The Trump administration has refused to spend billions of dollars that Congress appropriated for health programs, putting them at risk of expiring on Wednesday when the fiscal year ends. Such a move, which Democratic and even some Republican lawmakers say is illegal, poses a significant test of Congress's willingness to stand up to the Trump administration. It also comes after the White House late last week unilaterally cancelled nearly $1 billion in congressionally appropriated funding. Here is some of what is at risk: U.S. international development aid could fall off a cliff.

Congressional leaders have been warning for over a month that the administration is sitting on over $1 billion designated for global health initiatives. Congress appropriated $9.4 billion for global health programs for fiscal 2026, signaling bipartisan support for a rejection of much deeper cuts proposed by the administration. Congress preserved the President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight TB, AIDS and Malaria, as well as HIV/AIDS programs previously administered through the U.S. Agency for International Development (USAID).

But the administration has yet to spend $1.3 billion meant to protect maternal and child health and counter infectious diseases such as HIV/AIDS, malaria and tuberculosis. Last week, Sen. Susan Collins (R-Maine), who chairs the Senate Appropriations Committee, urged administration officials to spend the money as intended. Collins and top Democrats are worried the administration is diverting the $1.3 billion for global health programs, as well as $1.2 billion for development assistance to pay for shutting down USAID.

The lawmakers said the administration also plans to let an additional $725 million expire on Wednesday instead of spending it. Collins pressed administration officials for answers about how they’re going to use the money, but it’s not clear if she received a response.

Under the Trump administration’s “America First” foreign aid program, the U.S. is entering into bilateral agreements with individual countries, so they can eventually rely less on American funding. Congress passed $101 million for the Teen Pregnancy Prevention (TPP) program, but the Department of Health and Human Services (HHS) has spent only about $500,000. TPP was created in 2010 and is a national, evidence-based program that funds organizations to help youth make healthy decisions that reduce sexual risk behavior and decrease sexually transmitted infections and unintended teen pregnancy.

Conservatives have long targeted the program, and President Trump's 2027 budget request called for eliminating it, labeling it leftist and ineffective. But he signed the fiscal 2026 budget into law, which included the funding.

In June, HHS abruptly cut 53 grants to nonprofits, universities and health departments worth about $67 million two years before they were set to expire, because HHS said they were no longer aligned with the agency’s priorities. The administration wanted to reshape the TPP program into abstinence-only curricula. According to a list seen by The Hill, most of the grants were terminated because HHS said they normalized or promoted sexual activity for minors.

In response to a lawsuit, a federal judge in August blocked the administration’s changes to the program while the lawsuit proceeds. However, U.S. District Judge Christopher Cooper said he wasn't sure he had the authority to reinstate the canceled grants. A decision on that aspect is pending.

According to a letter to HHS from 92 House and Senate Democrats led by the Democratic Women's Caucus, none of the funding has been restored to TPP grant recipients. Local programs that work to reduce teen pregnancy, STIs, and other health risks for young people have halted work. “HHS’s only options are to either return the funding to the communities and teens who rely on it or let it go to waste,” they wrote.

The Agency for Healthcare Research and Quality (AHRQ) is a relatively small federal agency dedicated to making healthcare safer, more affordable, and more effective. It is estimated to have funded research that’s saved thousands of lives and billions of dollars over the past 27 years. The Trump administration has gutted it. Congress appropriated about $345 million for AHRQ this year. But the agency in July told researchers it was halting at least 104 grants across 32 states, with many aimed at improving patient safety.

Top Democratic appropriators Sens. Patty Murray (Wash.) and Tammy Baldwin (Wis.) said HHS told them it planned to award just 90 grants this year and is seeking to transfer $100 million specifically appropriated for AHRQ to other agencies. At his confirmation hearing on Sept. 16, Chris Klomp, the nominee for HHS deputy secretary, told senators that AHRQ is “on track to expend 97 percent of its appropriated funds by the end of the fiscal year.”

But the money apparently doesn’t reflect research grants. “We've seen almost no money go out the door, and so unless they actually somehow manage to ship it all out today or tomorrow, there's going to be a massive impoundment at AHRQ, and likely the result will be lawsuits or hopefully further congressional action,” said Aaron Carroll, chief executive of AcademyHealth, a health services research group that supports AHRQ's work.

This is also not the first time the White House has failed to spend AHRQ funding. The administration impounded $80 million after failing to award grants from fiscal 2025. "Everything that Americans hate about healthcare in the United States, that’s what AHRQ is supposed to be studying,” Carroll said. “They hate that they can't get in to see a physician ... they hate that they feel like they're not getting the quality that they should, or they hear about these amazing things that are happening, but they can't get them ... that's what AHRQ studies.”