Updates to HHS Restructuring and Funding Cuts: Impact on State and Local Public Health
April 3, 2025
Overview
As a result of federal grant claw backs, state and local public health agencies have halted work and initiated layoffs on projects which utilized those federal funds, including infectious disease prevention and surveillance, vaccination programs, outbreak responses, community health workers, and health disparities programs.
Each new presidential administration carries the potential for changes in federal policy and funding priorities, which may impact public health programs at the state and local levels. The first two months of the Trump Administration brought significant personnel, structural, and funding changes to the U.S. Department of Health and Human Services (HHS) and its agencies, including those with a significant public health role, such as the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH).
Significantly reducing the federal workforce is one of the priorities of the Trump administration. On his first day in office, President Donald Trump issued Executive Order 14158, “Establishing and Implementing the President’s ‘Department of Government Efficiency’,” which created a DOGE Team within each federal agency to take steps to maximize governmental efficiency and productivity. To date, the Trump administration has taken actions to eliminate about 31 percent of HHS employees. The short-term savings, less than 10 percent of the total HHS budget, are minor compared with the immediate and long-term negative impact of losing the expertise and experience of many of the nation’s top scientists and health professionals, along with the next generation set to replace those experts as they retire.
- Approximately 10,000 HHS positions were cut through voluntary separation, either through early retirement or the so-called “Fork in the Road” deferred resignation program, which ended on February 12, 2025.
- Next targeted were the approximately 8,466 probationary (1 year) and trial period (2 years) employees at the department. Initial plans targeted the termination of 5,200 probationary and trial period HHS employees. By March 13, 2025, HHS distributed 3,248 termination notices to probationary and trial period employees. U.S. District Judge James K. Bredar issued a temporary restraining order to stay the mass termination of probationary federal employees on March 13, 2025, ordering their immediate reinstatement.
- HHS announced a further 10,000 employee layoffs on March 27, 2025, as part of a massive agency restructuring. The Administration for Strategic Preparedness and Response (ASPR) will move from an HHS agency to a CDC sub-agency. The Agency for Healthcare Research and Quality (AHRQ) will move from an HHS agency to a sub-agency of the new Office of Strategy. Scheduled for elimination are one CDC institute (National Institute for Occupational Safety and Health (NIOSH)), and three HHS agencies: Administration for Community Living (ACL), Health Resources and Services Administration (HRSA), and Substance Abuse and Mental Health Services Administration (SAMHSA). Some of the duties of the eliminated agencies will move to a new HHS agency, the Administration for a Healthy America (AHA).
In addition to agency restructuring and a dramatic reduction in the federal public health workforce that provides support to state and local health officials, state and local jurisdictions are feeling the impact of dramatic federal funding cuts. Federal agency DOGE Teams were directed by Executive Order 14222, to review existing contracts and grants with the purpose of terminating where appropriate to reduce federal spending and advance the policies of the Trump Administration. In response, HHS confirmed on March 25, 2025, the claw back of $11.4 billion in COVID-19 pandemic funds from the CDC to state and local health departments. In addition, SAMHSA will claw back $1 billion in grants to address mental health and substance use issues.
Most of the CDC claw backs ($8.9 billion) relate to grants for Epidemiology and Laboratory Capacity (ELC) for Prevention and Control of Emerging Infectious Diseases, which were distributed in response to the COVID-19 pandemic. The COVID-19 pandemic demonstrated deficiencies in epidemiology and laboratory capacity. These funds were part of an effort to bolster that infrastructure, supplementing core ELC support.
While the COVID-19 pandemic has ended, the nation is in the midst of a major measles outbreak. State and local health department layoffs and program closures will significantly hamper efforts to control the spread of one of the most contagious diseases known. States losing the most ELC funds under this claw back are Texas ($985 million), Florida ($495 million), Pennsylvania ($439 million), and Illinois ($369 million).
The second category of significant funding cuts are $2.1 billion for state and local Immunization and Vaccines for Children grants. Types of funding impacted include the Bridge Access Program to prevent the loss of underinsured and uninsured adults’ access to COVID-19 vaccines and treatments at no-cost after commercialization; vaccine confidence programs to educate the public on vaccines and address misinformation; safeguarding of state immunization record data; assessing and improving vaccine coverage levels; and detecting, reporting, and controlling vaccine-preventable diseases, among many others.
There are many reports of immunization programs halting work and laying off staff as a result of these cuts as state and local vaccine budgets are nearly entirely composed of federal funds. In Texas, Dallas County Health and Human Services Director Philip Huang, M.D., M.P.H., reported to the Dallas County Commissioners on April 1, 2025, the layoffs off 11 full-time and 10 part-time staff as a direct result of the funding cuts. The health department also had to cancel 50 upcoming immunization clinics, including those targeted at combatting the measles outbreak. States losing the most Immunization and Vaccines for Children grants include Florida ($226 million), California ($176 million), Texas ($117 million), and New York ($80 million).
Additional funding cuts include:
- $348 million in grants to state and local jurisdictions for the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities;
- $60 million in grants to state and local jurisdictions for Community Health Workers for COVID Response and Resilient Communities Evaluation and Technical Assistance; and
- $21 million in grants to several universities for work in Strengthening Healthcare Infection Prevention and Control and Improving Patient Safety.
A lawsuit filed in U.S. District Court on April 1, 2025, seeks an emergency restraining order against the $11.4 billion in HHS claw backs. Plaintiffs from 23 state governments sued HHS and Secretary Robert F. Kennedy Jr., alleging that the “result of these massive, unexpected funding terminations is serious harm to public health, leaving Plaintiff States at greater risk for future pandemics and the spread of otherwise preventable disease and cutting off vital public health services.”
Recent actions by HHS to jettison nearly one-third of the agency’s ranks along with making billions of dollars in cuts to state and local health department budgets have not only the immediate effect of halting vital public health programs and research but will also cripple our nation’s public health infrastructure. The United States will lose the ability to address current and future public health threats due to the manufactured brain drain at the federal level.
The gaping holes in state and local public health budgets caused by $11.4 billion in CDC grant claw backs cannot be filled by impacted jurisdictions. The public’s health is at risk because HHS is not fulfilling its mission to “enhance the health and well-being of all Americans by providing effective health and human services and fostering advances in the sciences underlying medicine, public health, and social services.”
This post was written by Allison N. Winnike, J.D., Director, Network for Public Health Law —Western Region. The Network promotes public health and health equity through non-partisan educational resources and technical assistance. These materials provided are provided solely for educational purposes and do not constitute legal advice. The Network’s provision of these materials does not create an attorney-client relationship with you or any other person and is subject to the Network’s Disclaimer.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.