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The last month has been one of tremendous change. First, on March 25, our department learned of the elimination of millions of dollars in federal COVID related funds. Many of our contracted partners are affected, as is the department. On March 27, we began to learn more about planned changes at the U.S. Department Health and Human Services as a press release and fact sheet outlined plans including reductions in workforce, restructuring that includes the creation of the Administration for a Healthy America (AHA), and the priority of ending the chronic disease epidemic. On April 16, a leaked copy of a document from the Office of Management and Budget to the federal agencies was published online. This document is a pre-decisional “passback” which is a part of the federal budget process where the OMB responds to agencies’ budget requests. The document does not represent final budget decisions.
There are still steps that occur before budget decisions are final: agencies are permitted to appeal decisions, the administration could still make changes, and Congress must act on the submitted budget. While the White House has not acknowledged this draft, it appears likely that it is authentic. We have seen action on some of the items listed which makes it worthwhile to study the proposed changes and assess the potential impact to our partners, our department and the state.
The document represents a total cut in HHS discretionary funding of approximately $36.4 billion. Some programs are explicitly eliminated, while the status of others is not clear because the individual offices and agencies are eliminated but their work may be redistributed to the new AHA. The document states that the changes will still “enable agencies to fulfill their statutory responsibilities,” meaning federal programs that are explicitly authorized in federal statute should still exist.
It appears the newly formed AHA would have divisions aligning with issues of Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS and Health Workforce.
There appears to be elimination of some programs and services we provide as well as funds supporting major block grants and tobacco cessation programs. There are other areas expanding current state contracts where federal support may be lost – one example is states covering 100% of all routine food facility inspections.
Most programs administered by the Administration for Community Living that are associated with aging are said to shift to the Centers for Medicare and Medicaid Services with potential eliminations of certain programs being discussed.
Where do we go from here? We must understand the leaked document is not final. We also must recognize the proposed and actual federal changes over the last month represent a fundamental shift in the approach to health and human services, not just potential and actual cuts to existing programs. This recognition has been a catalyst for department leadership to evaluate our current reality and consider how we can define a strong and sustainable new reality which aligns the priorities of our federal and state administrations with our state’s identified health threats and needs.
We will be exchanging thoughts and ideas internally and externally to inform our path forward. Meanwhile at DHSS, we continue our mission to promote the health and safety of Missourians.
I am striving to have consistent, transparent and supportive communication both internally and externally of the organization. The Director’s Message is new and planned to be sent bi-monthly. Please drop me a note (sarah.willson@health.mo.gov) if you have any feedback or questions, and I look forward to continuing our partnership.
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