As Congress weighs spending cuts and other changes to Medicaid, more than half (54%) of the public say they are worried significant reductions in federal Medicaid spending would negatively affect their family’s ability to obtain and afford health care, a new KFF Health Tracking Poll finds. This includes about three in 10 (29%) who say they are “very worried” about such an outcome. 

Democrats (69%) and independents (68%) are much more likely to say they are worried about the impact of potential Medicaid cuts on their families compared to Republicans generally (31%) and supporters of President Trump’s Make America Great Again (MAGA) movement specifically (26%). 

Among Medicaid enrollees themselves, a large majority (86%) worry about the impact of cuts on their families, including six in 10 (60%) who say they are very worried. Three- quarters (76%) of MAGA supporters and other Republican Medicaid enrollees say they are worried about the potential impact of federal spending reductions on their families, as are about half (53%) of Republicans with household incomes less than $40,000. 

About seven in 10 people overall also say they are worried federal Medicaid spending reductions would lead to more adults and children becoming uninsured (72%, including 46% who are “very worried”) and would negatively impact hospitals, nursing homes, and other health care providers in their communities (71%, including 42% who are “very worried”). 

These concerns are shared by residents of rural communities, where providers often rely heavily on funding from Medicaid and other government health care programs. 

Among rural residents, about half (52%) say they are worried that Medicaid funding reductions would impact their or their family’s ability to get or pay for care. A sizeable majority of rural residents also worry that spending reductions would lead to more adults and children becoming uninsured (69%) and would negatively impact health care providers in their communities (66%).  

Nearly Half of Marketplace Enrollees Identify as MAGA Supporters and Other Republicans  

With Congress and the Trump administration weighing changes to the Affordable Care Act (ACA), the poll shows that ACA Marketplace enrollees represent a diverse group. 

Nearly half (45%) of those who purchase their own health insurance plans – the vast majority of which are ACA Marketplace plans – identify as or lean Republican, including three in 10 (31%) who identify as MAGA supporters. Smaller shares identify as Democrats or Democratic-leaning independents (35%), or do not lean toward either party (20%). 

Among Medicaid enrollees, about a quarter (27%) identify as MAGA supporters or other Republicans.  

Partisans Split on Trump Administration’s Impact on Medicaid and Medicare 

About six in 10 adults say the Trump administration’s policies will weaken Medicaid (59%) and Medicare (57%), more than twice the share who say the policies will strengthen each program (19% and 23%, respectively). Half of adults (49%) say the Trump administration’s policies will weaken health care services for veterans, a larger share than say the policies will strengthen care for veterans (32%). 

Unsurprisingly, there are dramatic differences in how partisans view the Trump administration’s impact in each of these areas.  

For example, much larger shares of Democrats (91%) and independents (70%) than Republicans (22%) expect the administration’s policies to weaken Medicaid. In contrast, more Republicans (42%) than Democrats (3%) or independents (7%) say that the administration’s policies would strengthen Medicaid. Among Republicans who get their insurance from Medicaid, roughly as many expect Trump’s policies to weaken the program (34%) as expect them to strengthen it (35%). 

Designed and analyzed by public opinion researchers at KFF, this survey was conducted May 5-26, 2025, online and by telephone among a nationally representative sample of 2,539 U.S. adults in English and Spanish. The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on other subgroups, the margin of sampling error may be larger. 

President Trump released the FY 2026 budget request, the first of his second term, on May 30, 2025, following a preliminary release with topline information earlier this month. A budget request lays out presidential administration priorities both in terms of the policy issues identified and the level of funding requested (or proposed for elimination). Congress then considers the request but ultimately has “the power of the purse” and is responsible for appropriating funding for discretionary programs. Congress may also pass temporary “continuing resolutions” rather than a full budget. Those appropriations can differ from levels proposed by the administration. At the same time, since taking office in January, the Trump administration has taken several executive actions to terminate or limit already appropriated funding – – including delaying and cancelling HIV-related grants – leading to litigation and creating some uncertainty regarding future spending even if funds continue to be appropriated. In addition, the administration has plans to use the recission process, whereby the president asks Congress to rescind appropriated funds, which, if approved by Congress, would reduce funding.

The FY 2026 request marks a significant change in approach for domestic HIV programs and funding levels. It eliminates or transforms several core programs, while maintaining others. Additionally, past proposals to bolster PrEP uptake were not included in this request. Notably, an OMB document leaked earlier this year indicated that the administration was considering eliminating the “Ending the HIV Epidemic” (EHE) initiative, an effort created by the first Trump administration, but the final budget request retains funding for EHE (at least for accounts where funding levels are available). While detailed funding information is not available for all accounts, where levels are known for both years, the FY 2026 budget request for domestic HIV programs represents a $1.5 billion (35%) decline compared to FY 2025 levels.

If these cuts are enacted, it could make addressing HIV more challenging at a time when Congress debates other changes to the health policy landscape, changes that could also have an impact on how people with, and at increased risk for, HIV receive access to care and prevention services.

A summary of the request for domestic HIV programs is below.

Overview

The request includes discretionary funding for key programs aimed at addressing the domestic HIV epidemic, including for the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS and Health Center Programs, programs that the budget moves to the new Administration for Healthy America (AHA). The request states that AHA “will prioritize prevention” and includes HIV/AIDS, among other named areas, as a focus. Funding previously provided to other departments/agencies for HIV activities is moved to AHA. This includes funding previously at the Office of Infectious Disease and HIV/AIDS Policy (OIDP) for HIV and other infectious disease related activities, as well as all EHE funding previously allocated to CDC. At the same time, the request eliminates a range of historical HIV programs including funding for domestic HIV prevention at the Center for Disease Control and Prevention’s (CDC), the Housing Opportunities for People with AIDS (HOPWA) program, Part F of the Ryan White HIV/AIDS Program, and at least some parts of the Minority AIDS Initiative (MAI). Additionally, large cuts are proposed for the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health, which has been the largest source of HIV research funding in the world.

Specific, known funding levels are as follows:

Centers for Disease Control and Prevention (CDC)- Domestic HIV Prevention

Funding for core HIV prevention programs at the CDC is eliminated in the budget request and funding previously provided to the CDC for EHE activities ($220 million) is moved to AHA. Historically, CDC has accounted for almost all (91%) federal funding for domestic HIV prevention. This cut would represent a $794 million decrease (78%) over FY25 level ($1 billion, including the EHE) in HIV funding, but a total elimination of funding for the division.

While CDC’s HIV prevention funds are eliminated in the proposal, some funding for infectious diseases has been retained and combined into one account. Previously, CDC funding for viral hepatitis, sexually transmitted infections, and tuberculosis prevention had separate funding lines. The request proposes to group those accounts into a single $300 million line. The $300 million funding level is $77 million below the sum of these individual accounts in FY 2025. These accounts were not traditionally part of the HIV prevention budget and it is unclear whether HIV activities would be allowable activities in the reorganized account.

Ryan White HIV/AIDS Program

The Ryan White HIV/AIDS Program, the nation’s safety net for HIV care and treatment (formerly housed at HRSA, now at AHA), receives $2.5 billion in the FY 2026 request, a $74 million (3%) decrease over the FY 2025 enacted level. The request includes $165 million for EHE activities within Ryan White, the same as in FY 2025. The overall program decrease of $74 million is attributed to the elimination of funding for Part F of the program which has included the following components:

• AIDS Education and Training Centers (AETCs) which provide education and training for health care providers who treat people with HIV.
• Dental Programs: The “Dental Reimbursement Program” reimburses dental schools and providers for oral health services. The “Community-Based Dental Partnership Program” supports dental provider education and expands access to oral care for people with HIV.
• Minority AIDS Initiative (MAI): Created in 1998 to address the impact of HIV on racial and ethnic minorities, MAI provides funding to strengthen organizational capacity and expand HIV services in minority communities.

Community Health Center HIV Funding

The FY 2026 budget request includes $157 million in HIV funding for the Health Center Program (formerly housed at HRSA, now at AHA), all of which is for the EHE initiative, and is the same amount as the FY 2025 level.

Administration for Healthy America (AHA) – EHE Coordination

The budget provides funding to support coordination and leadership of “EHE and other HIV/AIDS related activities, formerly carried out by OASH’s Office of Infectious Disease and HIV/AIDS Policy” (OIDP). It appears this is accompanied by $8 million in funding and may inlcude funding to support work related to other infectious diseases. Previously, these funds resided at OIDP for HIV and other activities.

Housing Opportunities for Persons with AIDS (HOPWA)

The Department of Housing and Urban Development’s HOPWA Program is eliminated in the budget. In FY 2025, HOPWA was funded at $505 million. HOPWA, which was established in 1992, has provided housing assistance and supportive services to low-income people with HIV facing housing insecurity and is the only federal program centered on the housing needs of people with HIV. Its funding supports grants to localities, states, and community-based organizations.

National Institutes of Health – Domestic HIV Research.

Historically, the National Institutes of Health (NIH) has carried out almost all federally funded HIV research activities. However, the budget proposes significant cuts to NIH overall, including to the National Institute of Allergy and Infectious Disease (NIAID) which would be cut by $2.4 billion (36%), from approximately $6.6. billion to $4.2 billion. While the amount of funding for domestic HIV research at NIH is not yet known, in FY 2025, it was $2.7 billion (amount provided to KFF via data request). The Office of AIDS Research, which sits in the Office of the NIH Director is mentioned in the budget’s technical appendix, although a specific funding amount is not provided. suggesting some level of funding may be retained. Notably though, the administration has reportedly decided not to renew core NIH funded HIV vaccine research.

Indian Health Service (IHS)

In the IHS budget justification, EHE is mentioned but no funding level is provided, nor is it described as eliminated. In FY 2025, IHS received $5 million for EHE activities to support ending HIV and hepatitis C in Indian Country.

The Minority AIDS Initiative (MAI)

As noted above, the MAI was created in 1998 to address the disparate impact of HIV on racial and ethnic minority communities and to build resources and organizational capacity within these communities. The status of the Minority AIDS Initiative is unclear. Funding that has been provided for MAI activities at the Substance Abuse and Mental Health Services Administration (SAMHSA), aimed at “improving the health of people of color who have or are at risk for HIV” is eliminated in the proposal. In FY 2025 SAMHSA received $119 million for the MAI. Another $60 in MAI funding is eliminated from the Secretary’s Minority HIV/AIDS. In addition, as noted, MAI Ryan White funding in Part F is also eliminated in the proposal.

The tables below compare federal funding levels for domestic HIV, where specified, in the FY 2026 request to the FY 2025 continuing resolution (CR) levels. EHE funding is included in the overall table (Table 1) and in a dedicated table (Table 2).

Sources:

HHS FY26 Budget in Brief: https://www.hhs.gov/sites/default/files/fy-2026-budget-in-brief.pdf

HHS FY26 Budget Technical Appendix: https://www.govinfo.gov/content/pkg/BUDGET-2026-APP/pdf/BUDGET-2026-APP.pdf

Indian Health Services Congressional Budget Justification: https://www.ihs.gov/sites/ofa/themes/responsive2017/display_objects/documents/FY_2026_IHS_Congressional_Justification_Plan.pdf

Centers for Disease Control and Prevention Congression Budget Justification: https://www.cdc.gov/budget/documents/fy2026/fy-2026-cdc-cj.pdf

Department of Housing and Urban Development Congressional Budget Justification https://www.hud.gov/stat/cfo/cj-fy26

Consolidated Appropriations Act, 2024 (basis for FY25 continuing resolution): https://www.govinfo.gov/content/pkg/CPRT-118HPRT55008/pdf/CPRT-118HPRT55008.pdf

In this JAMA Health Forum column, Larry Levitt highlights how the Make America Healthy Again agenda aimed at chronic disease does little to address the affordability of health care and that efforts to lower federal spending on health care may worsen the problem, raising out-of-pocket costs for many people with Medicaid and Affordable Care Act coverage.

On May 22, the House passed a reconciliation bill, the One Big Beautiful Bill Act. The Congressional Budget Office’s (CBO) latest cost estimate shows that the bill would reduce federal Medicaid spending by $793 billion and that the Medicaid provisions would increase the number of uninsured people by 7.8 million. Previous CBO estimates show that 10.3 million fewer people would be enrolled in Medicaid. Building on prior KFF analysis, this analysis allocates CBO’s federal spending reductions and enrollment losses across the states. The Medicaid reconciliation provisions are numerous and complicated, but the majority of federal savings stem from work requirements for the expansion group, increasing barriers to enrolling in and renewing Medicaid coverage, and limiting states’ ability to raise the state share of Medicaid revenues through provider taxes.

This analysis allocates the CBO’s estimated reduction in federal spending across states based on KFF’s state-level data and where possible, prior modeling work; and shows the federal spending reductions relative to KFF’s projections of federal spending by state under current law. KFF allocates the spending reductions provision-by-provision, pulling in a variety of data sources on which states are estimated to be most affected by each provision (see Methods). The analysis then uses KFF’s state-by-state estimates of reduced federal spending to allocate the reduction in Medicaid enrollment across the states. KFF only includes provisions expected to reduce Medicaid enrollment in that component of the analysis (see Methods).

This analysis does not predict how states will respond to federal policy changes, and anticipating how states will respond to Medicaid changes is a major source of uncertainty in CBO’s cost estimates. Instead of making state-by-state predictions, CBO generates a national figure by estimating the percent of the affected population that lives in states with different anticipated types of policy responses. For example, different states might choose to implement a work requirement with reporting requirements that are easier or harder to comply with. In estimating the costs of the legislation, CBO assumes that in aggregate, states would replace half of reduced federal funds with their own resources in response to provisions that reduce the resources available to states, such as limits on provider taxes. For provisions that reduce enrollment but don’t affect the division of costs between the federal and state governments, such as work requirements, CBO estimates that the federal and state governments would share those savings. However, those assumptions reflect states’ responses as a whole and are likely to vary and may not apply in all states.

To the extent that states’ responses are far different from the overall average response, changes in federal Medicaid spending and Medicaid enrollment will be larger or smaller than what is shown here. States could make further Medicaid cuts, which would result in enrollment loss and spending reductions greater than is estimated here and further reduce states’ Medicaid spending. Alternatively, states could increase their spending on Medicaid to mitigate the effects of federal cuts, which could result in enrollment loss and spending reductions that are smaller than is estimated here.  This analysis illustrates the potential variation by showing a range of spending and enrollment effects in each state, varying by plus or minus 25% from the CBO estimated midpoint.

Key Take-Aways

• After accounting for CBO’s estimated interactions, KFF estimates that the House-passed reconciliation bill would reduce federal Medicaid spending by $793 billion. (Without accounting for interactions, the total is $863 billion, see Methods).
• The five biggest sources of Medicaid savings in the House-passed reconciliation bill sum to $736 billion in savings, which is 85% of the uninteracted total, and include:
• Mandating that adults who are eligible for Medicaid through the ACA expansion meet work and reporting requirements ($344 billion),
• Repealing the Biden Administration’s rule simplifying Medicaid eligibility and renewal processes ($167 billion),
• Establishing a moratorium on new or increased provider taxes ($89 billion),
• Revising the payment limit for state directed payments ($72 billion), and
• Increasing the frequency of eligibility redeterminations for the ACA expansion group ($64 billion).
• Provisions that would only apply to states that have adopted the ACA expansion account for $427 billion, roughly half of the total amount of federal spending reductions.
• Federal cuts to states of $793 billion over 10 years would represent 12% of federal spending on Medicaid over the period. By state, the cuts range from 5% in Wyoming and Alabama to 17% in Washington.
• CBO’s estimated 10.3 million loss of Medicaid enrollment in 2034 represents 12% of projected enrollment in that year. The most heavily affected states include Washington and Virginia where Medicaid enrollment could decrease by 26% and 21%, respectively.

Methods

Data: This analysis uses the latest data available from various data sources to illustrate the potential impact of a $793 billion cut to federal Medicaid spending across states. Data sources include:

• KFF’s projections of Medicaid enrollment and spending in FY 2024 and over the 10-year period.
• KFF’s 5 Key Facts about Medicaid and Provider Taxes
• KFF’s 2024 Budget Survey, Provider Rates and Taxes
• KFF’s Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2025
• KFF’s State Health Coverage for Immigrants and Implications for Health Coverage and Care
• KFF State Health Facts, Distribution of Medicaid Spending by Service
• KFF State Health Facts, Federal and State Shares of Medicaid Spending
• KFF State Health Facts, Medicaid Enrollees Using Long-Term Care as a Percent of Full-Benefit Medicaid Enrollees
• KFF State Health Facts, Medicaid Spending per Enrollee Using Long-Term Care

Estimating Total Federal Funding Reductions After Interactions: CBO’s cost estimate provided the reduction in federal outlays for Medicaid provisions, which summed to $863 billion not accounting for interactions. (KFF summed CBO’s estimated changes in outlays and not budget authority. The analysis does not include associated reductions in federal revenues associated with the Medicaid provisions, which reflect reduced federal income taxes stemming from a small number of people who would newly have private health insurance after losing Medicaid.) The Medicaid provisions are part of the Energy and Commerce title of the bill, which was estimated to reduce federal outlays by $982 before accounting for interactions and $902 billion after accounting for interactions. KFF assumed that 88% of the reduction in outlays due to interactions was attributable to Medicaid because the Medicaid provisions accounted for 88% of the overall reduction in outlays. The interaction reduced the effects of the Medicaid provisions by $70 billion so the total estimated reduction in Medicaid spending is $793 billion.

Allocating Federal Funding Reductions Across States: This analysis allocates the ten-year federal Medicaid cut across states as follows:

• Changes that would affect the Affordable Care Act (ACA) expansion group, including work requirements, were allocated across expansions states proportionally to federal spending on people eligible through the ACA expansion in FY 2024.
  • Wisconsin is a non-expansion state, but adults eligible for Medicaid through their waiver could be subject to the work requirements provision. KFF estimated the percentage of spending that was Wisconsin’s “ACA-equivalent” by comparing the percentage of total federal spending that paid for adults ages 19-64 who were not eligible on the basis of disability in Wisconsin to that of other non-expansion states (24% and 11% respectively). KFF assumed that the “extra” spending on adults in Wisconsin comprised the state’s “ACA-equivalent” spending.
• Ending the increased share of federal spending for states that adopt the Medicaid expansion in future years is allocated across the states that had not adopted the expansion as of May 2025, proportionally to total federal spending.
• Reducing expansion FMAP for certain states providing payments for health care for undocumented immigrants is allocated across the states that offer state-funded coverage for people regardless of immigration status proportionally to federal spending on people eligible through the ACA expansion in FY 2024.
• Changing the requirements for state-directed payments was allocated across states that have state-directed payments in place in FY 2024 (according to KFF’s budget survey), proportionally to KFF’s estimates of federal spending on managed care in FY 2023 (which are calculated using total managed care spending in FY 2023 divided by the federal percentage of Medicaid spending in FY 2023).
• Waiving the uniform tax requirement for Medicaid provider taxes is similar to a recent proposed rule that would require changes to provider taxes in California, Massachusetts, Michigan, and New York. Thus, 50% of the CBO estimate for this provision was allocated to those states. The remainder of the CBO estimate was allocated proportionally to federal spending on managed care among states that have taxes on Medicaid managed care organizations in FY 2025.
• Reducing the maximum home equity limit was allocated based on federal spending for Medicaid enrollees who used long-term care in 2021 (the most recent year of data) among states that have home equity limits greater than $1 million as of 2025.
• All other provisions were allocated across states proportionally to their share of federal spending in FY 2024.

For all estimates, the federal share of spending in FY 2024 is estimated using a 90% match rate for the ACA expansion group and the FY 2024 traditional federal match rates plus a 1.5 percentage point increase for the first quarter of FY 2024 (accounting for the final phase out quarter of the pandemic-era enhanced federal match rate) for the remaining eligibility groups.

Estimating Enrollment Effects: CBO’s estimated enrollment effects are allocated across the states proportionally to states’ estimated reduction in federal funding. However, only provisions that are estimated to reduce Medicaid enrollment are included in this allocation. The allocation includes the following provisions:

• Provisions for which 100% of the spending reduction reflects enrollment loss: Sections 44101-14104, 44108 – 44111, 44122, 44131, 44141; and
• Provisions for which 50% of the spending reduction reflects enrollment loss and 50% of the spending reduction is expected to stem from other changes such as reduced Medicaid benefits and lower payment rates to providers: Sections 44107, 44131 – 44135, 44142.

Limitations: This analysis allocates the CBO’s estimated reduction in federal spending and coverage across states based on KFF’s state-level data and where possible, prior modeling work. The most significant limitations of this approach are as follows.

1. CBO’s estimated reduction in federal spending is distributed across states based on the policies they had in place at the time of enactment and their Medicaid spending in the most recent year for which data were available (usually FY 2024). The analysis does not account for future changes in state Medicaid policy. For example, the analysis does not account for the enrollment effects in states that had not expanded the ACA as of FY 2025 but would have done so in future years.

2. The analysis does not attempt to predict state behavior and to the extent that states respond in ways that differ greatly from the expected national effects, the spending estimates or enrollment estimates may be outside of the range reported in this analysis.

At the start of each administration, U.S. presidents often use their executive authority to reorganize the federal government in ways that reflect their priorities, and in his second term in office, President Trump is no exception. The Trump administration’s actions include sweeping reorganizations and large-scale staff reductions at virtually every department in the federal government, including a “dramatic restructuring” within the U.S. Department of Health and Human Services (HHS) and changes at other agencies that have responsibilities for various aspects of the Medicare program.

Medicare, the program that provides health coverage to more than 68 million adults ages 65 and older and younger people with disabilities, is administered primarily by the Centers for Medicare & Medicaid Services (CMS), an agency within HHS, but a number of other federal agencies within and outside of HHS, such as the Social Security Administration, the U.S. Department of Justice, and the U.S. Department of Treasury also play key roles in supporting the operations of the Medicare program.

While both President Trump and Speaker Johnson have vowed to not cut Medicare benefits, it is not clear how the reorganizations, staff reductions, resignations and retirements, along with budget cuts within these federal agencies will impact the administration of the program, or have spillover effects on coverage and benefits for people with Medicare.

This brief highlights some of the key federal agencies and offices that play a role in making Medicare work and, to the extent possible, describes the recent staffing and organizational changes that could affect the operations of Medicare in the future, based on publicly available information. Data related to staff reductions are likely to be conservative to the extent that they do not take into account employees who resigned as part of the “Fork in the Road” deferred resignation program or other voluntary departures or resignations, including early retirements, leaving unfilled positions within their respective offices. The information may also not reflect some number of employees who were let go and then asked to return to work, and do not account for potential increases in staff if federal courts intervene.

Centers for Medicare & Medicaid Services (CMS)

CMS, a federal agency within HHS, administers the Medicare program. CMS functions as an insurance payer and regulator, implementing and enforcing laws that affect Medicare beneficiaries, health plans, and providers, including approximately 380,000 Medicare-certified providers (such as hospitals and skilled nursing facilities), 1.5 million physicians and non-physician practitioners, and dozens of private insurers offering Medicare Advantage and Part D drug plans.

Within the scope of its statutory authority, CMS sets provider payment rates, makes coverage decisions, and coordinates benefits for beneficiaries. Its Center for Medicare serves as the central office for these policies and operations. Through its Center for Clinical Standards & Quality, CMS develops and enforces quality and safety standards that providers must meet in order to participate in the Medicare and Medicaid programs. The agency also contracts with State Survey Agencies to enforce nursing home standards and, through its Center for Program Integrity, works on efforts to combat fraud and abuse—often in collaboration with other entities, such as the HHS Office of Inspector General and the Department of Justice.

Through its Innovation Center, CMS implements various health care and service delivery models designed to improve the quality and affordability of patient care and reduce health care costs. Additionally, through its Medicare-Medicaid Coordination Office, CMS works with states and other entities to coordinate and streamline the delivery of Medicare and Medicaid benefits for people with both types of coverage (known as dual-eligible individuals). Further, the CMS Office of Minority Health has undertaken efforts to advance health equity in Medicare and other programs, such as the rural health initiative.

CMS is also responsible for consumer information and protections, including managing the 1-800-MEDICARE helpline, distributing the Medicare & You handbook, and supporting the Medicare Beneficiary Ombudsman, which assists beneficiaries with complaints, grievances, appeals, and other Medicare-related inquiries.

Many of these CMS activities are subject to notice-and-comment rulemaking, a process that involves review by the White House’s Office of Management and Budget (OMB).

Recent staffing and organizational changes within CMS

According to a March 27, 2025 HHS document, CMS has reduced its workforce by 300 federal employees since the start of the Trump administration—about 4% of its staff. At the time, the agency did not clarify whether this figure includes employees who voluntarily accepted buyouts or elected early retirement. The Trump administration’s FY 2026 budget justification for CMS, released May 30, 2025, estimates 192 fewer full-time equivalent employees (FTEs) compared to FY 2025. The document acknowledges that these FTE levels are subject to change per the planned HHS reorganization.

While HHS has not publicly disclosed how these staffing reductions were distributed across CMS offices, media reports indicate that affected staff include those from the Medicare-Medicaid Coordination Office (about a third of its staff), Office of Minority Health (closure of the entire office), Office of Equal Opportunity and Civil Rights (entire office), and the Office of Program Operations and Local Engagement. Additionally, HHS eliminated half of its 10 regional offices—including those in Boston, Chicago, New York City, San Francisco, and Seattle—which serve 22 states and include CMS division offices. These regional offices enable HHS to maintain closer contact with state, local, and tribal governments in implementing HHS programs and policies, and develop and maintain partnerships with local organizations, including beneficiary coalitions and professional associations. According to an op-ed by HHS Secretary Robert Kennedy, their functions will be transferred to HHS’ remaining regional offices and staff in Washington D.C.

Further, the Trump administration proposes in its FY 2026 HHS budget to shift the 340B Drug Pricing Program from the Health Resources and Services Administration (HRSA) to CMS. The 340B Program requires drug manufacturers participating in Medicaid to provide discounts on outpatient prescription drugs to certain safety net providers that treat low income and uninsured patients.

Social Security Administration

The Social Security Administration (SSA) plays a central role in determining Medicare eligibility and enrolling individuals into the program. In 2021, SSA enrolled 3.8 million new Medicare beneficiaries, including one in seven (14%) who qualified for Medicare on the basis of receiving Social Security Disability Insurance benefits. SSA also handles automatic deductions of monthly Medicare Part B (and in some cases, Part D) premiums from Social Security benefit payments, and receives data from the Internal Revenue Service to determine income-related monthly adjustment amounts for higher-income beneficiaries.

SSA also provides support to low-income Medicare beneficiaries by processing applications for the Medicare Part D Low-Income Subsidy (also called “Extra Help”), which helps to cover Part D premiums and cost sharing for nearly 14 million Medicare beneficiaries with limited incomes and resources. The agency then sends Extra Help eligibility data to state Medicaid programs to initiate enrollment into the Medicare Savings Program, which helps to cover Medicare premiums and, in many cases, cost sharing, for more than 10 million low-income Medicare beneficiaries. Finally, SSA is responsible for processing name changes, and, along with CMS, can mail Medicare replacement cards. Disruptions to these administrative processes can affect beneficiary access to care, for example, by resulting in claims denials.

Recent staffing and organizational changes at SSA

The Social Security Administration announced plans to reduce its workforce by 7,000 federal employees (roughly 12% of its workforce) and to eliminate 6 of its 10 regional offices. According to the agency, the 7,000 employees will include a limited number of employees offered buyouts and voluntary retirement. In addition, the agency issued (and later rescinded) a proposal that would have reduced access to its national 1-800 number by requiring individuals, including those applying for Medicare, to verify their identities in person. This proposal prompted significant phone wait times and additional strain on the agency’s website, resulting in slowdowns and crashes, according to media reports. Although the proposal was withdrawn, it highlighted the potential negative implications of changes to the agency’s operations on older adults and people with disabilities, including Medicare beneficiaries.

Other HHS Agencies and Offices with Responsibilities Related to Medicare

The Administration for Community Living (ACL): Through its Administration on Aging, ACL has administered programs under the Older Americans Act, a federal law that funds community social services for older adults, such as home-delivered and congregate meals, family caregiver support, the Long-Term Care Ombudsman program, and the National Center on Elder Abuse. Additionally, the ACL has administered:

• The State Health Insurance Assistance Program (SHIP), which provides one-on-one counseling, outreach, and education to Medicare beneficiaries. More than 4 million Medicare beneficiaries, their families, and caregivers received one-on-one counseling from SHIPs in 2022.
• The Senior Medicare Patrol program (SMP), which helps Medicare beneficiaries detect and report health care fraud, errors, and abuse. In 2023, 2 million people were reached through educational and outreach events under the SMP, with Medicare recovering more than $100 million in fraudulent claims (separate from recoveries under other fraud and abuse activities).

HHS announced that ACL will be dissolved, and the programs it administers will be absorbed into a newly-established Administration for Children, Families, and Communities. During the recent HHS staffing changes, four in 10 (40%) staff at ACL were either laid off or offered early retirement and buyouts to leave the agency, according to media reports.

The Assistant Secretary for Planning and Evaluation (ASPE): ASPE advises the HHS Secretary on various health policy matters, including analyzing issues to support the Secretary’s role as Trustee of the Medicare Trust Funds; supporting the Physician-Focused Payment Model Technical Advisory Committee; and providing analyses on several Medicare policy areas, including prescription drugs (e.g., the Medicare Drug Price Negotiation Program), federal spending on Medicare Advantage plans, and the impact of the CMS Innovation Center models and the Medicare Shared Savings Programs on Medicare spending and quality. Additionally, ASPE issues the annual U.S Federal Poverty Guidelines, which are used to determine eligibility for various federal programs including Medicaid, the Medicare Savings Program, and the Medicare Part D Low-Income Subsidy program.

HHS plans to merge ASPE with the Agency for Healthcare Research and Quality (AHRQ), the Office of Research Integrity, and the National Center for Health Statistics (formerly in the CDC) to create a new Office of Strategy. About 70% of ASPE’s 140 staff members have either been laid off or offered buyouts and early retirement during the recent staffing changes, according to reports in the media, but the President’s FY 2026 budget justification for HHS estimates 91 FTEs for planning and evaluation within the new Office of Strategy. AHRQ, which oversees the largest survey on U.S health care expenditures, including Medicare, and manages CAHPS, a set of survey tools used by Medicare Advantage and other plans to measure patient experience, reportedly laid off about half of its staff, according to media reports.

HHS Office of Inspector General: The HHS OIG is an independent body that oversees HHS’s programs with a focus on preventing and reducing waste, fraud, and abuse, including in Medicare. Its activities include auditing health care providers and grantees (e.g., reviewing diagnoses submitted by Medicare Advantage plans for use in CMS’ risk adjustment program), collaborating with the Department of Justice to operate the Health Care Fraud and Abuse Control Program (HCFAC), and enforcing penalties against entities that have been convicted of violations. In FY 2023, efforts by the HCFAC program returned nearly $1 billion to the Medicare Trust Funds.

At the HHS OIG, the Trump administration fired the former HHS Inspector General as well as other Inspectors General in January. It is unclear how many of HHS OIG’s 1,600 staff were laid off or accepted buyouts or early retirements during the recent HHS layoffs.

Newly-created Assistant Secretary for Enforcement: As part of the restructuring within HHS, a new Assistant Secretary for Enforcement has been created to oversee four existing offices: 1) Office of Medicare Hearings and Appeals, which handles disputes and appeals raised by Medicare beneficiaries and providers related to coverage and payments, 2) the Departmental Appeals Board, which provides a final administrative review of disputed Medicare claims, 3) the HHS Office for Civil Rights, which enforces various federal civil rights laws (e.g., the Age Discrimination Act) and HIPAA rules, and 4) the Office for Human Research Protections, which protects the rights of individuals who volunteer for biomedical and behavioral research. The Office of Medicare Hearings and Appeals currently adjudicates approximately 46,000 appeals annually, while the Departmental Appeals Board oversaw nearly 13,000 cases at the end of 2024.

Other HHS offices: In addition to the agencies and offices listed above, there are other offices that support Medicare operations, such as the HHS Office of the General Counsel, which provides legal counsel and supports enforcement and compliance functions in Medicare and other federal programs.

Other Federal Agencies Beyond HHS

The Department of Justice (DOJ): The DOJ supports Medicare in various ways, including representing and defending HHS in litigations, such as lawsuits challenging the Medicare drug price negotiation program and a case against Medicare Advantage plans alleging unlawful kickbacks and discrimination. Through its Health Care Fraud Unit, the DOJ enforces anti-fraud and abuse laws. In FY 2023, efforts by the Health Care Fraud and Abuse Control Program—a joint effort between DOJ and HHS OIG—resulted in nearly $1 billion transferred to the Medicare Trust Funds.

Additionally, the DOJ’s Antitrust Division, in coordination with the Federal Trade Commission, enforces federal antitrust laws that address anticompetitive practices among health care providers and within the Medicare Advantage program.

An internal memorandum proposes a major overhaul at the DOJ but does not mention changes or staffing reductions in the Department’s Health Care Fraud Unit or Antitrust Division.

The U.S Treasury Department: The U.S Treasury manages two trust fund accounts with $1 trillion in revenue that finance Medicare: the Hospital Insurance Trust Fund and the Supplementary Medical Insurance Trust Fund. In addition, the Internal Revenue Services (IRS), an agency within the Treasury Department, provides income data to the Social Security Administration to help determine income-related monthly adjustments for Medicare Part B and Part D premiums. The Treasury also helps to administer the Medicare Secondary Payer program, which outlines the circumstances in which private or other health insurance plans serve as the primary payer and Medicare acts as the secondary payer for beneficiaries with other forms of health insurance.

The Treasury Department is expected to eliminate approximately 20% of its workforce, according to a report submitted to the U.S. Office of Personnel Management (OPM) and obtained by the media. It is unclear whether, or how, these cuts would affect the oversight and investment of the Medicare Trust Funds.

On May 30, 2025, the administration released additional details of its Fiscal Year 2026 budget request, including more specific information on funding for global health activities at the State Department, U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH). The proposed budget includes significant reductions in global health funding including the elimination of some programs and activities as follows:

State/USAID:

• Global Health Programs (GHP) Account: The main account that supports global health programs totals $3.8 billion in the request, $6.2 billion below the FY 2025 amount ($10.0 billion).
• Funding for Bilateral Programs:
  • Reducing Funding: The request provides funding for HIV/AIDS, tuberculosis (TB), malaria, polio, and global health security (GHS), but at significantly reduced levels (see table below), except for polio, which is maintained at the prior year level.
  • Eliminated Funding: The request eliminates bilateral funding for family planning & reproductive health (FP/RH), the Global Health Workforce Initiative (GHWI), maternal and child health (MCH; except for polio), neglected tropical diseases (NTDs), nutrition, and vulnerable children.
• Funding for Multilateral Organizations:
  • The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund): The request does not include a specific funding amount for the Global Fund in FY 2026, but states that funding can be provided through either the GHP account or the newly created “America First Opportunity Fund” (A1OF) and that the amount provided cannot exceed 20% of total contributions during the 8th Replenishment for a total of up to $2.4 billion over the three year period.
  • Eliminated Multilateral Funding: The request eliminates funding for Gavi, the Vaccine Alliance (Gavi), the Pan American Health Organization (PAHO), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and the World Health Organization.

Centers for Disease Control and Prevention (CDC):

• CDC’s Global Health Center: The request eliminates CDC’s Global Health Center and funding for most of its bilateral programs.
  • Maintained Programs & Funding: The request maintains funding for “Disease Detection & Emergency Response” at the prior year level ($293 million), but places it under CDC’s “Crosscutting Activities and Program Support”. The request also continues support for “Parasitic Diseases and Malaria,” placing it under “Emerging and Zoonotic Infectious Diseases,” but does not specify a funding amount.
  • Eliminated Funding: The request eliminates funding for global HIV/AIDS, global tuberculosis, global immunizations (which includes polio), and parasitic diseases.

National Institutes of Health (NIH):

• Fogarty International Center (FIC): Eliminates FIC, which was funded at $95 million in FY2025.
• Global Research: While detailed funding amounts are not yet available, the request proposes significant cuts to NIH research funding, which will likely affect global research.

Additional Resources:

• White House – Office of Management and Budget (OMB): “The President’s FY 2026 Discretionary Budget Request”
• Department of State/USAID: “Fiscal Year 2026 International Affairs Budget”
• Department of Health & Human Services (HHS): “Fiscal Year 2026 – Budget in Brief”

Every summer, health insurers submit rate filings to state regulators detailing expectations and justifying premium rate changes for ACA-regulated health plans for the coming year. With the enhanced premium tax credits set to expire at the end of 2025, consumers can expect increases in how much they pay for coverage.

KFF examines 23 early insurer premium filings from Vermont, Oregon, Washington, and Washington, DC, which include an additional 4 percent increase in premiums, on average, due to the expected expiration of the credits. While not a complete picture and insurer responses differ, these filings provide early insights into how insurers are expecting premiums to change in 2026.

This analysis is available through the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

Since the enactment of Medicare and Medicaid in 1965, the federal government has played a central role in providing support to older adults and people with low incomes, with health insurance coverage under Medicare for those 65 and older and Medicaid for those with low incomes, including older adults. The Older Americans Act, enacted that same year, is perhaps lesser known than Medicare and Medicaid but also provides important support for older adults through a broad range of community-based social services programs, including home-delivered and congregate meals, transportation services, caregiver support, chronic disease prevention services, and the Long-Term Care Ombudsman program. These programs and services may face some disruption, however, in light of the Trump administration’s organizational changes and staffing reductions at the Department of Health and Human Services (HHS), which houses the Administration for Community Living (ACL), the agency that has administered the programs and services authorized by the Older Americans Act.

According to a recent HHS press release, ACL is releasing over $1 billion of Fiscal Year (FY) 2025 funding for Older Americans Act programs to state, local, and Tribal grant recipients – funds that had already been appropriated by Congress but withheld by the Trump administration. At the same time, the Trump administration recently announced a restructuring within HHS, including budget cuts for several divisions and layoffs of 10,000 employees, with the stated goal of saving money and reducing inefficiencies. As part of this effort, the President’s proposed HHS FY 2026 budget outlines the Trump administration’s plans to dissolve ACL and integrate its functions within a newly established Administration for Children, Families, and Communities (ACFC).

The reorganization and staffing reductions at HHS create some uncertainty about the potential effect on older adults that could result from dissolving the agency at the center of administering programs and services authorized under the Older Americans Act. While the Trump administration generally can make organizational changes of this nature at federal agencies, Congress typically has the final say in determining agency funding levels and appropriating funds. The most recent reauthorization of the Older Americans Act in 2020 appropriated funds through FY 2024, with funding for FY 2025 provided through continuing resolutions at FY 2024 levels.

With the changes to ACL and other restructuring at HHS as context, this brief provides an overview of programs and services provided under the Older Americans Act, the role that was played by ACL in administering Older Americans Act programs, and trends in Older Americans Act program funding and service utilization by older adults.

What programs and services are provided under the Older Americans Act?

The Older Americans Act was signed into law in 1965 with the goal of providing older adults with home and community-based social services to support independent living as long as possible. Unlike Medicaid, the Older Americans Act does not have explicit income criteria used to determine who can qualify to receive services funded under the Act. Instead, the law aims to support people age 60 and older with the greatest economic or social need, including older adults with limited English proficiency and older individuals at risk for institutional placement.

The Older Americans Act authorizes grants from the federal government to states to provide community social services to older adults and established the Administration on Aging, an office within ACL, to administer these grant programs. The scope of Older Americans Act programs has been expanded over time and now includes home-delivered and congregate nutrition services, transportation services, state Long-Term Care Ombudsman programs, elder abuse prevention, caregiver support, elder rights and legal assistance, employment training, chronic disease prevention, and several other activities. Through this wide array of programs and thousands of service providers across states, territories, and Tribal organizations, the Older Americans Act serves millions of older adults each year.

The Older Americans Act statute includes seven titles that describe the administration and funding of the programs (Appendix Table 1). Most of the funding for Older Americans Act services falls under Title III of the Act, which authorizes grants for state and community programs on aging to provide:

• supportive services and senior centers, including case management, transportation, help with homemaker tasks, chores and personal care, adult day care, and legal assistance,
• nutrition services, including home-delivered and congregate meals,
• evidence-based prevention and health promotion services, and
• the National Family Caregiver Support Program, which provides counseling, support groups, and relief from caregiver duties.

Separately, the law also provides funding for grants to encourage health, independence, and longevity, including research programs and demonstration projects in the areas of chronic disease management and fall prevention, for example; grants to promote part-time community service employment opportunities for unemployed low-income older individuals; grants for the provision of nutrition, supportive services, and caregiver support services to older American Indians, Alaska Natives, and Native Hawaiians; grants for the Long-Term Care Ombudsman program and Elder Abuse, Neglect, and Exploitation Prevention Programs, and funding for Aging and Disability Resource Centers. (Most but not all of these programs have been administered by the Administration on Aging within ACL; the community service program is administered by the Department of Labor, while Aging and Disability Resource Centers have been administered by the Center for Innovation and Partnership within ACL.)

How is the Older Americans Act administered and what has been the role of ACL?

Under the organizational structure that existed prior to the Trump administration’s restructuring at HHS, the Administration on Aging within ACL was the office that authorized Older Americans Act grant funds to 56 State Units on Aging and hundreds of Tribal organizations. The State Units on Aging are state- and territorial-level agencies that use funds to carry out policy and development responsibilities and the administration of Older Americans Act activities. The State Units on Aging in turn work with and distribute funding to over 600 local Area Agencies on Aging, which operate within a designated planning area within the state or territory. The Area Agencies on Aging are local entities that either directly, or through contracts with nearly 30,000 local service providers, oversee a system for the delivery of Older Americans Act services.

While not part of the Older Americans Act, the State Health Insurance Assistance Program (SHIP) has also been administered by ACL through its Office of Healthcare Information and Counseling. The SHIPs provide local, in-depth, and objective counseling and assistance to Medicare beneficiaries and their families to help them make informed decisions about their care and benefits. There are 54 SHIPs, organized at the state and territory level, which may have different names in different areas. SHIP staff and volunteers provide unbiased one-on-one counseling, information, and education about Medicare benefits, how Medicare works, different Medicare coverage options, low-income assistance programs, and other types of information. The provision of SHIP services is free and not limited by income or other beneficiary demographic criteria.

How many people are helped by Older Americans Act programs?

Millions of older adults are helped by programs funded by the Older Americans Act each year – one in six, according to HHS. Focusing in on programs and services funded under Title III, which represent nearly three-quarters of total Older Americans Act funding in FY 2024, more than 12 million individuals were served by select Title III programs in FY 2023 (the most recent year available), according to data from ACL (Figure 1).

Among the programs funded under Title III of the Older Americans Act, the number of older adults served and services provided in 2023 include:

• Nutrition counseling and education: Nearly 2 million individuals received some type of nutrition counseling and education, including 1.9 million individuals who received nutrition education to support food and nutrition choices, with 2.8 million education sessions provided, and 23,000 individuals who received nutrition counseling, which includes one-on-one counseling provided by a registered dietitian who provides options and methods for improving nutrition, with 37,000 hours of nutritional counseling provided.
• Meals: Well over 1 million older adults benefited from home-delivered or congregate meals provided through the Older Americans Act, including 1.3 million who received home-delivered meals and 1.3 million who received congregate meals, with 181 million home-delivered meals and 57 million congregate meals provided to these individuals.
• Case management: 413,000 older adults received case management services, such as developing care plans, coordinating services among providers, and conducting follow-ups as needed, with 3 million hours of case management provided to these individuals.
• Legal assistance: 216,000 individuals received legal assistance, including legal advice and counseling, with 1 million hours of legal assistance provided.
• Homemaker services: 116,000 people received homemaker services, which include assistance with routine tasks such as preparing meals, shopping for personal items, managing money, or doing light housework, with 12.4 million homemaker hours provided.
• Personal care: 77,000 older adults received personal care services, which include services that help individuals with activities of daily living, with 11.3 million hours of personal care provided to these individuals.
• Assisted transportation services: 34,000 individuals received assistance with transportation services, which include escorts for people who have difficulties using regular transportation, with 1.2 million one-way assisted transportation trips provided.
• Chore services: 27,000 people were provided with chore services, including assistance with such activities as heavy housework, yard work, or sidewalk maintenance, with 599,000 hours of assistance provided to these individuals.
• Adult day care services: 8,300 individuals received adult day care services, which include personal care for dependent older adults in a supervised group setting, such as social and recreational activities, training, and counseling, with 2.6 million hours of adult day care services provided to these individuals.
• Caregiving services: The National Family Caregiver Support Program provides help to thousands of caregivers. According to the HHS FY 2024 Congressional Budget Justification for ACL, 779,000 caregivers were served by the National Family Caregiver Support Program in 2021 (data not shown). In addition, the National Family Caregiver Support Program provided 50,245 family caregivers with nearly 4.9 million hours of temporary relief from their caregiving responsibilities and provided an estimated 1.5 million contacts to caregivers, assisting them in locating services from various agencies. Furthermore, the program provided an estimated 92,865 family caregivers with counseling, peer support, and training to better cope with the stresses of caregiving.
• Other services: that are provided under Title III include transportation, such as to medical appointments or the grocery store; information and assistance, such as about opportunities and services that are available in the community; and outreach on how to use existing services and benefits. Data on the number of people who used each of these services are not collected but data on the number of services provided is collected. According to ACL, in 2023, 13.1 million one-way transportation trips were provided from one location to another, and nearly 11 million contacts for information and assistance were provided.

Among older adults receiving select Title III services in 2023, 39% were living below the poverty level, 33% were people of color, and 29% lived in rural areas, according to data from ACL (Figure 2).

In addition to the programs mentioned above that are provided under Title III, the Older Americans Act provides funding for other programs that help older adults, including:

• Long-Term Care Ombudsman program: Each state is required to operate a statewide Office of the Long-Term Care Ombudsman to improve the quality of life and care of residents of long-term care facilities, including individuals living in nursing homes and assisted living facilities, and advocate on behalf of residents. In 2024, paid and volunteer staff conducted nearly 380,000 visits to over 50,000 long-term care facilities, investigated over 205,000 complaints, and provided more than 710,000 instances of information and assistance to individuals and facility staff. These services help support the 6 million people on Medicaid who live in institutional settings.
• Social supports for older American Indians, Alaska Natives, and Native Hawaiians: As part of the social supports provided to older American Indians, Alaska Natives, and Native Hawaiians under the Older Americans Act, in 2022, nearly 600,000 transportation services were provided, including for visits to medical providers, picking up prescriptions, and staying active within their communities, an estimated 4 million home-delivered and 2.1 million congregate meals were provided, and nearly 780,000 hours of information, referral, and outreach services were provided including help with navigating health care systems and payers, making appointments, and coordinating access to services.

What are the trends in funding for Older Americans Act programs?

Federal funding for all Older Americans Act services was $2.37 billion for FY 2024, the most recent year of fully appropriated funding, with nearly three-quarters (72%) devoted to grants to states and community providers for nutrition services, caregiver support services, and other social services (Figure 3).

This is roughly the same as funding from the prior fiscal year ($2.38 billion in FY 2023) but an increase of 23% since FY 2014, when Older Americans Act funding totaled $1.92 billion – or average annual growth of 2.1% (not adjusted for inflation; Figure 4). (Congress provided temporary increases in supplemental funding to Older Americans Act programs due the COVID-19 public health emergency in FY 2020 and FY 2021.)

However, the growth of overall funding for Older Americans Act programs and services has not kept pace with the growth in the older adult population in the U.S. Between 2014 and 2024, the number of people ages 60 and older increased by 28% (2.5% average annual growth), from 64.7 million to 82.5 million. As a result, Older Americans Act funding per person age 60 or older decreased slightly over these years by 3%, though this reduction would be larger in inflation-adjusted dollars, with general prices rising by 33% (2.9% annually, on average) over this period.

Based on the president’s proposed FY 2026 HHS budget, the Trump administration is proposing level funding for most Older Americans Act programs and services, including home and community-based supportive services, nutrition programs, caregiver and family support services, and programs for the protection of vulnerable older adults, like the Long-Term Care Ombudsman program. This would mean another year with no funding increases for these programs, unless Congress provides funding above current levels in new appropriations legislation or in reauthorizing the Older Americans Act. The Trump administration proposes a reduction in funding for the Alzheimer’s disease program, from $32 million in FY 2025 to $17 million in FY 2026, along with the elimination of chronic disease self-management education.

The Older Americans Act has been reauthorized and amended several times since its passage in 1965, including most recently through the Supporting Older Americans Act of 2020, which authorized appropriations for Older Americans Act programs through FY 2024. On December 10, 2024, the Senate unanimously passed the Older Americans Act Reauthorization Act of 2024, which would have reauthorized the Act for another 5 years. The House introduced legislation that included the Older Americans Act reauthorization but this funding deal fell apart under pressure from then President-elect Donald Trump. Subsequent legislation passed by Congress to keep the government funded until March 14, 2025, and then again through September 30, 2025, did not include reauthorization of the Older Americans Act.

How could the Trump Administration’s reorganization of HHS affect Older Americans Act programs?

According to the HHS FY 2026 Budget in Brief, ACL is being dissolved and its functions integrated into the newly established Administration for Children, Families, and Communities (ACFC). Programs being shifted include home and community based supportive services, nutrition programs, aging network support activities, family caregiver support services, caregiver support services for American Indians, Alaska Natives, and Native Hawaiians, Alzheimer’s disease supportive services, and prevention of elder abuse and neglect. The administration has not yet released a detailed budget justification for the new ACFC, which makes it difficult to assess whether funding for any of the former ACL’s functions will be scaled back or terminated.

Staffing reductions within HHS and at the former ACL specifically could hinder the ability of remaining staff to oversee Older Americans Act programs. Staff cuts reported to have occurred within ACL’s budget office, evaluation and policy teams, and regional offices could impede the effective administration of Older Americans Act programs, the provision of grant funding to state and local entities, and the direct delivery of services to older adults.

Appendix