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Midterm Elections: What to Watch Ahead of November

June 17, 2026

BY: Kylie Bowlds

The Current Landscape

As the Midterm elections approach, key primaries are beginning to shed light on potential outcomes of the November elections. Republicans are defending narrow majorities in both chambers, with a 5-seat margin in the House and a 3-seat margin in the Senate, while contending with historical headwinds. Republicans are less unified in their messaging, with leadership touting actions stemming from passage of H.R. 1, while other candidates in tight races are distancing themselves from the cuts made to Medicaid.

Meanwhile, Democrats seek to strengthen their chances of retaking House and potentially Senate majorities centered around cost-of-living concerns and opposition to recent health care cuts.

What’s at Stake?

A Democratic majority would likely result in efforts to reverse recent health care cuts, while continued Republican control of both chambers would likely mean a sustained emphasis on oversight and continued implementation of H.R. 1 provisions.

Race to Redistrict: The debate over the Voting Rights Act has brought redistricting into focus ahead of the upcoming elections. After the Supreme Court ruling in April in Louisiana v. Callais – which narrowed Section Two of the Voting Rights Act – states are allowed to redraw Congressional maps ahead of the 2026 midterms, potentially shifting control of a meaningful number of House seats.

Recent states who have passed new maps include Alabama and Florida, which will likely result in a total gain of 4-5 GOP seats. Other efforts remain undecided: Virginia’s redraw was blocked by the state supreme court, Louisiana is still drawing its replacement map, and additional states in both parties’ control are weighing action — meaning the competitive map will continue to evolve through the summer.

SAVE Act: White House demands to include the SAVE Act in a planned third reconciliation bill continue, but the Senate Parliamentarian has previously ruled the act did not quality for inclusion in the prior immigration reconciliation package. The SAVE Act would require documentary proof of U.S. Citizenship, such as a passport or birth certificate, for individuals registering to vote in federal elections. Because reconciliation is limited to predominantly budgetary matters, attempts to attach the SAVE Act again would likely face the same procedural objection.

Key Toss Ups in the House:

Republican:

Democrats:

Key Toss Ups in the Senate:

Republican

Democrat

What you can do now? 

With the midterms approaching and many competitive toss ups, we encourage our members to take the following steps to stay engaged and prepared:

  • Utilize our to advocate at the state level around the issues you want candidates to prioritize around health care issues
  • Monitor emerging candidates in toss-up congressional and gubernatorial races, and track redistricting in your state to identify newly competitive seats as maps evolve.
  • Strengthen Voter Outreach by ensuring your communities understand potential documentation requirements and any changes to voter registration processes.

Kylie Bowlds is an Issue Education & External Relations Associate at Lutheran Services in America.

OMB Proposes Sweeping Changes to Federal Grants

June 16, 2026

BY: Sarah Dobson

As an alternative to last year’s federal funding freeze attempts, the Office of Management and Budget (OMB) is proposing sweeping changes to the rules governing more than $1 trillion in federal grants and assistance. Although billed as “oversight,” the proposal broadly expands federal discretion over funding decisions, allowing agencies to withhold or terminate awards or change terms midstream.

An OMB Target List?

At the same time, OMB has directed agencies to compile detailed data on funding to 49 nonprofit organizations, signaling increased scrutiny of the sector.

Now What?

Together, these developments pose major financial, legal, and operational uncertainty for nonprofits. Like last year, it’s important to contact your governors and state and federal lawmakers to share your concerns.

 What You Can Do

Sarah Dobson is Senior Director of Advocacy and Public Policy at Lutheran Services in America.

Making Sense of Behavioral Health Measurement: Why It Matters Now

June 15, 2026

BY: Joshua Rubin

Like much of the American healthcare delivery system, providers of services for mental health and substance use disorders—collectively referred to as behavioral health—are increasingly expected to quantify the impacts of their work. These efforts to track quality of care are designed to advance the Triple Aim: improving the experience of care and outcomes, while controlling costs.

For faith-based health and human services organizations, this shift may feel both familiar and new. Many providers have long focused on holistic, person-centered care. Today, however, that work must also be translated into data to adapt to a changing system, because what gets measured gets paid for, and data is not the plural of anecdote.

A Changing Landscape: Measurement Is Driving the System

Accordingly, behavioral health service providers are adopting better data collection practices and quality measurement strategies.  These changes are not happening in a vacuum. The ongoing shift to value-based payment (VBP) models, with nearly every state Medicaid system pursuing strategies that tie funding to quality outcomes rather than volume, is accelerating the change. The implications are clear: outcomes, not activity, define success. Measurement is no longer optional; it is foundational to meaningful and sustainable practice.

Why Measurement Matters for the People You Serve

The stakes are particularly high in behavioral health. People with behavioral health needs face significant inequities—individuals with serious mental illness die 10 to 25 years earlier than the general population.[1] While there have been some recent declines in combined deaths from alcohol, drugs and suicide, that progress is vulnerable in a rapidly shifting policy environment.

This underscores why effective measurement matters: without it, gaps in access, quality, and outcomes remain elusive and unclear. If you are not measuring the problem, you can’t fix it. Quality measurement, when done well, is a practical tool for closing those gaps. It helps organizations identify successes, uncover opportunities, and focuses resources where they are most needed—improving access, efficacy, and the overall experience of care.

The Challenge: Too Many Measures, Not Enough Clarity

At the same time, the current measurement landscape spans multiple quality domains and comes from a wide range of sources—federal agencies, states, payers, accrediting bodies, and advocacy organizations. The result is often duplication, fragmentation, and confusion about what matters most.

Traditional measures capture only a fraction of meaningful outcomes, particularly for organizations delivering holistic, community-based care.  Perhaps the most meaningful indicators— the lived experiences of individuals and their families—are often not considered or accounted for in existing measures.

The result is that providers are navigating a system where administrative burden is high, data systems are not fully aligned, and resources for building infrastructure are limited. In many cases, data are used more for compliance than for continuous improvement. As such, the real challenge is not a lack of measurement—it is too much measurement without enough utility.

What’s Emerging: A More Focused, Outcome-Oriented Approach

Despite these challenges, recent guidance and industry trends point to a clearer direction for behavioral health measurement that includes:

  • Outcome-oriented approaches that reflect real-world impact
  • System-level accountability tied to Medicaid and state reform
  • Stronger alignment across payers and programs
  • Fewer, higher-value measures
  • Integrated data systems that support continuous learning

Given the growing recognition that true quality depends on integration across systems, linkages that consider access to medical care and essential social supports such as housing, nutrition, transportation, and employment will become increasingly important. For faith-based providers, this integrated, whole-person approach is not new—but the expectation to measure and demonstrate its impact is.

Building Measurement Readiness: Start Where You Are

One of the most important takeaways for providers is that being “measurement-ready” does not require complex systems. Instead, readiness depends on a few foundational elements:

  • A clear understanding of why you are measuring
  • Consistent definitions of populations and services
  • Reliable, workflow-aligned data collection
  • Basic data governance practices
  • The ability to generate and act on a focused set of core metrics

Equally important is how measurement is implemented. Successful organizations engage staff in the process—doing it with them, not to them—and start small, building capacity over time. Measurement should focus on what is actually actionable. More data are not always better; actionable data are what drives improvement.

Looking Ahead: Measurement as a Tool for Impact

Measurement is challenging, and it can be expensive. It is also essential—not only for participating in value-based payment models, but also for telling your organization’s impact story and describing your work in credible, compelling ways.

Ultimately, enabling people with behavioral health conditions to thrive requires a reliance on data-driven strategies to deliver the highest quality care in the most resource-conscious way. Measurement, when thoughtfully applied, strengthens care, amplifies the work of community partners, and supports better outcomes.

The behavioral health sector will continue moving toward shared accountability, aligned incentives, and systems that support continuous improvement. Providers who build measurement readiness in phased, realistic ways—paired with appropriate investment and support—will be best positioned to succeed.

Joshua Rubin is Vice President of Client Solutions at Health Management Associates.

[1] Plana-Ripoll O, Musliner KL, Dalsgaard S, et al. Nature and prevalence of combinations of mental disorders and their association with excess mortality in a population-based cohort study. World Psychiatry. 2020;19(3):339–49

Strengthening Support for Rural Family Caregivers

June 15, 2026

BY: Regan McManus

Lutheran Services in America, in partnership with the RRF Foundation for Aging and the National Alliance for Caregiving, released a new e-report to elevate the voices, expertise, and experiences of rural family caregivers who are often overlooked in policy and program design. The growing workforce shortage has only made the role of family caregivers more important.

Recognizing and centering lived experience is a priority for our network, and our new report, “Rooted in Care: Transforming the Future for Rural Family Caregivers,” highlights both the strengths and challenges of caregiving in rural communities while identifying opportunities to strengthen supports and services.

With the Rural Health Transformation Fund opening new windows for partnerships and innovation, this report supports members in both advocating for concrete change and telling the story of rural family caregivers to their own boards, funders, and policymakers. Contact Regan McManus for more information.

Regan McManus is Director of Aging Initiatives at Lutheran Services in America.

Major Policy Developments Shaping Medicaid, Housing and Workforce

June 15, 2026

BY: Sue Polis and Sarah Dobson

With midterm elections within sight this November, Congress will be working ahead of the August recess with a focus on our key policy priorities, including:

  • Medicaid: Reconciliation 3.0 poses more risk to Medicaid coverage and access
  • Expanding access to affordable housing: 21st Century Road to Housing Act – will the Senate Act?
  • Addressing health and direct service workforce shortages

More Medicaid Cuts?

Reconciliation 3.0

Federal policymakers are increasingly turning their attention to finding savings through additional healthcare cuts including to Medicaid to generate savings as the war with Iran continues. As part of a potential third reconciliation package (“Reconciliation 3.0”), which could advance later this summer, provisions related to Medicaid could include new program integrity measures and eligibility restrictions that could reduce coverage. This is on top of the significant cuts and program changes enacted as part of the first reconciliation bill, HR 1, which are still unfolding.

States Implement Work Requirements

At the same time, new federal guidance from CMS is moving forward with expanded work reporting requirements, which will require more frequent eligibility verification and potentially limit exemptions for medically frail individuals. Together, these developments increase administrative burdens for providers and create new barriers for patients in maintaining coverage. We encourage members to stay engaged and make their voices heard.

Take Action: Join your peers in telling Congress “no more cuts to Medicaid”. You can use our quick and easy advocacy tool to write your lawmakers and urge them to oppose any further cuts to Medicaid.

Expanding Access to Affordable Housing

House Advances Road to Housing

The House recently passed the bipartisan 21st Century ROAD to Housing Act, marking a significant step toward addressing the nation’s affordable housing shortage. While the legislation includes efforts to promote local zoning reforms and expand housing development, the House-passed version eliminated proposed incentive programs.

Now What?

Attention now turns to the Senate, where leaders have indicated that additional work is needed before a final agreement can be reached.

Yes in God’s Backyard

At the same time, we continue to advocate for “Yes In God’s Backyard” (YIGBY) legislation, which aims to   ease faith‑based land conversions for affordable housing development. Action on this effort is increasingly moving to the various states, with eight states having already passed some version of this bill, including Washington, California, Oregon, Minnesota, Maryland, Hawaii, Florida, and most recently in Virginia.

Addressing the Workforce Shortage

Because workforce shortages remain a significant concern across the health and human services sector, we continue to support efforts to strengthen the pipeline of healthcare and direct support professionals, including by removing barriers for internationally trained workers through the Healthcare Workforce Innovation Act.

Nursing Professional Designation Downgraded

At the federal level, a new policy change excludes most nursing programs from the definition of a “professional degree.” This action has prompted a lawsuit from major nursing organizations. If upheld, the change could limit access to federal student loans for advanced nursing education, with potential downstream effects on workforce supply at a time when shortages are already acute.

We will continue to monitor these developments closely and keep you informed as the policy environment evolves in the months ahead.

Sue Polis is Vice President of Public Relations and Government Affairs at Lutheran Services in America. Sarah Dobson is Senior Director of Advocacy and Public Policy at Lutheran Services in America.

A New Strategy to Turn Housing Potential into Reality

June 15, 2026

BY: Sarah Haight

Across our network, member organizations are sitting on something powerful: community trust, mission-driven infrastructure, and in many cases, land and property that could become affordable housing with services for young families and older adults.

Health Through Housing is Lutheran Services in America’s national strategy to turn that potential into reality. Through a flexible predevelopment loan fund, a peer learning cohort designed to get members “loan ready,” and partnerships that align capital with community need, we are building the early-stage support that makes housing projects move from blueprint to breaking ground.

Whether your organization is actively pursuing housing development or just beginning to explore what’s possible, this strategy was built with you in mind. Watch for more details on our Health through Housing strategy this summer, and reach out if you want to learn more about how Lutheran Services in America can help your organization take the next step. Contact Sarah Haight at Shaight@lutheranservices.org.

Sarah Haight is Vice President of Program Planning & Growth at Lutheran Services in America.

Leveraging the Rural Health Transformation Fund to Improve Access to Care

May 14, 2026

BY: Shao-Chee Sim and Sue Polis

Rural communities have been navigating serious health challenges for a long time—hospital closures, workforce shortages, long drives to see a specialist, and higher rates of chronic disease, to name just a few. These issues are deeply connected, and for many communities, they’ve reached a breaking point.

Congress aimed to address these challenges by creating the Rural Health Transformation (RHT) Fund, part of the One Big Beautiful Bill Act (HR1) passed last July. The RHT Fund represents an important federal investment—designed not just to keep rural health systems afloat, but to help them evolve into models that are more stable, preventive, and community‑centered over the long term.  And at the same time, while the RHT Fund is key in strengthening rural health access, with the level of Medicaid funding cuts overall including in HR1, resources will continue to be a challenge more broadly. And because the funding for the RHT Fund is for five years, sustainability also needs to be further considered as this work moves forward.

Now that states are moving from planning into implementation, the RHT Fund is starting to shape how rural health care is financed, organized, and delivered. While states receive the funding directly, nonprofits and community‑based organizations are essential partners in turning system‑level investments into real improvements in people’s lives.

If your organization works in or alongside rural communities, understanding how the RHT Fund works—and how your state is approaching it—is becoming increasingly important. To further inform how the Lutheran Services in America network can leverage the RHT Fund, read: The Rural Health Transformation Fund: What It Is, How States are Using It, and Where Nonprofits Fit In.

Shao-Chee Sim is Executive Vice President for Health Policy, Research, and Strategic Partnerships at Episcopal Health Foundation and Sue Polis is Vice President of Public Relations and Government Affairs at Lutheran Services in America.

Here We Stand: Coming Together with New Resources

May 14, 2026

BY: Sarah Dobson

On April 23, Lutheran Services in America network members from our Policy and Advocacy Committee, the Disability Network, and the board of directors convened in Washington, D.C., for a day of meetings with Congressional offices. Nineteen member organizations were represented, and over 40 meetings were conducted in total.

Our Asks? No more cuts to Medicaid. Support for Workforce and Housing.

As part of our recent re-launch of our Here We Stand campaign to protect Medicaid, network members went to the Hill with three primary asks:

What can you do?

This is a pivotal moment as we work on two fronts:

  • Federal: Congress is considering a third budget reconciliation bill that may mean even deeper cuts to Medicaid. Learn more and take action.
  • State-level efforts: Whether your state is already working on implementation of H.R. 1 provisions including work reporting requirements and limitations from provider tax constraints, state budgets are tightening and most will be trying to do more with less.

Also consider the following:

  • 5/21: Join our May Capitol Conversations webinar to learn more about future budget reconciliation efforts.
  • Sign-up for one-on-one consultation to review updated Here We Stand. Resources and options for action. to review updated Here We Stand. Resources and options for action.
  • Use our new Here We Stand resources to engage with lawmakers and the media. Materials include:
    • Medicaid Brief: Backgrounder on state fiscal challenges, Medicaid program integrity and waste, fraud and abuse.
    • Action Guide: Suggested ways you can engage policymakers at the state or federal levels.
    • Medicaid FAQs: Frequently asked questions and answers about the importance of Medicaid, policy impacts, and the Here We Stand campaign.
    • Messaging for Federal Lawmakers: Suggested messaging for meetings with members of Congress (House and Senate).
    • Messaging for State Lawmakers: Suggested talking points for your meetings/engagements with state lawmakers and officials.

Please contact the Lutheran Services in America government relations and public policy team:

Sue Polis
Sarah Dobson
Bill Kallestad
Kylie Bowlds

Support with communications efforts:

Christopher Findlay

 

Sarah Dobson is Senior Director of Advocacy and Public Policy at Lutheran Services in America.

Transforming Together Cohort Starts with Lived Experience

May 13, 2026

BY: LSA Staff

The people most affected by a system usually know the most about how to fix it. At Lutheran Services in America, we are building the capacity to act on that. 

We work with more than 300 organizations serving 1 in 50 people. And one of the most consistent things we hear from leaders across that network is this: we need to listen better to the families we serve and to the communities we’re part of.

Knowing it and building the capacity to actually do it are two different things. And that is what Transforming Together is about.

This week, 14 organizations from across the Lutheran Services in America network launched a nine-month action cohort — one of the first initiatives of its kind in our network — designed to embed lived experience at the center of how organizations work and how they influence the systems around them. Not as a checkbox or consultation, but as a genuine driver of strategy, evaluation, and practice.

With expert facilitation from Greater Good Studio, these 14 organizations are building real skills: 

  • how to gather and use community feedback in ways that actually change decisions 
  • how to tell stories rooted in lived experience 
  • how to design evaluation that captures what matters to the people served  

We have long recognized that the people closest to the problem are closest to the solution. Transforming Together puts capacity behind that belief with a cohort of leaders focused on building the infrastructure to truly listen and make change.

We’re excited to share what this cohort discovers and the changes we make alongside people and families.

Participating organizations include: 

This work is made possible, in part, through the generous support of the Evangelical Lutheran Church in America (ELCA) and other national partners. We are deeply grateful for their partnership and commitment to strengthening communities and advancing opportunities for those we serve. 

Lutheran Services in America Adds Four Members to its Board of Directors

May 4, 2026

Supporting
Our Neighbors,

TOGETHER.

Our shared Lutheran tradition of service to our neighbor is more vital than ever.

Join us as we work to ensure our network continues delivering essential services to all in need.

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