Department of Health & Human Services (HHS)

The Department of Health and Human Services (HHS) — established in statute at 42 U.S.C. Chapter 43 (§§ 3501–3515) and successor to the Department of Health, Education, and Welfare (HEW) created in 1953 — is the Cabinet-level federal agency responsible for protecting the health of all Americans and providing essential human services, especially for vulnerable populations. For the primary public health research agencies within HHS, see public health service, NIH, and CDC. For the Medicare and Medicaid programs HHS administers, see Medicare Part A hospital insurance. With a FY2024 total budget of approximately $1.7 trillion, HHS administers more federal spending than any other department — primarily through Medicare and Medicaid, which together account for roughly $1.5 trillion in annual outlays. The department's 13 operating divisions range from the Centers for Medicare and Medicaid Services (CMS), which oversees health coverage for over 160 million Americans, to the National Institutes of Health (NIH), the world's largest public funder of biomedical research at $47 billion annually, to the Food and Drug Administration (FDA), which regulates products accounting for approximately 20 cents of every dollar spent by American consumers. HHS also administers the nation's primary social service programs for children and families — Head Start, TANF block grants, foster care and adoption assistance, child care subsidies — through the Administration for Children and Families (ACF), and oversees community health centers, Ryan White HIV/AIDS programs, and substance abuse and mental health services. The Secretary of HHS serves as the second officer of succession to the Presidency (after the Secretary of State) in the Presidential Succession Act.

Current Law (2026)

Legal Authority

• 42 U.S.C. § 3501 — Establishment of Department of Health, Education, and Welfare (now HHS); Secretary vested with all functions, powers, and duties of the department
• 42 U.S.C. § 3502 — Establishment of position of Under Secretary of HEW (now Deputy Secretary of HHS); succession and delegation authority
• 42 U.S.C. § 3503 — Assistant Secretaries: authorized positions and subject matter responsibilities
• 42 U.S.C. § 3505 — Under Secretary for Health (position authority)
• 42 U.S.C. § 3508 — General Counsel of HHS (legal authority, advisory function)
• 42 U.S.C. § 3513 — Transfer of functions from Federal Security Agency to HEW/HHS (historical continuity provision consolidating public health, social security, and education functions)
• 42 U.S.C. § 3515 — Transfer of functions and offices (authority to reorganize component offices within statutory constraints)
• Pub. L. 96-88 (1979) — Department of Education Organization Act; created separate Department of Education, renamed remaining department "Department of Health and Human Services"
• 42 U.S.C. § 202 — Public Health Service Act: Secretary of HHS has the functions, powers, and duties of the former Federal Security Administrator with respect to public health
• Reorganization Plan No. 1 of 1953 — Transferred the Federal Security Agency (Public Health Service, Social Security Administration, Office of Education, FDA) to the new HEW

Principal Operating Divisions

Centers for Medicare & Medicaid Services (CMS) The largest single component of HHS by budget. CMS administers Medicare (~65 million beneficiaries), Medicaid (~95 million beneficiaries), CHIP (~7 million children), and the ACA Health Insurance Marketplace (~15 million enrollees). The CMS Administrator oversees programs representing roughly 90% of HHS outlays. CMS also regulates clinical laboratories (CLIA) and nursing homes, sets Medicare payment rates that effectively govern healthcare pricing nationwide, and administers quality reporting programs. See: medicare-part-a-hospital-insurance, medicaid-program-overview, chip-childrens-health-insurance, aca-health-insurance-marketplace.

National Institutes of Health (NIH) The world's largest public funder of biomedical research, with a ~$47 billion annual budget supporting over 300,000 researchers at universities, medical schools, and research institutions nationwide. NIH comprises 27 Institutes and Centers, each focused on a disease category or research function (National Cancer Institute, National Heart/Lung/Blood Institute, National Institute of Allergy and Infectious Diseases, etc.). NIH research has contributed to virtually every major medical advance of the past 50 years. See: public-health-service-nih-cdc.

Centers for Disease Control and Prevention (CDC) The nation's public health protection agency, responsible for disease surveillance, outbreak investigation, immunization programs, environmental health, occupational safety research (NIOSH), and global health security. CDC operates the Strategic National Stockpile in partnership with ASPR and publishes the Morbidity and Mortality Weekly Report (MMWR). See: public-health-service-nih-cdc, public-health-emergency-preparedness.

Food and Drug Administration (FDA) Regulates foods, drugs, biologics, medical devices, tobacco, cosmetics, and veterinary products — approximately $2.8 trillion in products sold annually. FDA approval is required for new prescription drugs, biologics, and devices before they can be marketed. FDA also regulates the safety of the U.S. food supply, including imported food. See: fda-drug-approval, generic-drugs-hatch-waxman, 340b-drug-pricing.

Administration for Children and Families (ACF) Administers over 60 programs promoting the economic and social well-being of children, families, individuals, and communities. Major programs: Head Start and Early Head Start ($13 billion), TANF block grants ($16.5 billion), Child Care and Development Fund (CCDF/CCDBG), foster care and adoption assistance (Title IV-E), child support enforcement (Title IV-D), Low Income Home Energy Assistance Program (LIHEAP), and Community Services Block Grants. See: head-start-program, tanf-cash-assistance, child-welfare-foster-care, ccdbg-child-care-development-block-grant, liheap-energy-assistance.

Substance Abuse and Mental Health Services Administration (SAMHSA) Leads public health efforts to advance the behavioral health of the nation through mental health and substance use disorder services. SAMHSA administers block grants (Community Mental Health Services Block Grant and Substance Abuse Prevention and Treatment Block Grant) to states and territories, the National Suicide Prevention Lifeline (988), the Certified Community Behavioral Health Clinic program, and the Treatment Referral Routing Service. See: samhsa-substance-abuse-mental-health, mental-health-substance-abuse-block-grants.

Health Resources and Services Administration (HRSA) Improves health care access to people who are geographically isolated or economically vulnerable. HRSA funds Federally Qualified Health Centers (~30 million patients), administers the Ryan White HIV/AIDS program, oversees health professions workforce training, manages the National Health Service Corps (loan repayment for providers in underserved areas), and administers the National Vaccine Injury Compensation Program. See: community-health-centers-fqhc, ryan-white-hiv-aids, vaccine-injury-compensation, health-professions-workforce-programs.

Indian Health Service (IHS) Provides health services to approximately 2.7 million American Indians and Alaska Natives, fulfilling treaty obligations through a system of hospitals, clinics, and health stations. IHS is supplemented by tribal health programs and Urban Indian Organizations. See: indian-health-service.

Agency for Healthcare Research and Quality (AHRQ) The primary federal agency for patient safety and healthcare quality research. AHRQ produces evidence reports, clinical practice guidelines, and patient safety tools; administers the Medical Expenditure Panel Survey (MEPS); and runs the Healthcare Cost and Utilization Project (HCUP). See: ahrq-healthcare-research-quality.

Administration for Community Living (ACL) The primary federal agency on aging and disability policy. ACL administers the Older Americans Act programs (Area Agencies on Aging, Meals on Wheels, caregiver support, elder justice) and disability services including the Developmental Disabilities Assistance and Bill of Rights Act programs. See: older-americans-act, developmental-disabilities-assistance-act.

Assistant Secretary for Preparedness and Response (ASPR) Leads the federal public health and medical preparedness and response system. ASPR oversees the Strategic National Stockpile (SNS), manages Emergency Support Function #8 (Public Health and Medical Services) under the National Response Framework, administers Hospital Preparedness Program grants to states, and oversees the Biomedical Advanced Research and Development Authority (BARDA), which funds vaccine and countermeasure development. See: public-health-emergency-preparedness.

Office of Inspector General (OIG) Investigates fraud, waste, and abuse in HHS programs; issues exclusions from Medicare and Medicaid for violations; publishes compliance guidance for healthcare providers and contractors. OIG oversight of Medicare and Medicaid fraud is one of the largest law enforcement operations in the federal government.

Office for Civil Rights (OCR) Enforces federal civil rights laws, HIPAA Privacy and Security Rules, and the ACA Section 1557 nondiscrimination provisions in healthcare. OCR investigates complaints against covered entities, conducts compliance reviews, and brings enforcement actions including civil monetary penalties. See: hipaa-health-information-privacy.

Key Numbers

• $1.7 trillion: HHS total FY2024 budget — the largest of any federal department and approximately 25% of all federal spending
• 160 million: Americans covered by Medicare, Medicaid, and CHIP combined
• $47 billion: NIH annual budget, supporting over 50,000 competitive grants to external researchers
• $2.8 trillion: Value of consumer products regulated by FDA — roughly 20 cents of every consumer dollar
• 30 million: Patients served annually by HRSA-funded health centers (FQHCs)
• 2.7 million: American Indians and Alaska Natives served by IHS
• 13: HHS operating divisions; 12 principal staff offices of the Secretary
• 1953: Year the department's predecessor (HEW) was established; renamed HHS in 1980 after Education was spun off

How It Affects You

If you receive Medicare or Medicaid: CMS within HHS sets every coverage rule, payment rate, and quality standard for your health coverage. Changes to the Medicare Physician Fee Schedule, Medicaid income limits, CHIP eligibility, and ACA marketplace rules are all CMS decisions — made through notice-and-comment rulemaking published in the Federal Register. If you are denied coverage or payment, HHS's appeals processes (Medicare Administrative Contractors, Quality Improvement Organizations, ALJ hearings) are the primary recourse.

If you work in healthcare: Your clinical practice is shaped by HHS at every level. FDA approval determines what drugs and devices you can prescribe. CMS determines what services Medicare and Medicaid will pay for and at what rate. OSHA (DOL, not HHS) governs workplace safety, but AHRQ's evidence reports and CMS quality measures shape clinical standards of care. ONC (within HHS) governs the EHR systems you use. OIG exclusions can remove you from all federal health programs.

If you work in public health, research, or health education: NIH grant programs, HRSA workforce training, CDC surveillance data, and AHRQ patient safety research are the primary federal infrastructure for your work. HHS operates the largest civilian federal employer of scientists, physicians, and public health professionals.

If you're a state government: HHS is the primary federal partner for state health and human services agencies. Medicaid matching funds (FMAP), TANF block grants, CCDBG child care funds, Head Start grants, mental health and substance abuse block grants, and CHIP all flow through HHS. State Medicaid directors work primarily with CMS Regional Offices. Changes to HHS funding formulas and block grant structures directly affect state budgets.

Recent Developments

The Trump administration's appointment of Robert F. Kennedy Jr. as Secretary and subsequent DOGE-driven restructuring of HHS constituted the most significant organizational disruption to the department since its 1980 renaming. In early 2025, HHS underwent large-scale workforce reductions across nearly all operating divisions, with particular cuts at CDC (estimated 1,700+ positions), FDA (hundreds of positions across product review centers), NIH (administrative and indirect cost reductions), and SAMHSA. The organizational changes included proposals to consolidate operating divisions into a new "Administration for a Healthy America" and to rename the FDA — proposals that as of mid-2026 remained partially implemented amid congressional resistance and legal challenges.

The department's policy direction shifted significantly under Kennedy's leadership toward skepticism of certain vaccines and pharmaceutical products, reduction in chronic disease prevention programs, and focus on food additive and ultra-processed food regulation. Several longstanding vaccine advisory committee positions went unfilled; CDC's ACIP (Advisory Committee on Immunization Practices) process was disrupted. The NIH indirect cost reduction policy — attempting to cap research institution overhead reimbursements at 15% — was blocked by federal courts after virtually every major research university challenged it.

Despite the organizational turbulence, HHS's core entitlement programs (Medicare, Medicaid, CHIP) continued to operate through CMS, which retained much of its career workforce and regulatory infrastructure. The operational continuity of CMS is largely driven by statutory requirements and appropriations that the executive branch cannot unilaterally alter.