If you want to understand what has happened to health and human services over the past year, do not start with press releases, budget summaries, or political speeches.
It starts with the phone.
Because when policy shifts, funding stalls, or rules change, people don’t call Washington. They call 211. They call when their fridge is empty, their power is off, their landlord has filed for eviction or is refusing accommodations, or the hospital is discharging them with nowhere to go. And one year into this administration, the calls tell a very clear story.
Let’s start with food. One year ago, one of the first executive orders paused all federal spending, including USDA funds, from the Inflation Reduction Act, triggering lawsuits and program disruptions.
The administration reinstated and expanded work requirements and tightened exemptions, particularly for adults without dependents and older adults who previously qualified for flexibility.
At the same time:
People who were eligible last year are suddenly told they’re not.
People lose benefits because paperwork deadlines were missed, not because their income changed.
People cycle off and back on benefits, creating gaps that food pantries and other community-based agencies are expected to fill.
At 211, we are fielding calls from people who lost food assistance outright — and from others who lost clarity about whether they were still eligible, when benefits would load, or what paperwork was suddenly required.
Both are devastating. Because when you’re living paycheck to paycheck, you don’t need one more problem to manage.
Healthcare is another place where the damage looks administrative.
Over the past year, we’ve seen:
So people who were covered suddenly aren’t. Or they think they are, until a claim is denied.
Or they lose coverage because the mail went to an old address. Or the premiums priced them out of insurance altogether.
This is especially brutal for people with chronic illnesses, disabilities, and behavioral health needs.
Medicaid loss is one of the fastest pathways to housing instability. Missed care leads to job loss. Job loss leads to income loss. Income loss leads to eviction.
Housing policy changes over the past year have also been devastating.
Federal guidance has increasingly emphasized:
At the same time, inflation and rent increases were not meaningfully addressed.
The result? Shelters are filling faster and emptying slower. Rapid rehousing becomes harder to access. Prevention programs are the first to lose funding, and at this point are almost entirely gone. And people who don’t meet a perfect definition are left out entirely.
Add to this the whiplash of funding notices and retractions, lawsuits, and ongoing litigation…which doesn’t help any of our community members in the meantime.
TANF was designed to be a flexible safety net.
Over the past year, we’ve seen:
So families hit a crisis and are told to comply first, stabilize later, if at all. For families with kids, that delay is everything. Missed rent doesn’t wait for compliance paperwork. Neither do utility shutoffs.
Federal utility assistance dollars did not increase to match reality this year.
What increased? Rates. Fees. Arrearages.
What didn’t? Assistance caps. Season length. Eligibility flexibility.
So programs run out earlier. Crisis funds disappear faster. And households with medical equipment, seniors, and families with children were pushed into emergency situations.
One of the clearest shifts over the past year has been the deprioritization of public health infrastructure.
Funding was reduced or deprioritized in favor of downstream responses for vital programs:
So people are showing up in ERs. In jails. In shelters. In crisis.
Every single one of these changes has something in common. Responsibility was pushed downward. Flexibility was framed as waste, fraud, and abuse, and communities were told to “innovate.” You cannot innovate your way out of structural divestment.
One year in, this administration didn’t eliminate health and human services. It hollowed them out. Through delays, restrictions, confusion, and shifting definitions. Through silence.
When people ask me what’s changed this year, I point to the realities of our community members and what we’re seeing at 211. More people are calling later. Fewer tools to intervene early. More damage to repair. And higher costs for everyone. 211 will keep answering the phones. But we cannot fix policy gaps with compassion alone.
We need leaders who understand that confusion and red tape is a cut, a funding delay is a cut, and program restrictions are cuts, even when the program technically still exists. Our most vulnerable community members did not need one more problem, and the first year of this administration has given them one problem after another, after another.
And it’s not slowing down.
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Sandra De Steno is the director of 211, a free, 24/7, information and referral service powered by United Way of Greater Toledo. 211 provides free and confidential referrals to anyone with a health or human service need. 211 serves 15 counties across Northwest Ohio.
Behind every call to 211 is a caring and compassionate person ready to listen, solve problems, and...
Behind every call to 211 is a caring and compassionate person ready to listen, solve problems, and...
Behind every call to 211 is a caring and compassionate person ready to listen, solve problems, and...
