Major HHS Restructuring Announced: What It Means for Tribal Nations and Child Care Programs

On March 27, 2025, the U.S. Department of Health and Human Services (HHS) announced a significant and far-reaching restructuring of its operations, marking one of the most extensive reorganizations in the Department’s history. Framed as an effort to streamline federal operations, improve efficiency, and better align resources with the Department’s priorities—including a renewed emphasis on addressing chronic disease—the restructuring introduces sweeping changes that Tribal Nations and Tribal organizations should understand closely.

What the HHS Restructuring Includes

The plan outlines a broad combination of personnel reductions, consolidation of divisions, and centralization of key administrative functions:

• Reduction of the federal health workforce from 82,000 to 62,000 full-time employees

• Consolidation of 28 divisions into 15

• Reduction of regional offices from 10 to 5

• Centralization of Human Resources, Information Technology, Procurement, External Affairs, and Policy functions

Impacts to Major HHS Agencies

• Food and Drug Administration (FDA):A reduction of ~3,500 full-time employees. The cuts will not impact drug, medical device, or food reviewers, nor federal inspectors.

• Centers for Disease Control and Prevention (CDC):A reduction of ~2,400 employees, focused on realigning efforts around epidemic preparedness. The Administration for Strategic Preparedness and Response (ASPR) will be moved under CDC for better coordination. (Net reduction is estimated at 1,400 when accounting for the ASPR transfer.)

• National Institutes of Health (NIH):A reduction of ~1,200 employees, primarily by consolidating administrative services across NIH’s 27 institutes and centers.

• Centers for Medicare and Medicaid Services (CMS):A modest reduction of ~300 employees, aimed at eliminating minor duplications. No changes to Medicare or Medicaid services are expected.

Creation of New Structures and Reorganizations

• Administration for a Healthy America (AHA):A new consolidated agency that merges:

  • Office of the Assistant Secretary for Health (OASH)

  • Health Resources and Services Administration (HRSA)

  • Substance Abuse and Mental Health Services Administration (SAMHSA)

  • Agency for Toxic Substances and Disease Registry (ATSDR)

  • National Institute for Occupational Safety and Health (NIOSH)

  AHA will focus on chronic care and disease prevention, with divisions that include:

  • Primary Care

  • Maternal and Child Health

  • Mental Health

  • Environmental Health

  • HIV/AIDS

  • Workforce Development

  These divisions will operate with the support of the U.S. Surgeon General and a centralized Policy team.

• Assistant Secretary for Enforcement: A newly established role that will oversee:

  • Departmental Appeals Board (DAB)

  • Office of Medicare Hearings and Appeals (OMHA)

  • Office for Civil Rights (OCR)This role is tasked with strengthening oversight and combating waste, fraud, and abuse.

• Office of Strategy: A merger of the Assistant Secretary for Planning and Evaluation (ASPE) and the Agency for Healthcare Research and Quality (AHRQ), this office will lead policy research and program evaluation for the Department.

• Administration for Community Living (ACL):ACL will be disbanded, and its critical services for older adults and people with disabilities will be redistributed across:

  • The Administration for Children and Families (ACF)

  • The new Office of Strategy

  • Centers for Medicare and Medicaid Services (CMS)

To read the details of the restructuring from HHS, visit their website. You can view Secretary Kennedy's video announcement below.

What This Means for Tribal Nations

HHS has made clear that further opportunities to streamline federal operations will continue to be explored.

For Tribal Nations and Tribal child care programs, these changes could have wide-ranging implications:

• Access to grants and technical assistance may be disrupted or delayed by agency consolidations and staffing reductions.

• Centralized services like HR, IT, and procurement may lead to less culturally responsive engagement with Tribal programs.

NICCA’s Commitment

NICCA is closely monitoring this evolving situation and is committed to providing regular updates as new details emerge. We are especially focused on assessing how these changes may impact Tribal child care programs and our shared work to ensure Native children and families thrive.

We encourage Tribal child care and early learning leaders and professionals to remain engaged and informed—and to reach out with any concerns, questions, or updates from your region. Your insights help us advocate effectively and ensure Tribal voices are at the table in every conversation about the future of federal service delivery.