On March 27, the Department of Health and Human Services (HHS) unveiled the framework of a reorganization plan, including an almost 25% cut in its workforce, closure of five of its 10 regional offices, and consolidation of divisions.

The goal, as outlined in a factsheet, HHS’ Transformation to Make America Healthy Again, is not only to reduce costs through cuts and reorganization, but to also make the organization more efficient and responsive to the needs of Americans. In addition, the reorganization is tied to the Make America Healthy Again goal of reversing, according to HHS Secretary Robert F. Kennedy Jr., “the chronic disease epidemic.” Beyond the cuts and reorganizations listed in the fact sheet, there are no additional cuts planned but HHS notes the “Department will continue to look for further ways to streamline its operations and agencies.”

Responding to HHS’ announcement, Katie Smith Sloan, president and CEO, LeadingAge, said, “The Department of Health and Human Services, through its agencies and offices, operate many of the programs and provide critical services and guidance that our nonprofit and mission-driven members—including providers of care in nursing homes, in home health care settings, hospice, adult day and Programs of All Inclusive Care for the Elderly (PACE)—rely on to serve older adults and their families. We are closely monitoring the execution of today’s announcement. We urge HHS to ensure that older adults and the providers who serve them will not be an afterthought in this reorganization.”

The goal, as outlined in a factsheet, HHS’ Transformation to Make America Healthy Again, is not only to reduce costs through cuts and reorganization, but to also make the organization more efficient and responsive to the needs of Americans. In addition, the reorganization is tied to the Make America Healthy Again goal of reversing, according to HHS Secretary Robert F. Kennedy Jr., “the chronic disease epidemic.” Beyond the cuts and reorganizations listed in the fact sheet, there are no additional cuts planned but HHS notes the “Department will continue to look for further ways to streamline its operations and agencies.”

According to the plan, HHS is planning to reduce staff from 82,000 full-time employees to 62,000. While the plan includes the following reductions to specific agencies, the reductions do not account for the full 20,000 planned cuts. According to news reports, 10,000 HHS employees have already resigned voluntarily, leaving 2,600 employee cuts unaccounted for. These may be accounted for in the unknown number of employees who were terminated during their probationary period. HHS’ efforts are part of a broader administration effort to reduce the size of the federal government and its workforce.

LeadingAge has followed the Trump Administration’s efforts to reduce the size of the federal workforce; for more background please review this explanation article; read our March 27 press announcement here.

Staffing Reductions

The following staffing reductions were outlined in the HHS memo:

• Food and Drug Administration (FDA) 3,500 employees: Focused on streamlining operations and centralizing administrative functions. According to the factsheet, this reduction will not affect drug, medical device, or food reviewers, nor will it impact inspectors.
• Centers for Disease Control and Prevention (CDC) 2,400 employees: Focused on “returning to its core mission of preparing for and responding to epidemics and outbreaks.”
• National Institutes of Health (NIH) 1,200 employees: Focused on centralizing procurement, human resources, and communications across its 27 institutes and centers.
• Centers for Medicare and Medicaid Services (CMS) 300 employees: Focused on reducing minor duplication across the agency. According to the factsheet, this reorganization will not impact Medicare and Medicaid services.

Division Reductions and Consolidations

Elimination of the Administration for Strategic Preparedness and Response (ASPR): ASPR will be consolidated under the CDC. ASPR leads the nation’s medical and public health preparedness for, response to, and recovery from disasters and public health emergencies. This consolidation will enhance the coordination of response efforts to future epidemics and outbreaks.

Elimination of the Administration for Community Living (ACL): ACL supports older adults and people of all ages with disabilities and was formed during the last HHS reorganization under President Obama. ACL programs 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). There are currently no details on where critical programs regarding the Older Americans Act funding will land.

New Administration for a Healthy America (AHA): AHA will consolidate the following offices to more efficiently coordinate chronic care and disease prevention programs. It will also “harmonize” health resources for low-income Americans.

• Office of Assistant Secretary for Health (OASH), focuses on improving the health and well-being of Americans by leading on policy, practices, and programs through the application of science, innovation, education and a commitment to all.

• Health Resources and Services Administration (HRSA), advises the HHS Secretary and increases the access to high quality health care in rural communities through innovative programs. HRSA also administers the Ryan White HIV/AIDS program.
• Substance Abuse and Mental Health Services Administration (SAMHSA), leads public health efforts to advance the behavioral health of the nation.
• Agency for Toxic Substances and Disease Registry (ATSDR), currently a division under the CDC that focuses on the human health effects of exposure to hazardous substances.
• National Institute for Occupational Safety and Health (NIOSH), currently a division of NIH that is focused on research and recommendations for the prevention of work-related injury and illness.

AHA will have six new divisions including 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.

New Assistant Secretary for Enforcement: This new assistant secretary will provide oversight of HHS programs to combat waste, fraud, and abuse. The following offices will be consolidated into this new enforcement body:

• Departmental Appeals Board (DAB), providing impartial, independent review of disputed decisions under more than 60 statutory provisions including support of Administrative Law Judges and alternative dispute resolutions.
• Office of Medicare Hearings and Appeal (OMHA), administering the nationwide Administrative Law Judge (ALJ) hearing program for appeals arising from individual claims for Medicare coverage and payment.
• Office for Civil Rights (OCR), enforces federal civil rights laws, conscience and religious freedom laws, the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security, and Breach Notification Rules, and the Patient Safety Act and Rule.

New Office of Strategy: HHS create a new office to conduct research that informs the Secretary’s policies and evaluates the effectiveness of the Department’s programs for a healthier America. This office will be created by combining the following divisions:

• Assistant Secretary for Planning and Evaluation (ASPE), advises the Secretary on policy development in health, disability, human services, data, and science; and provides advice and analysis on economic policy.
• Agency for Healthcare Research and Quality (AHRQ), develops and disseminates scientific evidence, tools, and data to help patients and their families, healthcare professionals, and policymakers make informed decisions.

Regional Office Reductions

In addition to the staff reductions, HHS will be closing five of its 10 regional offices. HHS has not identified the locations that will be closed. However, we deduce that, because HHS agency operations are co-located with those of the HHS Office of the General Counsel, which earlier this month announced a reorganization in which six of its 10 regional offices will be shuttered and four will be maintained (Philadelphia, Atlanta, Kansas City (MO), and Denver),  the locations in orange pentagons on the map of HHS regional office locations, below, are most likely at risk of closing. The regions identified with green circles will remain open, according to the HHS Office of the General Counsel release.

To follow news of the HHS reorganization, its impact on aging services, and related developments, see our HHS Reorganization, Staff Cuts, and Impact on Aging Services serial post.