Newborn screening (NBS) is one of the most successful public health programs in the United States, with thousands of lives saved or improved each year through the early identification and treatment of conditions. The mandatory nature of state NBS programs demands a high standard and rigorous scientific evidence for selecting conditions that should be included. Despite the development of new treatments for rare disorders and numerous pilot studies using genomic NBS, recent changes at the federal level have made the addition of new conditions recommended for NBS challenging.