Last week, the White House Office of Management and Budget (OMB) released its fiscal year (FY) 2026 discretionary funding request to Congress on its President’s Budget webpage. The administration released a “skinny” FY 2026 president’s budget first (as expected) and will likely issue a complete budget later in May or June. Each administration is required by law to submit a budget to Congress annually. It often takes time for new administrations to complete their first budget, so most administrations in their first year submit the budget to Congress in stages, with a high-level overview first followed by a comprehensive budget.
The “skinny” budget released last week represents the first stage in the budget submission process – and therefore it does not encompass the full president’s budget. President’s budgets in general are supposed to provide an overview of the administration’s priorities, and while last week’s skinny budget does provide some insight into the administration’s goals for the next year, it does not offer a complete picture. When it comes to the US Department of Health and Human Services (HHS) especially, we still need several pieces to complete the full budget puzzle.
Keeping with the puzzle analogy, here are the pieces that the skinny budget for HHS included and those that are still missing:
Included Puzzle Pieces: OMB states that the skinny budget represents the FY 2026 discretionary funding request to Congress. Discretionary funding is the part of the federal budget that is subject to the congressional appropriations process. The skinny budget provides top-line numbers for each federal department. Overall, the skinny budget includes a non-defense discretionary funding request of $163 billion, a 22.6% reduction from current levels. The skinny budget requests a discretionary funding level of $93.8 billion for HHS, a 26.2% decrease from the FY 2025 level of $127 billion.
Missing Puzzle Pieces: The skinny budget does not include the “mandatory” budget request that president’s budgets have historically included. Administrations typically have ideas for how to reform existing programs that do not rely on annual appropriations, and they can present those proposals to Congress’s authorizing committees for consideration through the president’s budget. For example, President Trump in his first term included many proposals in his budgets for how to reform Medicare and Medicaid and cut down on fraud, waste, and abuse. It remains to be seen whether the complete FY 2026 president’s budget will include any such proposals.
Included Puzzle Pieces: The skinny budget includes funding requests for some of HHS’s agencies and offices, programs, and activities in a table labeled “Major Discretionary Funding Changes.” The table provides the name of the program, the change in funding compared to FY 2025 levels, and a short justification for the recommended funding increase or decrease.
Below is a table I put together that compares the FY 2026 requests for the HHS agencies and offices that are included in the “Major Discretionary Funding Changes” section of the skinny budget to FY 2025 levels. The skinny budget only includes the difference between the FY 2026 requests and the FY 2025 levels for certain HHS agencies and offices and not the actual FY 2025 or requested FY 2026 funding levels themselves. Thus, I used previous budget documents to estimate FY 2025 levels and then used those to determine what the FY 2026 requests could be.
| Selected Programs Highlighted in Budget (Dollars in millions)* | Approximate FY 2025 Levels | FY 2026 Skinny Budget Request | Difference | % Difference |
| Health Resources and Services Administration (HRSA) | $9,487 | $7,755 | -$1,732 | -18% |
| Centers for Disease Control and Prevention | $8,366 | $4,778 | -$3,588 | -43% |
| National Institutes of Health | $45,447 | $27,482 | -$17,965 | -40% |
| Substance Use and Mental Health Services Administration (SAMHSA) | $7,370 | $6,305 | -$1,065 | -14% |
| Agency for Healthcare Research and Quality (AHRQ) | $374 | $245 | -$129 | -34% |
| Centers for Medicare & Medicaid Services (CMS) Program Management | $4,125 | $3,451 | -$674 | -16% |
| Total HHS | $127,000 | $93,700 | -$33,300 | -26% |
*This is not a complete overview of the budget. Therefore, the totals do not add up. Also, these numbers may change after taking into account HHS’s restructuring initiative (discussed more below). Bolded numbers are those explicitly specified in the skinny budget.
Beyond including funding for those agencies in the table above, the skinny budget also provides $500 million to support the Make American Healthy Again initiative, and notes that funding levels for the HHS Office of Minority Health and Office on Women’s Health will be reduced. The skinny budget eliminates the following programs and activities within other HHS agencies and offices:
Missing Puzzle Pieces: The skinny budget does not include complete funding levels for the following agencies and offices within HHS (as the department is structured currently):
The budget also does not include funding requests for new offices and agencies that HHS already announced would be formed through its major restructuring effort.
Included Puzzle Pieces: The skinny budget references the HHS restructuring effort, including describing HRSA and SAMHSA, agencies that HHS announced would be eliminated and integrated into the new Administration for a Healthy America (AHA), as “former” agencies. The skinny budget briefly mentions that the AHA has been “newly formed.” Further, the skinny budget states that “consistent with the recent announcement of HHS reorganization, AHRQ’s functions are now a part of the new HHS Office of Strategy.”
Missing Puzzle Pieces: The skinny budget does not include any funding requests for the new offices and agencies within HHS:
As described in a previous Regs & Eggs blog post, a leaked OMB FY 2026 discretionary budget “passback” document provided a preliminary look at how HHS will restructured (including a detailed schematic) and how much funding HHS would need for new offices and agencies. However, the skinny budget does not provide any such information. And since the skinny budget only includes funding levels for current HHS agencies and offices, and not new ones, it does not take into account how funding for current HHS agencies and offices would change once HHS is restructured. For example, the skinny budget describes reductions to the current budgets of HRSA, SAMHSA, and AHRQ. However, HHS’s restructuring announcement, the OMB passback leaked document, and the skinny budget’s references to these agencies as former ones seem to suggest that the actual FY 2026 funding requests for these agencies should be $0. Funding levels for other current agencies also will change as they take on new responsibilities and staff from the parts of HHS that are being eliminated. CMS’s discretionary program management budget, for example, is reflected in the skinny budget as a $674 million cut – but the OMB passback document (while preliminary) includes a slight increase to the same budget because CMS is set to absorb a few major programs from ACL and HRSA. In other words, while the administration is requesting a reduction to CMS’s core budget, CMS may wind up needing more funding than what it currently has once HHS completes its restructuring and CMS’s responsibilities grow.
The skinny budget does not follow the OMB passback document’s approach of including funding requests for each of the new agencies and offices that HHS plans to create, zeroing out funding for all the agencies and offices that the administration plans to eliminate, and shifting certain programs and their associated funding around to different parts of HHS, but the complete FY 2026 president’s budget may do so. If that ends up occurring, final budget requests for at least some of the current HHS agencies and offices could appear different from how they are presented in the skinny budget – even if the programmatic reductions described in the skinny budget as well as the top-line total funding request for HHS remain the same.
The missing puzzle pieces may create some uncertainty around how the administration plans to restructure HHS and how much funding it wants to support both current and new HHS agencies and offices. Thus, it could be useful to see the complete FY 2026 president’s budget to better understand the administration’s new vision for HHS. In terms of next steps, Secretary Robert F. Kennedy Jr. plans to testify before the US Senate’s Health, Education, Labor, and Pensions Committee on May 14, 2025, likely before the complete budget is submitted to Congress. During that hearing, he may be able to fill in some of the missing pieces and provide clarity on HHS’s current and future efforts to restructure the department. Once the full president’s budget is issued in the coming weeks (and the budget puzzle is hopefully completed), Congress will assess the budget’s funding requests and attempt to finish the full appropriations process before the start of the new fiscal year on October 1, 2025. I will keep you updated on how the budget process progresses!
Until next week, this is Jeffrey saying, enjoy reading regs with your eggs.
