At the start of each governance, U.S. presidents often use their executive authority to reorganize the federal government in ways that reflect their priorities, and in his second term in office, President TRUMP is no exception. The TRUMP administration’s actions include sweeping reorganizations and large-scale staff reductions at virtually every department in the federal government, including a “dramatic restructuring” within the U.S. Department of Health and Human Services (HHS) and changes at other agencies that have responsibilities for various aspects of the Medicare program.

Medicare, the program that provides health coverage to more than 68 million adults ages 65 and older and younger people with disabilities, is administered primarily by the centers for Medicare & Medicaid Services (CMS), an agency within HHS, but a number of other federal agencies within and outside of HHS, such as the Social Security Administration, the U.S. Department of Justice, and the U.S. Department of Treasury also play key roles in supporting the operations of the Medicare program.

While both President TRUMP and Speaker JOHNSON have vowed to not cut Medicare benefits, it is not clear how the reorganizations, staff reductions, resignations and retirements, along with budget cuts within these federal agencies will impact the administration of the program, or have spillover effects on coverage and benefits for people with Medicare.

This brief highlights some of the key federal agencies and offices that play a role in making Medicare work and, to the extent possible, describes the recent staffing and organizational changes that could affect the operations of Medicare in the future, based on publicly available details. data related to staff reductions are likely to be conservative to the extent that they do not take into account employees who resigned as part of the “Fork in the Road” deferred resignation program or other voluntary departures or resignations, including early retirements, leaving unfilled positions within their respective offices.The information may also not reflect some number of employees who were let go and then asked to return to work, and do not account for potential increases in staff if federal courts intervene.

Centers for Medicare & Medicaid Services (CMS)

CMS, a federal agency within HHS, administers the Medicare program. CMS functions as an insurance payer and regulator, implementing and enforcing laws that affect Medicare beneficiaries, health plans, and providers, including approximately 380,000 Medicare-certified providers (such as hospitals and skilled nursing facilities), 1.5 million physicians and non-physician practitioners, and dozens of private insurers offering Medicare Advantage and Part D drug plans.

Within the scope of its statutory authority, CMS sets provider payment rates, makes coverage decisionsand coordinates benefits for beneficiaries. Its Center for Medicare serves as the central office for these policies and operations. Through its Center for Clinical Standards & QualityCMS develops and enforces quality and safety standards that providers must meet in order to participate in the Medicare and Medicaid programs. The agency also contracts with State Survey agencies to enforce nursing home standards and, through its Center for Program Integrityworks on efforts to combat fraud and abuse-often in collaboration with other entities, such as the HHS Office of Inspector General and the Department of Justice.

Through its Innovation centerCMS implements various health care and service delivery models designed to improve the quality and affordability of patient care and reduce health care costs. Additionally, through its Medicare-Medicaid Coordination OfficeCMS works with states and other entities to coordinate and streamline the delivery of Medicare and Medicaid benefits for people with both types of coverage (known as dual-eligible individuals). Further,the CMS Office of Minority Health has undertaken efforts to advance health equity in Medicare and other programs,such as the rural health initiative.

CMS is also responsible for consumer information and protections, including managing the 1-800-MEDICARE helpline, distributing the Medicare & You handbook, and supporting the Medicare Beneficiary Ombudsmanwhich assists beneficiaries with complaints, grievances, appeals, and other Medicare-related inquiries.

Many of these CMS activities are subject to notice-and-comment rulemaking, a process that involves review by the White House’s Office of Management and Budget (OMB).

While both President TRUMP and Speaker JOHNSON have vowed to not cut Medicare benefits, it is not clear how reorganizations will impact the program.

Recent staffing and organizational changes within CMS

According to a March 27, 2025 HHS documentCMS has reduced its workforce by 300 federal employees since the start of the TRUMP administration-about 4% of its staff. At the time, the agency did not clarify whether this figure includes employees who voluntarily accepted buyouts or elected early retirement. The TRUMP administration’s FY 2026 budget justification for CMSreleased May 30,2025,estimates 192 fewer full-time equivalent employees (FTEs) compared to FY 2025. The document acknowledges that these FTE levels are subject to change per the planned HHS reorganization.

While HHS has not publicly disclosed how these staffing reductions were distributed across CMS offices, media reports indicate that affected staff include those from the Medicare-Medicaid Coordination Office (about a third of its staff), Office of Minority Health (closure of the entire office), Office of Equal Possibility and Civil Rights (entire office), and the Office of Program Operations and Local Engagement. additionally, HHS eliminated half of its 10 regional offices-including those in Boston,Chicago,New York City,San Francisco,and Seattle-which serve 22 states and include CMS division offices. These regional offices enable HHS to maintain closer contact with state, local, and tribal governments in implementing HHS programs and policies, and develop and maintain partnerships with local organizations, including beneficiary coalitions and professional associations. According to an on-ed by HHS Secretary Robert KENNEDY, their functions will be transferred to HHS’ remaining regional offices and staff in Washington D.C.

Further,the TRUMP administration proposes in its FY 2026 HHS budget to shift the 340B Drug Pricing Program from the Health Resources and Services Administration (HRSA) to CMS. The 340B Program requires drug manufacturers participating in Medicaid to provide discounts on outpatient prescription drugs to certain safety net providers that treat low income and uninsured patients.

Social Security Administration

The Social Security Administration (SSA) plays a central role in determining Medicare eligibility and enrolling individuals into the program. In 2021,SSA enrolled 3.8 million new Medicare beneficiariesincluding one in seven (14%) who qualified for Medicare on the basis of receiving Social