The Trump administration has tasked two top political appointees with monitoring the Department of Government Efficiency’s access to key systems inside the health agency responsible for managing Medicare and Medicaid, according to internal emails obtained by POLITICO.
The appointees, Kim Brandt and John Brooks, are leading the Centers for Medicare and Medicaid Services’ “collaboration” with the unofficial cost-cutting group led by Elon Musk, including “ensuring appropriate access to CMS systems and technology.”
“We are taking a thoughtful approach to see where there may be opportunities for more effective and efficient use of resources in line with meeting the goals of President Trump,” said one of the emails, which were sent to CMS staffers.
Brandt, who spent the last four years as a health care lobbyist, is the agency’s new deputy administrator and chief operating officer. Brooks, who ran a health consulting and research firm before joining the Trump transition, is deputy administrator and chief policy and regulatory officer. They both worked at CMS during the first Trump administration and were reappointed to senior roles at the agency in recent weeks.
CMS earlier this week said in a statement that it had assigned “two senior agency veterans” to work with DOGE. But it did not name Brooks and Brandt or specify that they were Trump political appointees, rather than career officials.
On Friday, the agency told POLITICO that the DOGE representatives are scrutinizing CMS systems technology and the funds that flow through it with a focus on “fraud and waste.” That access is read only, meaning they cannot make any changes, and does not allow them to see any personal health information for Medicare or Medicaid enrollees. DOGE also does not have access to CMS’ Healthcare Integrated General Ledger Accounting System, which contains sensitive financial information about providers and other organizations with financial ties to the entitlement programs.
The internal disclosure comes as DOGE representatives arrived at the agency earlier this week, sparking confusion and unease within the building over the extent of their access to critical payment and contracting systems. The DOGE team has fueled efforts to radically shrink USAID, as well as seek staff and spending reductions in other parts of the federal government.
CMS manages roughly $1.5 trillion in health spending between the Medicare and Medicaid programs, including a complex set of payments to the hospitals and doctors that care for the nation’s most vulnerable patients.
Republicans and Democrats have long called for stepped-up efforts to root out overbilling and other fraudulent activity that has driven up federal health spending. But DOGE’s involvement has raised fears that Musk and his deputies could take drastic action with little understanding of the consequences for those reliant on Medicare, which serves elderly people and those with disabilities, and Medicaid, which serves low-income people.
CMS leaders have so far offered little insight into the changes under consideration, writing in an email to staffers only that “components are already generating ideas on government efficiency, and we are looking forward to gathering direct input from staff as well.”
The fresh focus on cost cutting comes as the Trump administration has vowed to drastically shrink the federal bureaucracy — and as Republicans prepare to seek billions of dollars in savings from health programs managed by CMS, like Medicaid and Obamacare, to help fund a sweeping tax cut bill.
That legislative effort could include reining in the federal government’s share of funding for states’ Medicaid expansion populations — Obamacare incentivized states to cover a broader swath of low-income people — as well as tying health benefits to work and targeting other spending areas deemed to be waste, fraud or abuse.
Mehmet Oz, Trump’s nominee to run CMS, is still awaiting Senate confirmation. The television star and cardiothoracic surgeon in recent days has met with senators on Capitol Hill to build support for his confirmation.
In the interim, Trump officials have moved swiftly to build out the agency’s political leadership. Stephanie Carlton, a former McKinsey consultant hired as chief of staff, is serving as CMS’ acting administrator until Oz arrives at the agency — a move that displaced the senior career official initially put in charge on a temporary basis.
The agency in recent weeks also installed Peter Nelson — a critic of the Biden administration’s expansion of Obamacare subsidies to millions more Americans — as head of the CMS office responsible for running the Obamacare marketplaces and implementing many of its provisions.
Rebekah Armstrong, a former senior adviser to Senate HELP Chair Bill Cassidy (R-La.), is now in charge of CMS’ Office of Legislation. She spent three years as a lobbyist for insurance industry trade association America’s Health Insurance Plans in between stints on Capitol Hill.