Significant Staff Changes at HHS Impact Health Priorities and Programs. In recent weeks a number of staff changes have occurred at HHS, including several departures in Secretary Kennedy’s immediate office, as well as the appointment of key leaders at the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). These changes may impact the prioritization and timing of future administrative actions.
- Secretary Kennedy’s Chief of Staff, Heather Flick Melanson, and Deputy Chief of Staff for Policy, Hannah Anderson, departed in July. Ms. Melanson held senior roles at HHS during President Trump’s first term, and Ms. Anderson has previously worked in congressional offices. Following their departures, Matt Buckham has been named Acting Deputy of Chief of Staff. He previously held positions at the White House office that handles political nominees, the Heritage Foundation, and with the House Freedom Caucus.
- Dr. George Tidmarsh was appointed as Director of the Center for Drug Evaluation and Research (CDER) at FDA, which regulates over-the-counter and prescription drugs, including generics. Dr. Tidmarsh has an M.D. and Ph.D. in cancer biology from Stanford University and has completed residencies in pediatrics, pediatric oncology, and neonatology. Dr. Tidmarsh was an executive at multiple pharmaceutical companies before joining the FDA.
- Dr. Vinay Prasad, who led the FDA center which regulates vaccines, also departed the agency in recent days. Dr. Tidmarsh will be the acting head of the vaccine center, in addition to leading CDER. These FDA centers have experienced significant turnover as several long-time senior leaders left the agency in recent months.
- The Senate voted 51-47, along party lines, to confirm the nomination of Susan Monarez to be the Director of the CDC. Dr. Monarez also serves as and the Administrator of the Agency for Toxic Substances and Disease Registry and comes to CDC after serving as deputy director of the Advanced Research Projects Agency for Health since January 2023. She holds doctorate degrees from the University of Wisconsin-Madison in microbiology and immunology. After being sworn in on July 31, Dr. Monarez will be responsible for leading an agency that has been significantly affected by layoffs and proposed budget cuts.
Additionally, Senate Committees advanced several other nominees for health care positions, who will need to be confirmed by the Senate before they can fill the roles:
- Dr. Brian Christine, a urologist at the Urology Centers of Alabama, was nominated to serve as Assistant Secretary for Health (ASH). The ASH position is focused on developing health policy recommendations that cut across HHS agencies and operating divisions.
- Gustav (Gus) Chiarello III was nominated to be Assistant Secretary for Financial Resources (ASFR) at the Department of Health and Human Services. The Assistant Secretary for Financial Resources works closely with the White House Office of Management and Budget (OMB), leads the budget process for the department, and responds to requests from Congressional appropriations committees on budget and spending plans. Mr. Chiarello currently serves as Senior Special Counsel to the House Committee on the Judiciary. His prior roles include attorney at the Federal Trade Commission (FTC).
- Michael “Mike” Stuart, a State Senator from West Virginia has been nominated to serve as General Counsel, a position that leads the Department’s legal analyses for interpreting and implementing laws passed by Congress and setting the Department’s positions on legal challenges. Previously, Senator Stuart served as a United States District Attorney, as the Chair of the West Virginia Republican Party, and as a corporate attorney.
- Alex Adams was nominated for the position of Assistant Secretary for Family Support, to lead the Administration for Children and Families (ACF). Mr. Adams has served as Director of the Idaho Department of Health and Welfare since June 2024 and previously served as Administrator of the Idaho Division of Financial Management. ACF administers funding for Head Start, as well as programs for refugees and foster care.
The Administration for Children and Families (ACF) announced the availability of one-time supplemental funding to enhance nutrition services and promote healthy eating for children and families enrolled in Head Start programs. Head Start is a family services program that supports children’s growth from birth to age five through early learning and development, health, and family well-being. Services are delivered in center-based, home-based, or family child care settings, and operate in every state, many tribal nations, and several U.S. territories. This new funding can be used broadly by Head Start programs to improve or expand their nutrition services and support for healthy eating. The announcement includes four categories into which funding requests may fall: food service upgrades; materials, supplies, and equipment; nutrition education resources; and/or non-recurring personnel costs. The deadline for applications is August 22, but the agencies recommend applying as soon as possible as applications will be reviewed on a rolling basis.
On July 17, CMS announced it does not expect to approve extensions of or new 1115 waivers that provide for continuous eligibility Medicaid-funded workforce initiatives. In letters to states, the Centers for Medicare and Medicaid Services (CMS) stated the agency will no longer approve or renew Section 1115 authorities that allow continuous enrollment, which allows individuals to maintain eligibility for Medicaid for longer periods of time without going through an eligibility redetermination. Twelve states currently have waivers providing for continuous eligibility, mostly providing for continuous eligibility for children ages six and younger. One state, Colorado, has a waiver set to expire at the end of this year. The CMS guidance notes that states will have to conduct outreach to enrollees whose continuous eligibility period will be ending, and CMS will work directly with affected states on operationalizing the changes needed to phase out the continuous eligibility authorities.
Additionally, CMS will no longer approve or extend existing Medicaid-funded initiatives intended to support the workforce serving Medicaid beneficiaries through primary care, behavioral health, dental, and home and community-based services. CMS notes that California, Massachusetts, New York, North Carolina, and Vermont have such Medicaid-funded workforce initiatives. Current initiatives will be allowed to run their course, but will not be extended. Funders can work with state Medicaid programs to understand the impacts of these announcements in specific states, such as more frequent eligibility determinations, a loss of Medicaid for some individuals, and the expiration of workforce initiatives.
On July 17, President Trump signed H.R. 4, the Rescissions Act of 2025, into law, rescinding more than $9 billion in unobligated federal funds that were provided to the Department of State, USAID, the U.S. Institute of Peace, and the Corporation for Public Broadcasting. In accordance with processes under the Congressional Budget and Impoundment Control Act of 1974, President Trump proposed rescinding $7.9 billion provided for global health and foreign assistance programs as well as $1.1 billion provided for the Corporation for Public Broadcasting. Specific exemptions protect global health funding for HIV/AIDS, tuberculosis, malaria, nutrition, and maternal and child health, provided that funding for family planning and reproductive health is fully rescinded.
On July 17, Democratic House and Senate Committee Leaders sent letters to several large health insurance companies raising concerns about Secretary Kennedy’s efforts to revise vaccine recommendations, including removing the COVID-19 vaccine recommendation for pregnant women and children. In the letters, Committee leaders request answers to a series of questions regarding whether insurers will continue to cover all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) without cost-sharing, as well as what process exists to make coverage decisions if ACIP’s recommendations are non-evidence-based. The letters follow the removal of previous ACIP members and the installation of new members by Secretary Kennedy. ACIP’s recommendations are important because they guide both clinical practice and insurance coverage, influencing what vaccines are covered under Medicaid, Medicare Part D, employer-sponsored coverage, and private insurance. Additionally, ACIP recommendations determine which vaccines should be offered under the federal Vaccines for Children Program, which provides vaccines for eligible children at no charge.
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