HHS’s Transformation to Make America Healthy Again
U. S. Department of Health and Human Services, March 27, 2025
The restructuring of HHS is proceeding in accordance with President Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.” Over the past four years, during the Biden administration, HHS’s budget increased by 38% and its staffing increased by 17%.
- The plan combines personnel cuts, centralization of functions, and consolidation of HHS divisions, including:
- The current 82,000 full-time employees will be reduced to 62,000
- 28 divisions will be consolidated to 15
- 10 regional offices will become 5
- Human Resources, Information Technology, Procurement, External Affairs, and Policy will be centralized.
- Regarding FDA, CDC, NIH, and CMS:
- The FDA will decrease its workforce by approximately 3,500 full-time employees, with a focus on streamlining operations and centralizing administrative functions. This reduction will not affect drug, medical device, or food reviewers, nor will it impact inspectors.
- The CDC will decrease its workforce by approximately 2,400 employees, with a focus on returning to its core mission of preparing for and responding to epidemics and outbreaks. This includes moving ASPR under CDC to enhance coordination of response efforts. NOTE: The “CDC” decrease would only be 1,400 if you included the individuals coming over from ASPR (approx. 1,000 individuals).
- The NIH will decrease its workforce by approximately 1,200 employees by centralizing procurement, human resources, and communications across its 27 institutes and centers.
- CMS will decrease its workforce by approximately 300 employees, with a focus on reducing minor duplication across the agency. This reorganization will not impact Medicare and Medicaid services.
- The consolidation and cuts are designed not only to save money, but to make the organization more efficient and more responsive to Americans’ needs, and to implement the Make America Healthy Again goal of ending the chronic disease epidemic.
- No additional cuts are currently planned, but the Department will continue to look for further ways to streamline its operations and agencies.
- A new Administration for a Healthy America (AHA) will consolidate the OASH, HRSA, SAMHSA, ATSDR, and NIOSH, so as to more efficiently coordinate chronic care and disease prevention programs and harmonize health resources to low-income Americans. Divisions of AHA include Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce, with support of the U.S. Surgeon General and Policy team.
- HHS will have a new Assistant Secretary for Enforcement to provide oversight of the Departmental Appeals Board (DAB), Office of Medicare Hearings and Appeal (OMHA), and the Office for Civil Rights (OCR) to combat waste, fraud, and abuse.
- HHS will combine the Assistant Secretary for Planning and Evaluation (ASPE) and Agency for Healthcare Research and Quality (AHRQ) into the Office of Strategy to conduct research that informs the Secretary’s policies and evaluates the effectiveness of the Department’s programs for a healthier America.
- The critical programs within the Administration for Community Living (ACL) that support older adults and people of all ages with disabilities will be split across the Administration for Children and Families (ACF), Assistant Secretary for Planning and Evaluation (ASPE), and Centers for Medicare and Medicaid Services (CMS).
American Society on Aging’s Statement on the Restructuring of Department of Health and Human Services
The Trump Administration announced yesterday a major restructuring of the U.S. Department of Health and Human Services (HHS) that includes massive staff cuts and the elimination of the Administration for Community Living (ACL). ACL is the only federal agency exclusively focused on supporting older people and people with disabilities.
The American Society on Aging (ASA) is deeply troubled by losing the agency that oversees lifeline programs used by 11 million older Americans and their families every year. We are also very concerned by what this could mean for millions of adults with disabilities also supported by ACL, and for their ability to continue living and aging in communities with dignity and economic opportunity. The critical programs people receive through ACL’s coordination include transportation, meals delivered to homes and served in community centers, health and wellness programs, support for families managing work and caregiving responsibilities, legal and elder rights services, and so much more. Every day, ACL’s widespread reach touches so many lives, and if not ours today, likely tomorrow as we grow older.
Over 11,000 people turn 65 every day, and in four years we will have more older Americans than children for the first time. ASA believes that every federal agency should be factoring aging into its work. Yet ACL orchestrates a highly effective network through which services are delivered. We have serious questions about what its dissolution will mean for the continuity of critical services, and how HHS will effectively integrate ACL’s operations into other agencies, especially with reduced staff.
In addition, for the past two years, ACL has made remarkable progress leading the first National Plan on Aging, effectively coordinating and advancing strategy across 16 federal agencies and departments. ACL has also established important initiatives like the Direct Care Workforce Strategies Center, which is working to ensure a well-prepared sector of professionals is available to help people and families who need care.
Questions about how this momentum and coordination will continue at a time of such significant population change also remain.
Taken together with recent attacks on Social Security, Medicaid, Medicare, the prevention of elder fraud and abuse, and cuts to Alzheimer’s disease funding, ASA is deeply concerned that this action and the gutting of HHS will further threaten our ability to live full, meaningful lives as we age. Eliminating ACL effectively renders older people, people with disabilities, and those who serve them invisible in the structure of HHS.
Defending the Administration for Community Living
SAGE
On March 27, the Trump Administration and DOGE proposed the so-called “Make American Healthy Again” (MAHA) plan, which would include the dismantling of the Administration for Community Living (ACL), the federal agency focused on aging and disability. This could have disastrous implications for older people, disabled people, family caregivers, and the programs upon which they rely.
Most people, including LGBTQ+ elders and people living with HIV, overwhelmingly prefer to age at home and receive care from family, friends, or chosen family. ACL has been the primary voice within the government to advocate for programs like home-delivered meals, adult day programs, caregiver respite, elder abuse prevention, transportation to medical care, free legal aid, and other critical resources. Programs that allow aging-in-place are both popular and cost-effective, reducing taxpayer spending on expensive institutional long-term care. Dismantling this agency would not only harm older people, family caregivers, and people with disabilities, but it would also cost taxpayers more money and put additional pressure on our already-strained healthcare system.
“ACL has consistently fought for the right of all older people, including LGBTQ+ older people and older people living with HIV, to age-in-place,” said Aaron Tax, SAGE’s Managing Director of Government Affairs and Policy Advocacy. “It has a dedicated staff with unparalleled subject matter expertise that administers critical programs that support all of us as we age. ACL has been a champion for all of us. Now it’s time for us to be a champion for ACL.”
SAGE urges our community to call and email your Members of Congress and ask that they speak out against this potentially catastrophic plan. Critical supports for older people, disabled people, and family caregivers are on the line, and we must do everything in our power to preserve these life-saving programs.
TAKE ACTION NOW TO DEFEND CRITICAL PROGRAMS
Justice in Aging
March 27, 2025
We are alarmed by the announcement this morning that the Department of Health and Human Services (HHS) will dramatically reduce its workforce and shutter critical agencies that support older adults.
The announcement specifically calls for the Administration for Community Living (ACL), whose programs older adults and people with disabilities rely on to remain healthy and independent in the community, to be dissolved into other offices within the Department. ACL incorporates the Administration on Aging and the Administration on Disabilities, among others. The loss of an agency focused on older adults and people with disabilities will likely result in needs being overlooked and worse outcomes for older adults.
The press release that announced these changes stated that the services ACL and the other eliminated agencies provide will be absorbed into other parts of HHS but offered no specifics on how the programs ACL oversees will continue as the agency fires 10,000 people and closes five regional offices. HHS has provided no information about how the agency will continue vital services that people across the country rely on every day.
If access to the programs that ACL oversees is hindered, older adults and people with disabilities will lose the ability to choose where and how they want to live and fully participate in their communities. Many will be forced into institutions when they need help with activities of daily living such as bathing, dressing, and eating. Families who are struggling to care for loved ones will have nowhere to turn for the training, respite, and support they need. Older adults will lose access to Adult Day Programs where they can receive meals, socialize with others, and access basic preventative care. Availability of transportation services to senior centers and doctor appointments will end. When an older adult experiences financial exploitation or abuse, the free legal services they rely on will not be available.
This latest move is part of a pattern of attacks from this Administration on the well-being and health of older adults and people with disabilities, including the administration’s support for Congress’ planned cuts to Medicaid, DOGE’s hollowing out of the Social Security Administration, the termination of funding for research into Alzheimer’s disease and the shuttering of agencies like the Consumer Financial Protection Bureau that protect older adults and others from financial fraud and abuse.
National Consumer Voice for Quality Long-Term Care’s Statement on Announced Restructuring and Cuts to the US Department of Health and Human Services
The Consumer Voice, March 28, 2025
National Consumer Voice for Quality Long-Term is extremely troubled by the U.S. Department of Health and Human Services (HHS) announcement that it would be cutting thousands of jobs and restructuring critical agencies. Such actions are likely to result in reduced access to and oversight of services, impacting the health and safety of millions of older and disabled adults.
Consumer Voice is particularly concerned that the Administration for Community Living (ACL) would be eliminated and absorbed by other HHS agencies. ACL provides and oversees critical programs for older adults and people with disabilities. ACL helps ensure that these individuals can receive support services in a setting of their choice, often helping them avoid institutionalization. ACL provides nutrition assistance, helps support caregivers, and helps protect vulnerable elders from abuse and neglect. It is essential to ensure the health and well-being of older adults and people with disabilities.
Additionally, proposed cuts affecting Centers for Medicare and Medicaid Services (CMS), Centers for Disease Control (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA) and other critical agencies, as well as reduction in Regional Offices, combined with previous announcements of reductions in government staff and services, are threatening essential programs and placing some of our most vulnerable citizens at risk of institutionalization, homelessness, poor health, neglect, and abuse.