Reorganization of the US Department of Health and Human Services: Selected Legal Issues

CRS Legal Sidebar: Reorganization of the U.S. Department of Health and Human Services: Selected Legal Issues – “On March 27, 2025, the U.S. Department of Health and Human Services (HHS, or the Department) announced a reorganization plan to consolidate several of its operating divisions and offices in accordance with an executive order. Among the changes, the press release describes

• the creation of the Administration for Healthy America (AHA), which will combine “into a new, unified entity” five existing HHS operating divisions and offices: the Office of the Assistant Secretary for Health (OASH), the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Agency for Toxic Substances and Disease Registry (ATSDR), and the National Institute for Occupational Safety and Health (NIOSH);
• the “transfer” of the Administration for Strategic Preparedness and Response (ASPR) to the Centers for Disease Control and Prevention (CDC);
• the “[r]eorganization” of the Administration for Community Living (ACL) to “integrat[e]” its critical programs “into other HHS agencies, including the Administration for Children and Families (ACF), [the Assistant Secretary for Planning and Evaluation (ASPE)], and the Centers for Medicare and Medicaid Services (CMS)”;
• the creation of an Office of Strategy that “merge[s]” ASPE with the Agency for Healthcare Research and Quality (AHRQ); and
• the closure of 5 of HHS’s 10 regional offices.

A fact sheet accompanying the press release further states that the plan will entail personnel cuts at certain HHS agencies, such as the Food and Drug Administration, that are not being consolidated. In total, the fact sheet states that the plan will reduce HHS’s full-time employees by 20,000, or about 25%. The press release and fact sheet leave several unanswered questions regarding the implementation of the reorganization plan. For example, it is unclear what it means for AHA to “combine” the five existing agencies—some of which are statutorily established—as well as who will be the AHA Administrator and what functions will the AHA Administrator serve with respect to these agencies. As another example, to the extent the plan appears to dissolve ACL, at least in name, it is unclear how its functions would be assigned to other entities. Amid the uncertainties, some Members of Congress have questioned the legality of the Secretary’s actions. On May 5, 2025, 19 states and the District of Columbia filed suit to challenge the reorganization and personnel cuts described and implemented following the March 27, 2025, announcement, alleging impacts to the plaintiff states resulting in particular from HHS’s personnel and program cuts. This Sidebar provides an overview of the legal framework governing the HHS Secretary’s authority to reorganize the agency and analyzes selected legal questions—stemming from relevant authorizing statutes, appropriations, and constitutional principles—raised by the reorganization plan described in the March 27, 2025, press release. The Sidebar also highlights examples of factual questions that may be relevant to the authority analysis. The Sidebar does not address the Secretary’s authority to reduce the HHS workforce, or to eliminate or reduce particular HHS programs or functions…”