Overview
Over the past several weeks, the Network has taken formal public positions in three significant federal matters: joining an amicus brief before the U.S. Court of Appeals for the Fifth Circuit in Louisiana v. FDA; and submitting public comments on the new Medicaid community engagement requirements, as well as on proposed changes to federal grant regulations, including a provision addressing voter registration activities. Taken together, these matters illustrate the range of legal and policy actions that increasingly shape public health practice and ultimately the health of communities.
Over the past several weeks, the Network has taken formal public positions in three significant federal matters: joining an amicus brief before the U.S. Court of Appeals for the Fifth Circuit in Louisiana v. FDA; and submitting public comments on the new Medicaid community engagement requirements, as well as on proposed changes to federal grant regulations, including a provision addressing voter registration activities.
Although these matters arise in different legal and policy contexts, each reflects issues the Network has tackled for years including reproductive rights, health care access, Medicaid, and civic participation, for which we provide legal technical assistance to partners and closely monitoring the court decisions, regulations, and federal guidance that affect how public health programs operate in communities.
The three matters also illustrate the range of ways federal law shapes public health practice. One involves litigation, another federal rulemaking, and the third the administration of federal grants. Yet each raises questions that matter to public health and health equity, like who can access care, what conditions can be attached to public benefits, and how federal policy affects the ability of organizations and communities to participate in civic life.
Louisiana v. FDA
In Louisiana v. FDA, the State of Louisiana is asking the courts to require the FDA to reinstate a nationwide in-person dispensing requirement for mifepristone, an FDA-approved medication that has been used for more than 25 years in medication abortion and miscarriage care. The case raises a broader question about whether a single state can displace the FDA’s evidence-based determination about how an approved medication may safely be accessed, including in states where abortion remains legal and protected.
The Network joined an amicus brief led by Morrison Foerster LLP, urging the Fifth Circuit to reject that outcome. The evidence supporting the current framework is substantial. Mifepristone has been dispensed through telehealth and by mail for years, and a significant body of peer-reviewed research supports its safety under the current framework, with serious adverse events remaining rare across hundreds of thousands of patients.
More broadly, telehealth has become an established component of health care delivery, including behavioral health, chronic disease management, rural health, and reproductive care. Restricting telehealth access to mifepristone would create additional barriers for patients who already face significant obstacles to care, including people in rural communities, people with disabilities, and people without reliable transportation or paid leave.
The implications also extend beyond mifepristone. The federal regulatory system depends on the ability of scientific agencies to make evidence-based determinations within their statutory authority. If those determinations can be displaced through litigation whenever a state disagrees with them, the stability of evidence-based public health regulation is weakened more broadly.
The Network has previously joined efforts to defend telehealth access in the mifepristone litigation, including an amicus brief before the Supreme Court also led by Morrison Foerster LLP.
Medicaid Community Engagement Requirement
The Network’s comments to the Centers for Medicare & Medicaid Services address the interim final rule implementing the new Medicaid community engagement requirements. Medicaid is the nation’s largest payer of mental health and substance use disorder services, and nearly one in four adults enrolled through the expansion pathway lives with one of these conditions.
The statute expressly excludes people who are medically frail or have special medical needs from the community engagement requirements, including people with substance use disorders and disabling mental disorders. The interim final rule introduces an additional standard, however, requiring individuals to demonstrate that their condition significantly impairs their ability to comply and, in many cases, to provide clinical documentation.
That distinction has practical consequences. Fewer than one in five people who need substance use disorder treatment receive it, and nearly half of adults with mental illness go untreated. For people who cannot obtain timely clinical care, securing the documentation necessary to establish an exclusion can itself become a significant barrier.
Experience with prior state demonstrations provides further reason for concern. Administrative and documentation requirements can result in eligible individuals losing coverage not because they fail to meet the underlying eligibility criteria, but because they are unable to navigate the process required to demonstrate that eligibility.
Those coverage losses shift costs and consequences to emergency departments, local health departments, providers, families, and communities already managing the effects of the opioid epidemic and the national mental health crisis.
The Network’s comments urge CMS to implement the rule consistent with the statutory language, permit ongoing self-attestation as contemplated by longstanding Medicaid regulations, and recognize the role of peer support specialists and community health workers in serving affected populations.
The Uniform Guidance and Voter Registration
The Network, in partnership with Health & Democracy Partners, submitted comments opposing proposed amendments to Title 2 of the Code of Federal Regulations, the Uniform Guidance governing federal grants. Among the proposed changes is a provision that would prohibit the use of federal award funds for voter registration activities.
The comments build on the Network’s ongoing work with Health & Democracy Partners at the intersection of public health and democracy. Civic participation and health are shaped by many of the same structural conditions, including transportation, language access, broadband access, disability access, and economic security. Barriers in these areas can limit both participation in civic life and access to health-promoting resources. Public health organizations are also trusted institutions that can reach people who may be missed by traditional voter registration efforts, including people with disabilities and people experiencing financial or systemic barriers.
The proposed prohibition would constrain that role without articulating a clear rationale for doing so. It also raises legal concerns, including whether the provision is arbitrary and capricious under the Administrative Procedure Act and whether it is consistent with the National Voter Registration Act. Our comments urge withdrawal of the proposed rule and, at minimum, removal of the voter registration provision.
Taken together, these matters illustrate the range of legal and policy actions that increasingly shape public health practice and ultimately the health of communities. They also reflect the role the Network has long played in addressing the challenges created by laws and policies including monitoring developments, analyzing their implications, supporting partners, and engaging directly when federal policy or legal action warrants a response.
Public health has navigated consequential legal and policy changes before. The history of efforts to address industrial pollution, expand community health centers during the civil rights era, and respond to HIV/AIDS demonstrates the importance of sustained engagement when law and policy affect the conditions in which communities can be healthy.
That work continues today. Every brief we join and every comment we submit applies the Network’s legal and policy expertise to decisions that will affect public health practice and the communities we serve. It also contributes to the legal infrastructure on which the field depends.
We will continue to follow these matters as the Fifth Circuit considers Louisiana v. FDA, as CMS reviews comments on the Medicaid rule, and as the Title 2 rulemaking proceeds. Our law and policy experts will continue to work with partners as these developments unfold, bringing together legal analysis and public health experience to understand their implications and identify opportunities for engagement.
In Solidarity,
Quang “Q” Dang Executive Director Network for Public Health Law
The Network promotes public health and health equity through non-partisan educational resources and technical assistance. These materials are provided solely for educational purposes and do not constitute legal advice. The Network’s provision of these materials does not create an attorney-client relationship with you or any other person and is subject to the Network’s Disclaimer. Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.
