Primary writer for this story is Ricardo Martin of the Cadillac Evening News. Contributing were Mark Constance of UpNorthVoice.com; Michael Livingston of Interlochen Public Radio, and Rick Brewer of WCMU.
###
NORTHERN MICHIGAN – A cloud of uncertainty hangs over Michigan’s local public health departments as they prepare their fiscal year 2026 budgets.
Health departments have recently been hit with a triple whammy of budget setbacks: In March, President Donald Trump abruptly cut federal COVID-19 relief funding expected through June 2026. On July 4, Trump signed his “big, beautiful bill” into law, aiming to trim Medicaid spending by about $1 trillion through 2034.
And the proposed 2026 federal budget could eliminate funding for emergency preparedness and preventative health care programs.
Supporters say the changes aim to right-size the federal government and eliminate fraud and waste in health care programs.
But Michigan’s 45 public health departments — responsible for everything from immunizations to restaurant inspections — are now cutting or scaling back programs such as school health educators and tuberculosis outreach.
“My level of concern is high right now,” said Kevin Hughes, health officer for District Health Department No. 10, which serves northwest and west Michigan. “It’s a lot of uncertainty and it’s a lot of wait and see.”
Michiganders will feel the cuts, said Norm Hess, executive director of the Michigan Association for Local Public Health.
“A lot of people think they don’t use public health when they actually do,” Hess said. “They would notice that the service is slower, or the services aren’t available, or (they) have to travel farther to get them.”
‘The rug got pulled out from under us’
As the pandemic wound down, DHD No. 10 used some federal relief funds to enhance existing work, including COVID-19 vaccinations. But much of the funding supported school-based health resource advocates who provided education on nutrition, mental health, and more.
After the cuts, seven advocates were reassigned, but two positions were eliminated. Hughes said remaining advocates now operate under adolescent health center funding or U.S. Department of Education money.
Under the new model, services expanded to include evaluating sick students and treating minor injuries.
Steve Hall, health officer for Central Michigan District Health Department, said his department lost three temporary health resource advocates. While officials expected the jobs to end eventually, Hall said the funding disappeared sooner than anticipated.
The Central Michigan DHD also ended a pilot project aimed at treating latent tuberculosis in rural areas. The initiative would have spanned 19 counties and involved DHD No. 10 and the Mid Michigan District Health Department.
Hall said they hoped to make the program self-sustaining, but without COVID relief funds, it couldn’t move forward.
“It was very disappointing,” he said. “We had just flipped the switch to start the program and the rug got pulled out from under us.”
More uncertainty looms, said Hess. Proposed cuts to the Public Health Emergency Preparedness Program, which is federally and state-funded, could jeopardize requirements for emergency preparedness coordinators at every department.
Since 9/11, coordinators have helped local agencies plan and train for emergencies. Losing them, Hess warned, would leave communities less prepared.
“There’d be training that doesn’t happen. There’d be things that aren’t thought about ahead of time,” he said.
Also at risk: $6 million in flexible funding the state health department uses for workforce development and preventative care.
Cadillac resident Laura Grider, who has been on Medicaid for 20 years, said proposed Medicaid cuts are terrifying.
Diagnosed with thyroid cancer in 2012, Grider relies on levothyroxine and other medications, as well as therapy, psychiatric care, and transportation — all covered by Medicaid.
“It’s a scary thought to possibly lose my Medicaid because, without it, I would be out of luck,” she said.
Grider, who lives in a homeless shelter, has unsuccessfully applied for disability benefits, which would exempt her from new Medicaid work requirements.
“It’s not that I don’t want to work,” she said. “It’s just that I can’t work.”
As of December 2024, more than 2.6 million Michigan residents — about 26% of the population — were enrolled in Medicaid. Roughly 30% of those served by DHD No. 10 and Central Michigan DHD are on Medicaid.
Without it, primary care access could shrink, forcing more people to turn to public health departments already stretched thin.
In the First Congressional District, which covers Michigan’s Upper Peninsula and the Northern Lower Peninsula, about 27 percent of the population receives services through Medicaid.
U.S. Representative Jack Bergman insisted in a May 20 interview that cuts in Medicaid will not negatively affect rural health care.
“Medicaid is not going to be cut for the people who need it,” Bergman said.
Medicaid comprises $4.6 million of DHD No. 10’s $32 million budget and $3.2 million of Central Michigan DHD’s $18.7 million.
Many students accessing adolescent health services at school are Medicaid recipients. The department’s breast and cervical cancer screening program also uses Medicaid to provide treatment once a diagnosis is made.
Peter Marinoff, president of Munson Healthcare Cadillac Hospital, said Medicaid patients make up a significant portion of their population.
“In a rural setting, we typically have lower operating margins,” Marinoff said. “There’s a lot of hospitals that could potentially go negative if there are cuts to Medicaid.”
He said patients may avoid care if they lose coverage, worsening health outcomes.
“That’s something we don’t want to see,” he said. “We want to see healthy communities.”
Joe Calabrese credits Medicaid with helping him overcome severe depression and anxiety. With coverage, he could see mental health providers, get prescriptions, and attend checkups. Now employed full time and moving to employer insurance, he remains grateful.
“With Medicaid, I basically have multiple lifelines that pulled me out of dark places,” he said.
Calabrese said it’s painful to think about others losing access.
“My heart definitely goes out to anyone on it, or that’s going to need it coming up here.”
###
This reporting is made possible by the Northern Michigan Journalism Project, led by Bridge Michigan and Interlochen Public Radio, and funded by Press Forward Northern Michigan.
