
Trump administration removing 988 hotline service tailored to LGBTQ+ youth in July
Advertisement
News of the LGBTQ+ service shutting down comes as the U.S. Supreme Court upheld Tennessee's ban on gender-affirming care for transgender minors on Wednesday.
Get Starting Point
A guide through the most important stories of the morning, delivered Monday through Friday.
Enter Email
Sign Up
The Trevor Project said it received official notice Tuesday that the program was ending. The nonprofit is one of seven centers that provides 988 crisis support services for LGBTQ+ people — and serves nearly half of the people who contact the lifeline.
" Suicide prevention is about people, not politics," Trevor Project CEO Jaymes Black said in a statement Wednesday. 'The administration's decision to remove a bipartisan, evidence-based service that has effectively supported a high-risk group of young people through their darkest moments is incomprehensible.'
In its statement on the 988 decision, SAMHSA referred to the 'LGB+ youth services.'
Advertisement
Black called the omission of the 'T' representing transgender people 'callous.' 'Transgender people can never, and will never, be erased,' he said.
The Trevor Project will continue to run its 24/7 mental health support services, as will other organizations, and leaders of 988 say the hotline will serve anyone who calls with compassion.
The U.S. Centers for Disease Control and Prevention said there were 49,300 suicides in 2023 — about the highest level in the nation's history, based on preliminary data.
Studies have shown that LGBTQ+ youth are at higher risk of suicide, including a 2024 analysis by the CDC that found 26% transgender and gender-questioning students attempted suicide in the past year. That's compared with 5% of cisgender male and 11% of cisgender female students.
Young transgender people flooded crisis hotlines with calls after President Donald Trump was re-elected. Trump made anti-transgender themes central to his campaign and has since rolled back many civil rights protections and access to gender-affirming care.
Trump signed the National Suicide Hotline Designation Act of 2020 into law in October 2020.
The specific 988 subprogram for LGBTQ+ youth cost $33 million in fiscal year 2024, according to SAMHSA, and as of June 2025, more than $33 million has been spent on the services. The Trump administration's 2026 budget proposal called for keeping 988's total budget at $520 million even while eliminating the LGBTQ+ services.
Health Secretary Robert F. Kennedy Jr. wants to wrap SAMHSA and other agencies into a new HHS office called Administration for a Healthy America, where it would coexist with employees from other agencies responsible for chemical exposures and work-related injuries.
Advertisement
Hashtags

Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles


Los Angeles Times
39 minutes ago
- Los Angeles Times
Trump voters wanted relief from Medical bills. For millions, the bills are about to get bigger
President Trump rode to reelection last fall on voter concerns about prices. But as his administration pares back federal rules and programs designed to protect patients from the high cost of health care, Trump risks pushing more Americans into debt, further straining family budgets already stressed by medical bills. Millions of people are expected to lose health insurance in the coming years as a result of the tax cut legislation Trump signed this month, leaving them with fewer protections from large bills if they get sick or suffer an accident. At the same time, significant increases in health plan premiums on state insurance marketplaces next year will likely push more Americans to either drop coverage or switch to higher-deductible plans that will require them to pay more out-of-pocket before their insurance kicks in. Smaller changes to federal rules are poised to bump up patients' bills, as well. New federal guidelines for COVID -19 vaccines, for example, will allow health insurers to stop covering the shots for millions, so if patients want the protection, some may have to pay out-of-pocket. The new tax cut legislation will also raise the cost of certain doctor visits, requiring copays of up to $35 for some Medicaid enrollees. And for those who do end up in debt, there will be fewer protections. This month, the Trump administration secured permission from a federal court to roll back regulations that would have removed medical debt from consumer credit reports. That puts Americans who cannot pay their medical bills at risk of lower credit scores, hindering their ability to get a loan or forcing them to pay higher interest rates. 'For tens of millions of Americans, balancing the budget is like walking a tightrope,' said Chi Chi Wu, a staff attorney at the National Consumer Law Center. 'The Trump administration is just throwing them off.' White House spokesperson Kush Desai did not respond to questions about how the administration's health care policies will affect Americans' medical bills. The president and his Republican congressional allies have brushed off the health care cuts, including hundreds of billions of dollars in Medicaid retrenchment in the mammoth tax law. 'You won't even notice it,' Trump said at the White House after the bill signing July 4. 'Just waste, fraud, and abuse.' But consumer and patient advocates around the country warn that the erosion of federal health care protections since Trump took office in January threatens to significantly undermine Americans' financial security. 'These changes will hit our communities hard,' said Arika Sánchez, who oversees health care policy at the nonprofit New Mexico Center on Law and Poverty. Sánchez predicted many more people the center works with will end up with medical debt. 'When families get stuck with medical debt, it hurts their credit scores, makes it harder to get a car, a home, or even a job,' she said. 'Medical debt wrecks people's lives.' For Americans with serious illnesses such as cancer, weakened federal protections from medical debt pose yet one more risk, said Elizabeth Darnall, senior director of federal advocacy at the American Cancer Society's Cancer Action Network. 'People will not seek out the treatment they need,' she said. Trump promised a rosier future while campaigning last year, pledging to 'make America affordable again' and 'expand access to new Affordable Healthcare.' Polls suggest voters were looking for relief. About 6 in 10 adults — Democrats and Republicans — say they are worried about being able to afford health care, according to one recent survey, outpacing concerns about the cost of food or housing. And medical debt remains a widespread problem: As many as 100 million adults in the U.S. are burdened by some kind of health care debt. Despite this, key tools that have helped prevent even more Americans from sinking into debt are now on the chopping block. Medicaid and other government health insurance programs, in particular, have proved to be a powerful economic backstop for low-income patients and their families, said Kyle Caswell, an economist at the Urban Institute, a think tank in Washington, D.C. Caswell and other researchers found, for example, that Medicaid expansion made possible by the 2010 Affordable Care Act led to measurable declines in medical debt and improvements in consumers' credit scores in states that implemented the expansion. 'We've seen that these programs have a meaningful impact on people's financial well-being,' Caswell said. Trump's tax law — which will slash more than $1 trillion in federal health spending over the next decade, mostly through Medicaid cuts — is expected to leave 10 million more people without health coverage by 2034, according to the latest estimates from the nonpartisan Congressional Budget Office. The tax cuts, which primarily benefit wealthy Americans, will add $3.4 trillion to U.S. deficits over a decade, the office calculated. The number of uninsured could spike further if Trump and his congressional allies don't renew additional federal subsidies for low- and moderate-income Americans who buy health coverage on state insurance marketplaces. This aid — enacted under former President Joe Biden — lowers insurance premiums and reduces medical bills enrollees face when they go to the doctor or the hospital. But unless congressional Republicans act, those subsidies will expire later this year, leaving many with bigger bills. Federal debt regulations developed by the Consumer Financial Protection Bureau under the Biden administration would have protected these people and others if they couldn't pay their medical bills. The agency issued rules in January that would have removed medical debts from consumer credit reports. That would have helped an estimated 15 million people. But the Trump administration chose not to defend the new regulations when they were challenged in court by debt collectors and the credit bureaus, who argued the federal agency had exceeded its authority in issuing the rules. A federal judge in Texas appointed by Trump ruled that the regulation should be scrapped. Levey writes for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism.


Business Journals
an hour ago
- Business Journals
Waiting for pharmacy benefit manager reform from Washington? Here's what to do now.
If you're frustrated with your pharmacy benefit manager (PBM), join the club. A recent survey found that three-fifths of large-company benefit leaders said their PBM contracts were opaque, overly complicated, and contained clauses that profit the PBM at the expense of employers and patients. Thankfully, you're not stuck. Washington is working on PBM reform, one of the rare issues for which there is agreement between both parties in Congress and the Trump administration. Of course, consensus isn't always enough to create legislation, and any passed law will take time to come into force. A recently-enacted bill in Colorado addresses some of these issues, but will not apply to many large employer-sponsored plans. What follows is a guide to the problems with PBM contracts, the reform proposals, and two approaches to addressing the existing issues that don't require waiting on Washington: Finding a new generation of PBM committed to more transparency; and Negotiating a more transparent arrangement with your current PBM. The problem with large PBMs Pharmacy benefit managers were created to reduce employer costs, yet over time they have evolved in ways that often incentivize increases in plan sponsor and employee costs: Vertical Integration: Nearly 80% of the prescription market (which totaled $600 billion in 2023) is controlled by PBMs run by the three largest health insurance carriers: CVS Caremark (owns Aetna), OptumRX (owned by UnitedHealth Group), and Express Scripts (owned by Cigna). Spread pricing: PBMs charge employers more than they pay pharmacies for drugs, keeping the difference. Drug company rebates: These payments are often in return for PBMs steering business to their products and can include other undisclosed fees. Misaligned Incentives: By favoring their own specialty and mail-order (or retail) pharmacies, PBMs may be restricting competition and limiting their interest in negotiating the lowest pharmacy markups. A recent FTC study found that PBMs often charged employers a markup for specialty drugs distributed through their affiliated pharmacies of more than 100% — and sometimes more than 1,000%. Recently, the big PBMs have started joint ventures to manufacture their own generic and biosimilar drugs, creating another potential conflict. Secrecy: PBM common practices such as spread pricing, rebates, contractual gag clauses, price list manipulation and others have created an environment ripe with opaqueness and confusion for employers. The proposed legislation Congress has been looking closely at PBM reform for several years, and a detailed bipartisan bill was removed from last December's stop-gap budget after Elon Musk tweeted that it was too long. Leading committees are now working to pass something similar. Indeed, two bills that passed Committee last year were reintroduced: The Prescription Pricing for the People Act directs the Federal Trade Commission to complete its ongoing study of PBM practices. The Pharmacy Benefit Manager (PBM) Transparency Act bans spread pricing, incentivizes PBMs to pass 100% of the rebates they receive to plan sponsors, encourages transparency, and requires annual reporting by PBMs of their pricing, reimbursement, and rebate practices. Other proposals go further, including the Patients Before Monopolies Act, which would ban PBMs and insurance companies from owning a pharmacy. The states have been busy as well, increasing their oversight of PBM practices through new legislation and reporting requirements. Unintended consequences of all of this are a concern for consultants and employers looking to control costs. In Colorado, Governor Polis signed HB 25-1094 into law in May. Effective in 2027, this law will regulate how PBMs can earn income, how they structure their formulary, and how they reimburse unaffiliated versus PBM-affiliated pharmacies, among other changes. Unfortunately, this new law won't apply to many large employer-sponsored healthcare programs. So large employers in Colorado are still left to design their own pharmacy strategy. Switching to a transparency-oriented PBM In recent years, more employers have switched their pharmacy programs to a new crop of PBMs who are unaffiliated with large insurers—including Navitus Health Solutions, Rightway Rx, Capital Rx, and SmithRx—and offer a more transparent business model. The advantages Pass-through pricing: Employers get the full benefit of network discounts and rebates, and instead of spread pricing, they pay a disclosed administrative fee per prescription. Fewer conflicts: The independent PBMs are less likely to have pharmacy operations or other business interests that differ from those of employers. Transparent disclosures: Employers get access to granular information about the pricing of each prescription rather than the opaque summaries provided by the large PBMs. Aggressive cost management: The independent PBMs emphasize lower net cost options in their formularies and have strict prior authorization requirements for more expensive drugs. The disadvantages Negotiating intermediaries: Since the upstart PBMs are small, many band together by using rebate aggregators, entities that negotiate lower prices with drug companies. But these negotiations have a downside: They can obscure the details of drug company rebates, especially since most of the aggregators are owned by the same insurance conglomerates that own the big PBMs. Potential disruption: Changing PBMs means employees must adjust to a new formulary, pharmacy network, and prior authorization procedures. Members may also object to the stricter utilization controls these companies use. Buying power: Smaller PBMs do not have the volume that the larger players do and are also unable to take on the risk of aggressive discount and rebate guarantees which can lead to a financial arrangement that appears to be less advantageous for employers. Renegotiating with your existing PBM Many companies that have investigated using a more transparent PBM ultimately decide that the advantages of sticking with a large provider outweigh the frustrations and potential conflicts. They are: Convenience: Dealing with one company that provides medical benefits, pharmacy benefits, and mail-order pharmacy service can be easier for employers and plan members alike. Lower effective prices: Some employers find that the greater bargaining clout of the large PBMs delivers good value even if the mechanics of their arrangements remain murky. Increased transparency efforts: Faced with the prospect of increased regulation, CVS Caremark, Express Scripts, and OptumRX have all announced programs that disclose more information about pricing and pass more of their rebates to employers. As they are just being instituted, their real-world impact remains to be seen. In any case, employers and their advisors can't afford to wait to scrutinize their PBM's business practices and press for more advantageous contracts. The time is now to: Look at the fine print: A typical PBM contract may specify high-level drug discounts, rebates, and dispensing fees. Dig deeper, and you can find exclusions and key definitions, such as what is a 'specialty drug.' Press for full pass-through of rebates: Work through every category and proposed exception to insist that rebates for all drugs go to the employer. Ask about conflicts: How does the PBM interact with its affiliated pharmacies? Are reimbursements different than those for independent pharmacies? Are the dispensed drugs made by brands it owns? Check its approach to cost control: What is its philosophy for adding drugs to its formulary? How does it generate prior authorization guidelines for drugs with high rebates? What percent of authorization requests are approved? Audit performance: At the end of a contract, demand a detailed itemization of all claims to ensure that the PBM has met its commitments. If it hasn't, fight for a financial adjustment. Whether your company decides to find a new PBM or renegotiate its deal with the current provider, there are a lot of details to consider. An experienced broker or consultant will help you sort through those complex contracts designed to confuse. And if Washington does end up passing PBM reform, that advisor will also be able to adapt your plan to take maximum advantage of the new rules. To learn more, contact Chris Mast, an actuary and benefits consultant with Alliant Employee Benefits in Greenwood Village, CO. Mast has worked with employers across Colorado and the US for more than 20 years. He can be reached at Alliant's Pharmacy team is made up of industry experts, pharmacists, and data specialists who provide marketplace perspective and insights, vendor capabilities, and practical knowledge to secure the best pricing and contract arrangements. Our buying power and partnerships enable us to support your benefits strategy, pharmacy program, and cost management throughout the entire program lifecycle. Learn more about Alliant at


Los Angeles Times
3 hours ago
- Los Angeles Times
Criminalization or support? President Trump's executive order on homelessness gets mixed reaction
An executive order signed by President Trump purporting to protect Americans from 'endemic vagrancy, disorderly behavior, sudden confrontations, and violent attacks' attributed to homelessness has left local officials and homeless advocates outraged over its harsh tone while also grasping for a hopeful message in its fine print. The order Trump signed Thursday would require federal agencies to reverse precedents or consent decrees that impede U.S. policy 'encouraging civil commitment of individuals with mental illness who pose risks to themselves or the public or are living on the streets and cannot care for themselves.' It ordered those agencies to 'ensure the availability of funds to support encampment removal efforts.' Depending on how that edict is carried out, it could extend a lifeline for Mayor Karen Bass' Inside Safe program, which has eliminated dozens of the city's most notable encampments but faces budget challenges to maintain the hotel and motel beds that allow people to move indoors. Responding to the order Friday, Bass said she was troubled that it called for ending street homelessness and moving people into rehabilitation facilities at the same time as the administration's cuts to Medicaid have affected funding 'streams for facilities for people to stay in, especially people who are disabled.' 'Of course I'm concerned about any punitive measures,' Bass said. 'But first and foremost, if you want to end street homelessness, then you have got to have housing and services for people who are on the street.' Kevin Murray, president and chief executive of the Weingart Center homeless services and housing agency, saw ambiguity in the language. 'I couldn't tell whether he is offering money for people who want to do it his way or taking money away from people who don't do it his way,' Murray said. Others took their cue from the order's provocative tone set in a preamble declaring that the overwhelming majority of the 274,224 people reported living on the street in 2024 'are addicted to drugs, have a mental health condition, or both.' The order contradicted a growing body of research finding that substance use and mental illness, while significant, are not overriding factors in homelessness. 'Nearly two-thirds of homeless individuals report having regularly used hard drugs like methamphetamines, cocaine, or opioids in their lifetimes. An equally large share of homeless individuals reported suffering from mental health conditions.' A February study by the Benioff Homeless and Housing Initiative at UC San Francisco found that only about 37% of more than 3,000 homeless people surveyed in California were using illicit drugs regularly, but just over 65% reported having regularly used at some point in their lives. More than a third said their drug use had decreased after they became homeless and one in five interviewed in depth said they were seeking treatment but couldn't get it. 'As with most executive orders, it doesn't have much effect on its own,' said Steve Berg, chief policy officer for the National Alliance to End Homelessness. 'It tells the federal agencies to do different things. Depending on how the federal agencies do those things, that's what will have the impact.' In concrete terms, the order seeks to divert funding from two pillars of mainstream homelessness practice, 'housing first,' the prioritization of permanent housing over temporary shelter, and 'harm reduction,' the rejection of abstinence as a condition of receiving services and housing. According to the order, grants issued under the Substance Abuse and Mental Health Services Administration should 'not fund programs that fail to achieve adequate outcomes, including so-called 'harm reduction' or 'safe consumption' efforts that only facilitate illegal drug use and its attendant harm.' And the Secretary of Health and Human Services and the Secretary of Housing and Urban Development should, to the extent permitted by law, end support for 'housing first' policies that 'deprioritize accountability and fail to promote treatment, recovery, and self-sufficiency.' To some extent, those themes reflect shifts that have been underway in the state and local response to homelessness. Under pressure from Gov. Gavin Newsom, the California legislature established rules allowing relatives and service providers to refer people to court for treatment and expanded the definition of gravely disabled to include substance use. Locally, Bass' Inside Safe program and the county's counterpart, Pathway Home, have prioritized expanding interim housing to get people off the streets immediately. Trump's order goes farther, though, wading into the controversial issue of how much coercion is justified in eliminating encampments. The Attorney General and the other federal agencies, it said, should take steps to ensure that grants go to states and cities that enforce prohibitions on open illicit drug use, urban camping and loitering and squatting. Homeless advocacy organizations saw those edicts as a push for criminalization of homelessness and mental illness. 'We'll be back to the days of 'One Flew Over the Cuckcoo's Nest,' 'Berg said, referring to the 1962 novel and subsequent movie dramatizing oppressive conditions in mental health institutions. Defending Housing First as a proven strategy that is the most cost-effective way to get people off the street, Berg said the order encourages agencies to use the money in less cost-effective ways. 'What we want to do is reduce homelessness,' he said. 'I'm not sure that is the goal of the Trump administration.' The National Homelessness Law Center said in a statement saying, 'This Executive Order is rooted in outdated, racist myths about homelessness and will undoubtedly make homelessness worse.... Trump's actions will force more people into homelessness, divert taxpayer money away from people in need, and make it harder for local communities to solve homelessness.' Murray, who describes himself as not a fan of Housing First, noted that key policies pressed in the order—civil commitment, encampment removal and substance use treatment—are already gaining prominence in the state and local response to homelessness. 'We all think if it came from Trump it is horrible,' Murray said. 'It is certainly overbearing. It certainly misses some nuances of what real people with mental illness and substance use are like. But we've started down the path of most of this stuff.' His main concern was that the order might be interpreted to apply to Section 8, the primary federal financial tool for getting homeless people into housing. What would happen, he asked, if someone with a voucher refused treatment? 'It might encourage more people to stay on the streets,' he said. 'Getting people into treatment isn't easy.'