Given the Trump Administration’s hollowing out of U.S. foreign assistance in 2025 and its efforts to rescind and drastically slash foreign assistance funding from its previous levels of roughly $60 billion with little pushback from the legislative branch of government, it was a welcome relief earlier this month when Congress largely rejected this path. Congressional appropriators released the Fiscal Year 2026 National Security and State Department appropriations bill (formerly the State, Foreign Operations and Related Programs bill) and accompanying Explanatory Statement which funded foreign assistance at levels far above the Trump Administration’s FY 2026 budget request. Lawmakers funded global health programs overall at levels significantly higher than the White House proposal and preserved rather than eliminated many development and humanitarian accounts as the president’s budget had proposed.

FY 2025 versus FY 2026 Funding Levels

Compared to the FY 2025 enacted level, this year’s bill reduces total international affairs funding with notable cuts to development assistance and economic support through consolidation into a new investment account and reductions in overall humanitarian assistance funding. While humanitarian assistance is smaller than in FY 2025, it remains substantially above the Administration’s request. The bill also had good news for global health programs such as malaria, maternal and child health/Gavi, the Vaccine Alliance, and nutrition, which were flat-funded rather than being slashed or eliminated. Lawmakers made modest reductions in other areas of global health, however, including for Vulnerable Children, bilateral HIV, the Global Fund to fight AIDS, TB and Malaria, and Neglected Tropical Diseases.

FUNDING

Children’s programs that were flat-funded:

  • Maternal Newborn & Child Health/GAVI ($915 m)
  • Nutrition ($165 m)
  • Malaria ($795 m)

Children’s programs and programs benefitting children that were slightly reduced:

  • Vulnerable Children ($29.9 million, down from $31.5 million)
  • TB ($378.7 million, down from $406 million)
  • Bilateral HIV/PEPFAR ($4.63 billion, down from $5.44 billion)
  • Global Fund to Fight AIDS, TB & Malaria ($1.25 billion, down from $1.65 billion)
  • Neglected Tropical Diseases ($108.8 million down, from $115 million)
  • Basic Education ($691.5 million down, from $922 million)

UNICEF and other UN Agencies

Unlike the Administration’s request, which would have zeroed-out or sharply curtailed funding for many multilateral partners including UNICEF and other UN agencies, the FY 2026 appropriations bill does not entirely eliminate U.S. contributions to international organizations (though some accounts are significantly reduced), preserving a foundation for multilateral engagement.

Congress Seeks Increased Oversight, Reporting, and Accountability

The FY 2026 appropriations bill also includes surprisingly extensive reporting and accountability requirements directed at the Department of State. Both the bill and the explanatory statement require the Administration to provide regular reporting to Congress on multiple fronts, including the transition of the President’s Emergency Plan for AIDS Relief to country ownership, details on the Administration’s new bilateral agreements (which have thus far excluded Congress), and coordination with multilateral institutions. Perhaps most importantly, the bill and report require the Administration to provide detailed financial reporting on all stages of the federal budget execution process, thereby closely monitoring funding as it moves from congressional approval to final expenditure. And for the first time in recent memory, the bill specifically mandates that funding “shall be made available at not less than the amounts specifically designated in the respective tables included in the explanatory statement.” This additional text is incredibly important given that the Administration rescinded $8 billion and then an additional $5 billion in foreign assistance last year. It then slow walked spending any remaining funding provided by Congress, causing it to expire at the end of the fiscal year.

Rebuilding global health at the Centers for Disease Control and Prevention

Additionally,the FY 2026 appropriations bill mandates coordination with the Centers for Disease Control and Prevention (CDC) on global health activities and establishes a new Prevention, Treatment, and Response Initiative. This initiative is intended to support research and development of vaccines and other prevention technologies and the delivery and implementation of prevention tools in partner countries. This emphasis on the critical global health role of the CDC is very welcome given the Administration’s withdrawal from the World Health Organization and its undermining of the CDC (including its elimination of much of its global health expertise), all of which has left the United States and the rest of the world less able to detect and monitor diseases and effectively respond to global health challenges.

What is Missing

Sadly, neither the appropriations bill nor the report mention the Orphans and Vulnerable Children (OVC) programs that were key to the President’s Emergency Plan for AIDS Relief (PEPFAR) and that the Trump Administration eliminated a year ago. Appropriators, perhaps overwhelmed by the number of fires they were forced to put out this year, seem to have given up pushing for OVC. Advocates including First Focus on Children’s Campaign for Children and faith-based organizations had pressed appropriators to include bill and report language to reestablish the OVC program at the State Department. Negotiators clearly did yeoman’s work, which resulted in funding far above what the Administration had wanted, but the lack of supportive OVC language, which had for years been included in U.S. foreign aid reports, is nevertheless a huge loss for children.

The importance of PEPFAR’s OVC work and its protective qualities for children who would otherwise end up orphaned and living on the streets, sick, or dying due to causes associated with HIV, or trafficked into dangerous or dehumanizing situations, cannot be overstated. The Administration’s abrupt termination of these programs left 6.6 million OVC and their caregivers to fend for themselves and caused documented preventable death and suffering. Advocates including First Focus Campaign for Children will continue pushing congressional authorizers to make a different decision and to include OVC the next time they reauthorize PEPFAR, but it is entirely possible that children will once again be left on the cutting room floor.

Appropriators Did Their Job, But What Happens Next?

It is clear that Congress rejected the deep cuts and dismantling of foreign assistance envisioned by President Trump. But it remains to be seen whether the Administration will abide the new congressional backbone displayed in the foreign aid funding bill and report’s legislative directives. And even if it does, the devastating dismantling of the US Agency for International Development and loss of thousands of expert staff, including OVC staff, will hamper efforts to administer and oversee the funding that Congress provided. The State Department will require a massive ramping up to actually fulfill the Congressional directives contained in the FY 2026 appropriations bill.