A wave of uncertainty has recently swept through the Department of Health and Human Services (HHS) as officials at various agencies within the department brace for a significant number of layoffs. These anticipated cutbacks are part of a substantial restructuring of the department, a move orchestrated by HHS Secretary Robert F. Kennedy Jr. and his team. The reshuffling of the department and the subsequent layoffs are expected to be announced in the coming weeks, leaving many HHS employees in a state of apprehension.
The restructuring of the HHS is a complex and far-reaching endeavor that will drastically alter the face of the department. Kennedy and his team are in the process of making their final decisions about the changes that will be made to the department’s structure and organization. While the details of these changes remain undisclosed, senior health officials have been informed that they can expect an announcement within a week or two. It has been reported that Kennedy’s aides have already begun the process of drafting the reorganization announcement.
While the HHS has yet to issue a public response to requests for comment, the anticipation of these impending changes has already triggered a significant amount of internal tension and apprehension. With the formal head of the White House’s Department of Government Efficiency (DOGE) team, Amy Gleason, and several other DOGE members in the mix, the restructuring is expected to have significant impacts throughout the HHS. Among the DOGE members involved in the plans are former insurance executive Brad Smith, who served as a top Medicare and Medicaid official during the first Trump administration.
This impending reorganization and the associated “reduction-in-force” plans mandated by the White House follow a series of dismissals and layoffs throughout the country’s health agencies. This includes efforts to eliminate thousands of probationary workers, terminate fellowship programs, and end contractor agreements. The following is an overview of the latest information about the reorganization at several agencies within the HHS, based on discussions with over a dozen health officials who were not authorized to speak publicly.
The Agency for Healthcare Research and Quality (AHRQ) is one of the agencies within the HHS that could face unprecedented workforce cuts. On March 11, DOGE officials informed the leaders of the AHRQ that they could expect up to 90% of their staff to be cut. The AHRQ, which employs around 300 individuals, is responsible for collecting and analyzing some of the federal government’s most widely referenced healthcare metrics. This includes decades-old datasets that track hospitalizations and emergency room visits nationwide, which are frequently used by economists and health policy researchers.
In addition to these responsibilities, the AHRQ also manages several programs funded by Congress that aim to address patient safety and healthcare mishaps. One of these programs is designed to combat antibiotic-resistant bacteria. One health official noted that the DOGE intends to cut the team of 45 highly skilled economists and statisticians who oversee a large federal database on medical spending down to just six staff members. The official expressed concerns about the quality of the staff that would be willing to stay under these conditions.
The Centers for Disease Control and Prevention (CDC) is also bracing for significant cuts. Some managers at the CDC, which employs close to 12,820 people, have been told to expect cuts from the department that could result in up to 30% of the agency’s staff being laid off. This would be a devastating blow to the agency, which one official noted is already understaffed in several key areas. The agency has been struggling with burnout for the past five years, and such a large cut would only exacerbate these issues.
There are several ways in which these cuts could potentially be achieved. For instance, many employees have voluntarily chosen to leave the CDC. Agency managers have been informed that around 400 workers have sought early retirement, and approximately 600 have applied for a buyout. However, it is unclear how many workers applied for both options. Another strategy that officials are considering to achieve these cuts involves rearranging the agency’s functions. For example, they may decide to transfer the CDC’s HIV prevention work to another part of the department.
The Food and Drug Administration (FDA) is another agency that is expected to experience significant changes as a result of the restructuring. Unlike other health agencies, certain groups of workers at the FDA were told that they were not eligible to accept the HHS buyout offer. This includes the reviewers of new drug applications, whose salaries are primarily funded by the fees paid by drugmakers seeking approval, not by taxpayers.
However, other employees at the FDA have been told to prepare for layoffs. FDA managers have communicated to their employees that they were not informed about the scale and targets of the cuts. According to one official, DOGE officials have made several visits to the FDA’s Maryland headquarters. Another official noted that DOGE officials had been inquiring about the FDA’s labs during the week. Several FDA employees anticipate that some of the cuts will result from what they referred to as the growing brain drain at the agency, which has been dealing with a challenging transition back to the office that is unlikely to ease in the near future. The agency is currently processing hundreds of retirement applications.
The physical constraints of the FDA’s headquarters have also contributed to the challenging environment at the agency. The FDA employs far more staff than its headquarters can accommodate, leading to overcrowded parking lots and offices, and shortages of essential supplies like toilet paper in the bathrooms.
Another agency that is expected to face cuts is the National Institutes of Health (NIH). Officials are predicting that the workforce at the NIH will be reduced to levels similar to those seen at the end of the Trump administration. The medical science research agency employed more than 21,000 people at the end of the 2024 fiscal year, a significant increase from the 17,705 workers it employed at the end of the 2019 fiscal year.
As with the other agencies, some of the expected cuts at the NIH could potentially be offset by the voluntary departure of scientists and other workers. One person reported that about 1,400 workers have sought either the buyout, early retirement, or both. This individual also estimated that up to 3,800 employees could be removed from the agency’s payroll, depending on the number of staff departures that can be accounted for.
The Centers for Medicare and Medicaid Services (CMS) may experience smaller cutbacks, as some suspect, because the agency was already subject to hiring restrictions under the Biden administration. The CMS’s chief operating officer announced late last year that the agency could resume hiring due to a turnaround in its finances. The CMS employed 6,557 people in 2024, a slight increase from the 6,074 workers it employed in 2019. One CMS official reported hearing internally that the early retirements and buyouts taken up by employees in some parts of the agency may have been enough to spare much of the agency’s remaining staff.
Lastly, multiple workers within the Substance Abuse and Mental Health Services Administration (SAMHSA) have reported that they have not heard anything from agency leadership about potential cuts. Some workers are hopeful that a letter from House Democrats to Kennedy denouncing reports that half of the staff from the agency could be cut might deter steep layoffs. The SAMHSA’s workforce, which numbered 916 workers at the end of the last fiscal year, had fallen to a low of 521 employees at the end of the first Trump administration. The firings of probationary workers earlier this year by DOGE already resulted in more than 10% of the staff at the agency being cut, including employees working on projects related to the 988 hotline for people facing mental health crises.
The significant restructuring of the Department of Health and Human Services and the anticipated layoffs have already begun to shape the future of the department. As the final decisions about the restructuring and layoffs are made in the coming weeks, the impact of these changes on the nation’s health agencies will start to become clear. Although the details of these changes remain undisclosed, the anticipation and tension within the department are palpable. The anticipation of these changes has already begun to shape the department’s future, and the impact of these decisions will undoubtedly be felt throughout the nation’s health agencies.
