CMS advances major policy changes with fewer staff after HHS restructuring, experts say
The Centers for Medicare and Medicaid Services is pressing ahead with major policy changes while operating with fewer employees following the Department of Health and Human Services’ restructuring, a combination that could complicate the agency’s ability to deliver on its goals, experts say.
CMS lost around 300 employees in the Trump administration’s sweeping purge of the federal workforce last year, according to people familiar with the changes. Remaining staff are now responsible for historic policy shifts, including the first-ever national work requirement for Medicaid, an ambitious health technology initiative and tighter fraud oversight.
By comparison, other HHS divisions saw deeper cuts. The Food and Drug Administration lost about 3,500 roles, sources said. “CMS, by and large, they left it intact,” said one former CMS employee, who was laid off last year and granted anonymity to speak freely.
“They just sort of pruned the hedges — they didn’t cut the bush down.” The agency has also benefited from steady leadership, with top executives like CMS Administrator Dr. Mehmet Oz and Medicare Director Chris Klomp remaining in place. Other agencies, including the FDA and the Centers for Disease Control and Prevention, have experienced a revolving door of political appointees.
Even so, CMS — which provides health insurance coverage to more than 160 million Americans — now has a smaller workforce to carry out its agenda. The agency currently employs about 1,000 fewer workers than it did in 2024, according to the Office of Personnel Management, a decline CMS attributes to voluntary departures, retirements and layoffs.
Achieving the agency’s goals takes staff, time and resources, and the workforce felt “stretched” even before the reductions, said Jonathan Blum, nonresident senior scholar at the USC Schaeffer Institute for Public Policy and Government Service and former principal deputy administrator of the CMS during the Biden administration.
“The reality is they have complicated requirements to implement,” he said. The teams that hire, contract and build systems “have had a whole ton of departures,” he added. Employees say the restructuring has also dampened morale and introduced new uncertainty. All current and former staff interviewed were granted anonymity to discuss their experiences.
One current employee said colleagues are more open to outside job opportunities than before. Government work had long been seen as stable, they said, but “with the new leadership, there’s been a shift in that mindset, where you never know if your job is secure anymore.” Layoffs of many probationary workers across the federal government last year removed colleagues that some had spent significant time training, another employee said.
That has stalled career advancement for those who expected to hand off responsibilities. “My ability to be promoted has been essentially eliminated,” the employee said.
“I feel like I’ve been put into a position where I’m irreplaceable.” Experts and staff said the attrition risks slowing CMS’s policy work just as the agency helps states implement Medicaid work requirements, advances its health technology initiative and tightens fraud oversight — tasks that depend on the same core teams now operating with fewer hands.