Last week, the federal Department of Health & Human Services (HHS) announced a major reorganization, including the dismantling of the Administration for Community Living (ACL), along with massive cuts to staff. The Center for Medicare Advocacy issued a statement opposing these cuts which we reproduce here:
The Center for Medicare Advocacy is deeply concerned about plans to drastically cut and restructure the Department of Health & Human Services (HHS), as announced in a press release today (March 27, 2025). This restructuring includes cutting and dividing the critical work of the Administration for Community Living (ACL), which was formed to better coordinate services for older adults and individuals with disabilities. We are also concerned about announced plans to consolidate oversight of independent agencies that administer Medicare appeals, and what it could mean for Medicare beneficiaries in need of meaningful and fair appeals. Given what we have already seen with cuts and restructuring of the Social Security Administration (SSA), HHS’ claim that they are engaging in “dramatic restructuring … without impacting critical services” rings hollow. These proposed changes must not proceed.
Numerous organizations that represent older adults and individuals with disabilities also issued statements opposing these changes, as did several coalitions that CMA belongs to, including: Disability and Aging Collaborative, Leadership Council of Aging Organizations, and the Consortium for Constituents with Disabilities.
According to an HHS Fact Sheet (3/27), the reorganization includes the following change: “HHS will have a new Assistant Secretary for Enforcement to provide oversight of the Departmental Appeals Board (DAB), Office of Medicare Hearings and Appeal (OMHA), and the Office for Civil Rights (OCR) to combat waste, fraud, and abuse.” As CMA noted to Axios in a recent article titled “HHS ushers in a new enforcement regime” by Maya Goldman (March 31, 2025), the Medicare appeals process is not usually the venue in which waste, fraud and abuse are dealt with. Further, we expressed concern that if these entities “‘are under the thumb of HHS … there will be more of a focus on the policy preferences of a given administration, rather than focus on existing Medicare rules and statutes’”
Among the massive staff cuts, which, when combined with recent staff departures will lead to an estimated 25% reduction in the HHS workforce, Politico (3/28) reported that staff cuts at the Centers for Medicare & Medicaid Services (CMS) include 200 people from the Office of Program Operations and Local Engagement which “ensures Medicare health plans and providers are in compliance with CMS requirements and helps manage case work for Medicare Advantage and Affordable Care Act marketplace patients.” These workforce cuts will undoubtedly have a negative impact on the resolution of problems faced by Medicare beneficiaries and others.
Samuel Bagenstos, former HHS General Counsel under President Biden, wrote about the reorganization and staff cuts in a recent blog post (March 31, 2025):
The first thing to say about this restructuring is that it’s going to devastate important programs on which people rely. The dismemberment of ACL will cause great harm to individuals with disabilities. The dismantlement of the Substance Abuse and Mental Health Services Administration will kneecap the response to the opioid crisis–and at just the moment when it had been showing real success. And the massive cuts to the Food and Drug Administration (losing 3,500 staff), the CDC (losing 2,400 staff), and the National Institutes of Health (losing 1,200 staff) will significantly hobble their ability to protect the public health.
The restructuring announced last week is part of Trump, Musk, and RFK’s sustained assault on HHS and public health generally – an assault that will ensure that people lead shorter lives, that their lives will be worse, and that they will be easier pray for fraudsters and charlatans selling products with bogus health claims … [emphasis added].
As we noted in our statement, these proposed changes must not proceed.
April 3, 2025 – D. Lipschutz