Department of Health and Human Services (HHS) reorganization plans appear to have been revealed through a leaked Office of Management and Budget (OMB) document.
The 64-page PDF with HHS’ plans were first reported by Inside Medicine and later reported by The Washington Post and other news publications. In an update, Inside Medicine said the entire document was authenticated by The Washington Post.
The HHS has not authenticated the document and has not yet responded to a request for comment.
The preliminary budget document, labeled “Not For Distribution, 04/10/2025,” includes a “Pre-decisional” header and outlines the department’s budget for the fiscal year 2026 president’s budget, which requires congressional approval. It also includes a blurry organizational chart.
While the restructuring was broadly announced, and individual offices have been reportedly axed in recent weeks, the leak provides greater insight into how the reorganization, firings, reductions in force and office eliminations and consolidations will fundamentally alter the agency.
“Many difficult decisions were necessary to reach the funding level in this passback,” the OMB said in the document.
The overall budget for the HHS would decrease by approximately $40 billion to slightly over $80 billion, not counting funding from additional sources. The HHS’ newest agency, the Administration for a Healthy America (AHA), would have a budget of approximately $14 billion. The National Institutes of Health (NIH) budget will decrease by about 40%, from $47 billion to $27 billion, reports The Washington Post.
Notably, the budget at the Centers for Medicare & Medicaid Services (CMS) “assumes a decline in Federal Exchange enrollment due to the expiration of the enhanced premium tax credits.”
These Affordable Care Act subsidies have been a longtime target of Republicans. A recent report from the Commonwealth Fund found that letting these subsidies expire would cost states $34 billion in gross domestic product and $2 billion in tax revenue, while states that have not extended Medicaid would lose out the largest over time. Hospitals and providers would also see big revenue declines, particularly in rural areas. Others estimate 4 million individuals would lose their insurance, and the Congressional Budget Office projects a 4.3% premium increase.
A closer look at the reorg
Eliminated agencies include the Health Resources Services Administration (HRSA), the Administration for Community Living (ACL), the Substance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality and the Administration for Strategic Preparedness and Response.
The new AHA will include components of these agencies. It will house the surgeon general and a primary care department made up of former HRSA offices, the Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control and an Office of Minority Health.
It will also include departments for policy and research, maternal and child health, mental health, environmental health, HIV/AIDS and the workforce.
Within agencies, entire offices are deleted or absorbed by other agencies. They include the Head Start program, the Low Income Home Energy Assistance Program and the National Institute on Minority Health at the NIH.
At the CDC, gone too are the Global Health Center, HIV and AIDS programs, the Office of Readiness and Response and almost the entirety of the Prevention & Public Health Fund.
The document also outlines eliminations at certain agencies. These items are listed via bullet point on the first page.
In the HRSA, that includes “State Offices of Rural Health,” Title V Block grants, certain Ryan White HIV program services, public health workforce development, geriatric programs, primary care training and enhancement, nursing workforce diversity, medical school education, training in oral health and behavioral health programs.
For the CDC, that includes youth violence prevention, traumatic brain injury, elderly falls, climate and health, asthma, childhood lead poisoning, mining research and personal protective technology.
Under “GDM Eliminations,” possibly representing general departmental management, food as medicine, still birth taskforce and teen pregnancy prevention are listed. “Embryo Adoptive Awareness Campaign” is listed twice.
At the CMS, “Health Equity” and discretionary Inflation Reduction Act implementation funding is eliminated. Under the Office of the Assistant Secretary for Health, the Office of Population Affairs is gone. For Indian Health Services, “Preventive Health” is a casualty.
The CMS appears to pick up a number of ACL offices focused on aging under the restructuring. Funding for National Institute for Occupational Safety and Health programs is discontinued, except for the Firefighter Cancer Registry, the National Mesothelioma Registry & Tissue Bank, the World Trade Center Health and Energy Employees Occupational Illness Compensation Act programs.
The NIH will be restructured into an eight-institute structure.
More budgetary impacts
The budget would institute significant changes, if approved by Congress.
Among the changes, it implements a pay freeze for employees and eliminates funding for the HIV Epidemic Initiative.
The Food and Drug Administration will no longer have a “direct role in routine inspections of food facilities,” but the budget promises the department will be able to meet user fee requirements as outlined in federal law.
Funding by the CDC for two monthly peer-reviewed journals, Emerging Infectious Diseases and Preventing Chronic Disease, will be cut. So is funding for programs on Lyme and Prion diseases.
It does establish a “new biodetection system that can rapidly detect novel pathogens with 24-hour turnaround times” in collaboration with the Department of Defense.
At the Administration for Children and Families, the budget will “scrub” grants and contracts that “promote abortions and high-risk sexual behavior, inflict radical gender ideology on already vulnerable children, and facilitate discriminatory practices in service delivery.”
“Examples: The Budget ends federal dollars for facilitating abortions for migrant children, and eliminates grants to woke NGOs that promote abortion and teach kids how to engage in high-risk sexual behavior in the Personal Responsibility Education Program,” the document reads.
The budget, if approved, also instructs the Advanced Research Projects Agency for Health to “update all contracts to include a clause for the agency to recoup profits for invested products.” These funds will be directly utilized in a newly created U.S. Sovereign Wealth Fund, as announced in this executive order.