Neel Hajra, CEO, Michigan Health Endowment Fund
Kari Sederburg, Vice President, Programs, Michigan Health Endowment Fund
By now, the health philanthropy field is familiar with the potential harms posed by H.R.1., the budget reconciliation act signed into law in 2025. In Michigan, possible impacts from the legislation include up to 355,000 people losing Medicaid coverage, $32 billion in projected reduced federal Medicaid spending over the next decade, up to 796,000 families with reduced or lost SNAP benefits, and up to $2.3 billion in reduced annual provider tax payments to hospitals.
Filling these gaps is impossible for any foundation, including ours, which is the largest health foundation focused solely on serving the state. Even the combined resources of all Michigan foundations would not meet the scale necessary to neutralize this escalating crisis. Instead, at the Michigan Health Endowment Fund (the Health Fund for short), we are prioritizing solutions that reduce H.R.1’s potential harm on people and communities. We are aiming to maximize our impact through four interrelated strategies: Greater agility to move from opportunity to action, teaming up with state government for systems change work, forging new networks to scale our collective impact, and leading from the center to make our progress more durable.
We can illustrate these interrelated strategies through three distinct interventions we have undertaken since H.R. 1 was passed last summer. We understand that not every foundation shares our statewide or grantmaking scale, but whether your foundation is local, regional, or national, we think the kinds of efforts described below are worth exploring.
Delivering food and strengthening food systems
Last fall, the continued government shutdown prompted the federal government to freeze SNAP funding to states, with little time to prepare. The fast-moving chaos made it hard for anyone to pinpoint a single cohesive solution.
In response, our board allocated $2.5 million as a block grant due to the speed of disruptions to SNAP funding at the federal level. This approach allowed staff to mobilize funding nimbly without needing to return to the board for approval of individual grants. What emerged from the SNAP block grant was a dual approach that sought to blunt the worst immediate effects of the government shutdown, as well as longer-term SNAP reductions under H.R.1:
- Direct food assistance: The Health Fund co-invested with a family foundation and the Kalamazoo Community Foundation to provide grants to GiveDirectly, which quickly deposited funds onto food benefits cards for families with the greatest need during the SNAP funding freeze. This effort ultimately reached 7,800 families.
- Emergency food infrastructure enhancement: Working through a network of a dozen local funders who know their communities better than we do, we distributed $1.75 million to strengthen local emergency food systems in anticipation of the longer-term effects of H.R.1 on food access.
Preserving access to Medicaid
This winter, our state faced another crunch: adapting Michigan’s Medicaid application and renewal systems to help eligible residents enroll in and retain Medicaid coverage, while knowing that work had to start as soon as possible to be ready when new H.R.1 requirements start taking effect in January 2027, including work requirements and more frequent renewals.
By leveraging our relationships with the State of Michigan—and again with leeway from our board to quickly deploy a $1.5 million block grant—we moved forward to collaborate with the Michigan Department of Health & Human Services (MDHHS) to reduce administrative and procedural denials of Medicaid applications and renewals in two ways:
- Improve administrative policies and systems: Alongside the Ballmer Group, we funded the Tech Talent Project to provide critical policy and technology expertise that will help MDHHS enhance the state’s systems and processes to increase automated Medicaid renewal rates and reduce procedural denial rates.
To date, this work has supported important improvements, including identifying data measures to enable ongoing improvement in beneficiary non-response rates, removing long-standing technical barriers that prevented Medicaid applicants from using their cell phones to upload documents, improving wayfinding on the MDHHS website, and aligning renewal dates for households with multiple beneficiaries. - Develop effective outreach, education, and navigation tools: We funded Civilla to work with the state on centering the voice of Medicaid enrollees in the creation of processes, tools, and materials for outreach, education, and navigation.
This included extensive interviewing and user testing with residents and nonprofits, which supported clear, accurate, actionable communications. The resulting resources included a detailed plain-language website, an integrated four-part webinar strategy targeting nonprofits, and an interactive digital tool allowing users to input their details to see whether and how new regulations apply to individualized scenarios. These tools added to the state’s integrated strategy for equipping beneficiaries to comply with new requirements and maintain their Medicaid coverage.
Enhancing outreach and navigation
Since spring we have been building on these collaborative efforts with the state to strengthen its strategies and systems. We have also been leveraging an important insight from the human-centered design research with Civilla: while Medicaid beneficiaries trust what they hear from MDHHS, they also want to verify what they hear with community-based organizations they trust.
These efforts have involved a separate round of investments to support individuals who might lose Medicaid coverage due to a lack of awareness, or a misunderstanding, of changing Medicaid requirements.
Combating these risks calls for speed, ongoing public sector collaboration, and network activation with foundations and community-based organizations (CBOs) across our state. Accordingly, we are investing in enhanced education, outreach, and navigation resources through an approach supported by a third board designation of $2.25 million:
- Statewide CBO Network: We joined forces with the Kresge Foundation and the W.K. Kellogg Foundation to fund a statewide technical assistance network for CBOs that aid residents in navigating Medicaid. This includes substantial support for the Michigan Nonprofit Association who, in coordination with MDHHS, is working to disseminate enhanced Medicaid outreach tools to local CBOs across the state, provide them with technical assistance to leverage those tools, and make subgrants to local organizations who play key navigation roles for beneficiaries in communities with the greatest needs.
Leading from the center
Underlying all these initiatives is an important ethos of leading from the center. We are a structurally bipartisan foundation serving a purple state, so we understand that not every foundation shares our context. Based on our scope and environment, we must lead strongly from the center to optimize our impact.
In practice, this includes convening bipartisan policymaker conversations on health topics, commissioning nonpartisan research briefs—on issues like insurance access and Michigan’s Medicaid program, meeting periodically with elected officials from both sides of the aisle, embracing perspectives from diverse communities across Michigan, and honoring all voices on our bipartisan, politically-appointed board of directors.
We believe this approach enhances our ability to speak with credibility in support of health equity, gives us seats at more tables, protects the durability of our relationships with the public sector across changing administrations, expands our potential networks of local and statewide partners, and enables effective action across a diverse range of communities throughout Michigan.
Key Takeaways
Several lessons learned have emerged so far through these initiatives:
- Elevating voices is critical for greater impact: In the spirit of centering health equity, foundations need to more deeply incorporate the views of the people most affected by our actions, even when timeframes are tight.
- Agility is more important than ever: A chaotic federal policy environment, and its downstream effects in states, require foundation boards and staff to be more agile to preserve our value to those we serve.
- Networks are also more important than ever: Using a ‘network first’ mindset increases our collective impact and leverages complementary strengths (e.g., pairing our scale with local expertise of regional funders).
- Relationships and credibility are a long game: Building relationships and credibility over time, particularly with the public sector, increases the chance of having a seat at the table during times of acute crisis. It is never too late to start playing this long game.
- Leading from the center is a strength: This is our path to greatest impact.
H.R.1 will transform health care in ways we know and ways we cannot predict. What we do know is that foundations must keep evolving to preserve or increase our collective potential for impact.
Our aim in Michigan has been to forge action-oriented strategies and networks to deliver durable change. Beyond the immediate impacts of H.R.1., we believe our enhanced agility, collaboration with the public sector, and the network orientation we have strengthened through this process will pay dividends across all our work for years to come.