What Impact Could the HHS Downsizing Have on Older Adults?

Takeaways

• The U.S. Department of Health and Human Services (HHS) has been undergoing organizational changes and layoffs in recent weeks.
• These changes include the dismantling of such agencies as the Administration for Community Living (ACL) and terminating staff of the Division of Energy Assistance.
• Advocates and lawmakers are raising concerns that older adults and individuals with disabilities who rely on programs such as Meals on Wheels and the Low-Income Home Energy Assistance Program (LIHEAP) could face potential service disruptions amid the HHS staff terminations and restructure.
• Cuts to HHS personnel and the closure of numerous regional offices may also affect oversight of health care facilities, such as nursing homes, according to experts.

In recent weeks, the second Trump administration initiated a comprehensive restructuring and downsizing of the United States Department of Health and Human Services (HHS), leading to significant staff reductions and organizational changes. The department is responsible for overseeing a vast array of programs. These include Medicare and Medicaid as well as offices that help coordinate services for people who qualify for both types of benefits. A host of other programs within the HHS focus on food and drug safety, disease prevention, patient safety, health research, anti-poverty efforts, and more.

Along with buyouts and retirements, the layoffs will bring full-time staff at the HHS down to about 62,000 from 82,000 and will purportedly boost savings for the agency by about $2 billion annually.

However, these actions are raising concerns among advocates and some lawmakers regarding their potential effects on older adults and people with disabilities, including how they will affect far-reaching programs such as the Administration for Community Living (ACL), Meals on Wheels, and the Low Income Home Energy Assistance Program (LIHEAP).

Dismantling of the Administration for Community Living

The ACL, established in 2012 to support community living for older adults and individuals with disabilities, is set to be dismantled. Its functions are being integrated into other HHS agencies, including the Administration for Children and Families and the Centers for Medicare and Medicaid Services (CMS).

Community living advocates argue that this fragmentation could disrupt coordinated services essential for these populations. According to Disability Scoop, this move is also alarming for advocates because the ACL was established as a centralized hub to promote efficiency and prevent duplication.

Meanwhile, the HHS states that the changes to the ACL will not impact Medicare or Medicaid services.

Effects on Meals on Wheels

Meals on Wheels, another program whose funding and support is overseen by the ACL, delivers more than 200 million meals to homebound seniors and people with disabilities nationwide. It also faces potential service disruptions under the HHS restructuring. Meals on Wheels America expressed concerns that these changes could hinder their ability to provide essential nutrition and safety visits to millions of vulnerable Americans.

“We are extremely worried about the impact this workforce reduction and dismantling of key functions will have on seniors and the vital programs that serve them,” Meals on Wheels America President and CEO Ellie Hollander and Bob Blancato, executive director of the National Association of Nutrition and Aging Services Programs, said in a statement.

Low Income Home Energy Assistance Program (LIHEAP) Staff Terminations

The Trump administration has terminated the entire staff of the Division of Energy Assistance, which oversees LIHEAP, a $4.1 billion program assisting approximately 6 million low-income households with heating and cooling costs.

Some state officials are expressing concern about whether federal funding and the administration of energy assistance programs will continue. Thirteen U.S. senators, including Republicans Susan Collins of Maine and Lisa Murkowski of Alaska, wrote a letter to HHS Secretary Robert Kennedy, Jr., urging him to reverse the decision, highlighting potential harm to elderly and low-income families.

“Access to affordable home energy is a matter of health and safety for many low-income households, children, and seniors,” they wrote. “To that end, we urge you to reverse course on any staffing or funding cuts that would jeopardize the distribution of these funds to our constituents.”

Risks to Nursing Homes

The cuts to HHS’ personnel and the closure of about half of its regional offices will also affect the department’s ability to oversee Medicare and Medicaid health care facilities, such as nursing homes, hospitals, and dialysis centers.

According to Chiquita Brooks-LaSure, the most recent administrator of the CMS, the drastic changes within the HHS are causing “devastating disruption,” including to oversight of nursing homes. Since HHS regional offices play a key role in nursing home enforcement, closing a significant portion of them could affect the health, safety, and comfort of thousands of older adults across the country.

In another letter addressed to Secretary Kennedy, nearly 40 lawmakers wrote that the HHS cuts removed the “staff responsible for conducting audit and compliance activities, ensuring safety in our nation’s nursing homes, hospitals, and other settings, providing coverage for innovative therapies, and developing payment models that improve care and lower costs for patients.

“Your claim that decreasing the CMS workforce … ‘will not impact Medicare and Medicaid services,’ without explanation, is unfathomable and incorrect,” the letter continues.

Broader Implications for Older Adults and Individuals With Disabilities

The restructuring and staff reductions at HHS could have far-reaching consequences, advocates warn:

• Service Disruptions. The dismantling of the ACL and staff cuts in key programs may lead to interruptions in essential services, affecting nutrition, energy assistance, and community support for older adults and individuals with disabilities.
• Increased Vulnerability. Reduced support could heighten the risk of food insecurity, isolation, and exposure to extreme temperatures among these populations.
• Administrative Challenges. The sudden layoffs have created confusion among state agencies responsible for implementing federally funded programs, potentially delaying or halting critical assistance.

Hundreds of advocacy groups are pushing against the changes, asking Congress, for instance, to halt the dismantling of the ACL. Some organizations are calling for the HHS to involve them in future discussions. Among them is the ANCOR Foundation, which urged the HHS to “first seek input from federal partners, community groups, and other stakeholders that will be directly impacted.” Two members of the Senate health committee have also invited Kennedy to testify on the HHS changes.

Planning in Uncertain Times

During uncertain times, it is wise to take stock of one’s assets and create a plan that factors in a potential reduction in government benefits and other forms of public assistance. As you plan for the future, whether it is assessing your long-term care needs, applying for Medicaid, or understanding your rights, an elder law attorney in your area can help you create a plan that fits your unique situation.