars worth of grants already allocated around the country. 

In Nebraska, it will mean less federal money for university research, childhood vaccinations and mental health and substance abuse treatment. It means fewer dollars for battling opioid addiction, addressing health disparities in underserved areas and responding to infectious diseases.

“It’s going to hit the community at some point,” Pofahl said of her district’s cut funding. “Whether that’s tomorrow, a month or a year from now, it’s going to happen.”

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A grant termination order recently sent to leaders at the Nebraska Department of Health and Human Services lays out two reasons for the cuts.

One: It will save money. A representative of the federal government wrote in an email that the cancellation was part of President Donald Trump’s February executive order to start the “Department of Government Efficiency” Cost Efficiency Initiative, to reduce federal spending.

And two: The COVID-19 pandemic is over. 

“These grants were issued for a limited purpose: To ameliorate the effects of the pandemic,” the federal HHS rep wrote. “The end of the pandemic provides cause to terminate COVID-related grants. Now that the pandemic is over, the grants are no longer necessary.” 

Dr. Mark Rupp, a professor of infectious diseases and the interim chair for the Department of Internal Medicine at the University of Nebraska Medical Center, said that in some ways, the message seems correct: COVID-19 is no longer a public emergency. Hospitals aren’t overcrowded with COVID patients, he said, the vaccine is available and effective and the general population has largely developed immunity. 

But what the cancellation email from the federal government doesn’t capture, Rupp thinks, is the fact that COVID-relief dollars have since been used to address other serious public health concerns. 

At the University of Nebraska-Lincoln, multiple studies on alcohol’s connection with intimate partner violence were wounded by grant cancellations. UNMC lost awards to be used for strengthening infectious disease prevention. Nearly $19 million vanished that had been set aside to combat substance abuse and grapple with various mental health issues. More than $15 million for childhood immunization grants to the state got chopped as well.   

“They don’t sit on their hands waiting for the next pandemic to occur,” Rupp said of public health officials across Nebraska. “I think that’s the concept people have is that, ‘oh you’re just going to be dumping money into folks who aren’t going to be doing anything because we don’t have a pandemic right now.’ Nothing could be further from the truth.”

The Nebraska Hospital Association lost a part of one of the grants, more than $3 million, that was supporting a pilot program meant to limit Nebraskans’ exposure to opioids after hip and knee replacements. 

Instead of sending patients home with something like a 30-day opioid prescription after surgery, the pilot program assigned patients case managers to help them manage pain in other ways during the recovery process, said Margaret Woeppel, chief nursing and informatics officer at the hospital association.

The first hundred or so people had just received guidance through the pilot program when its funding was canceled. The program was supposed to impact the recoveries of 4,000 Nebraskans over a year. In Woeppel’s career with the NHA, she said it had never received a grant that could impact so many people in a year.

That data from the pilot program was meant to be shared with hospitals, both in Nebraska and elsewhere, Woeppel said. But without data-backed outcomes, it’s unlikely that Nebraska hospitals will make the necessary investments on their own to try similar opioid-reduction programs.

“The work that’s been done, it’s in a way, kind of wasted,” she said. “All the money that was spent, in a way, was kind of wasted.”

***

Teresa Anderson, health director of the Central District Health Department, said that there were lots of indicators that federal cuts were coming with the change in presidential administrations. But what was new – what jarred Anderson – was the federal government canceling funding that had already been committed. 

“It’s the first time in 21 years that I’ve seen it,” said Anderson, who runs the department overseeing public health in Hall, Hamilton and Merrick counties. “It’s totally unexpected that they would claw back funds.”

Emails that the Flatwater Free Press obtained through a public records request show that the specific grant cancellations weren't expected at the state level either. 

A representative from the federal Department of Health and Human Services emailed Nebraska DHHS at 4:50 p.m. on Monday, March 24, to cancel grants effective that same day. Subsequent emails the following day show Nebraska DHHS employees communicating to figure out what funds were cut and which sub-recipients were affected.

One of the impacted programs was Vaccines for Children (VFC), which provides vaccines for free to children without health insurance. It was first established by Congress after a measles outbreak starting in 1989 killed hundreds of people. The state is awarded the funds, and passes some money to local health departments. 

Jeff Powell, communications director for Nebraska DHHS, declined multiple requests for interviews, but responded to a list of emailed questions, saying that the majority of the federal money for the VFC program paid for “staff support” and “data system costs.” 

The state “immunization programs and systems remain active,” he wrote.

Twenty-three states and Washington, D.C. have filed a lawsuit against the U.S. Department of Health and Human Services, alleging that these grant cancellations were unlawful and outside of HHS’s authority. 

So far, the judge has issued a temporary restraining order in favor of the states, effectively pausing the funding cuts until the court reaches an official ruling. But the restraining order only applies to the 23 states and the District of Columbia suing HHS.

Nebraska is not among these 23 states.

A spokesperson for the Nebraska Attorney General’s Office declined to comment as to why Nebraska did not join the lawsuit. The lawsuit is ongoing.

Rep. Don Bacon, a Republican who represents most of the Omaha metro area, said in a written response that freezing grants and firing personnel should be done with a scalpel, not a sledgehammer, and that money appropriated by Congress must be honored by the White House.

“While I agree with the White House that we need to find the waste, I sometimes feel as if those working for Pres. Trump rush to make a big move and make big headlines, then turn around and correct it,” Bacon wrote. “If they just measure twice and cut once, we would be in a much better position.”

Reps. Adrian Smith and Mike Flood, both Republicans, did not respond to requests for comment.

***

More than half of the $100 million Nebraska is losing is funding meant to help detect, prevent and respond to infectious diseases. 

Nebraska’s DHHS was already preparing for an end to this funding Powell said in an email. The grant was scheduled to end in 2027.

“The announcement in March expedited those plans,” Powell wrote. “DHHS is prepared to address any emergencies that may occur.”

These grant cancellations to combat infectious diseases filtered down to the local level. It’s the money Pofahl was counting on in central Nebraska. The Lincoln-Lancaster County Health Department lost more than $600,000 in infectious disease funding. The Douglas County Health Department lost $900,000. 

And in south-central Nebraska, $350,000 in funding disappeared, money that would have been used to build that health department’s ability to track and respond quickly to future emergencies or outbreaks in Adams, Clay, Webster and Nuckolls counties, said Michele Bever, the South Heartland District Health Department’s executive director.  

“Without those federal funds that help stretch our chronically limited resources, we use more of our general funds for that purpose,” Bever said. “Other community outreach programs and essential services: cancer prevention, vaccine access, anything else that our families and schools and our communities rely on, those things will be impacted.”

A potential emergency that Bever and others are bracing for: Measles, one of the most contagious human diseases. 

Neighboring Kansas and Colorado have recently reported outbreaks. Multiple local health directors and UNMC’s Rupp said that it’s a matter of time until a similar measles outbreak happens in Nebraska. 

Rupp said that local health departments would be critical for the initial response to any infectious disease, whether that was measles, bird flu or some new, unknown virus. In his estimation, it’s worth the cost to have well-trained, well-funded public health teams able to meet the next challenge. 

“When public health is working appropriately, nobody hears about it, because they’re taking care of a lot of things and preventing a lot of issues,” Rupp said. “It’s only when it’s underfunded and under-resourced, and can’t do the job that we want them to be able to do – (the job) that they want to be able to do – that it becomes problematic.”

The Flatwater Free Press is Nebraska’s first independent, nonprofit newsroom focused on investigations and feature stories that matter.