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On April 16, 2025, the Washington Post reported on a leaked budget proposal from the Department of Health and Human Services (HHS). Presidential and agency budgets can be confusing, especially in the context of legislative action in the U.S. House and Senate. This resource describes what this draft budget might mean and outlines a few of its policy proposals that will most significantly impact disabled Americans.
What is the President’s Budget?
Every year, the President of the United States sends a proposed budget to Congress, referred to as “The President’s Budget,” or the Presidential Budget. The President’s Budget includes costs for every program at every federal government agency, including new programs to be funded and old programs to be removed. However, the numbers in the President’s budget do not actually change the amount of funding that agencies or programs receive. Congress does not have to adopt the President’s budget.
That means Congress can spend funds as it sees fit, and it does not have to use the President’s budget to make decisions. Congress can spend funds in whatever way it determines during congressional negotiations. In this way, the President’s budget is what we call a messaging document, meaning it exists to send a message about the President’s top priorities and share them with Congress and the American people.
Members of the President’s party may pressure other members of Congress to support the President’s goals by supporting the President’s budget. The President also may try to pressure members of Congress to support certain parts of the budget. Still, ultimately, it is up to Congress what the budget of each federal agency looks like. This means that once the President’s budget is finalized, significant negotiations begin in Congress. It also means that none of these proposals will become policy without the active consent of Congress. There will be much more news about the budget to come in the next few weeks and months.
While this proposed draft HHS budget is a leak from one agency that is part of the President’s overall budget, AAPD expects the full final Presidential budget to come out in May. Congressional committees that oversee spending, i.e., appropriations committees, will then begin to discuss and negotiate how federal funds will be spent for the next fiscal year. They may consider the administration’s priorities in their discussions or disregard them as they develop Congress’s funding bill.
Why should I be concerned about a draft proposed budget?
The proposed HHS budget may or may not be the final version submitted to the Office of Management and Budget (OMB) and eventually Congress. However, this leaked draft shows that the Trump Administration has a desire to eliminate vast amounts of infrastructure and key programs to support disabled people, children, and older adults. The draft proposal would significantly reduce access to health equity services. Everyone should be concerned about the draft proposed budget, as it could substantially impact the future of healthcare, independent living, community integration, and disability rights in the United States.
What can I do to fight against this draft budget?
If you are worried about the changes outlined here and want to take action, you can contact your member of Congress to share how vital these programs are to you and people with disabilities. You can use this action alert from the National Disability Rights Network to easily contact your members of Congress to ask them to oppose these cuts.
Who does this draft proposed HHS budget harm?
If OMB accepts these proposals and they become part of the President’s budget, and appropriators adopt the proposals in the House and Senate, there will dire consequences and significant harm for disabled people, young children, families, caregivers, older adults, researchers, and organizations that provide critical services to millions of people around the country.
What are the most concerning parts of the proposed draft budget?
- Eliminating Disability-Related Agencies and Divisions: One of AAPD’s major concerns with the draft proposed budget is that it would eliminate several divisions and agencies within HHS that do essential work for our community. The budget document proposes to eliminate the following divisions and agencies: Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Healthcare Research & Quality, Administration for Community Living (ACL), Office for Civil Rights (OCR), Assistant Secretary for Technology Policy, Medicare Hearings and Appeals, and Administration for Strategic Preparedness and Response (ASPR). In particular, for disabled people and older adults, the elimination of ACL, HRSA, SAMHSA, OCR, and ASPR is seriously concerning, given the programs run and oversight provided by these agencies.
- Restructuring with Sweeping Program Eliminations: The draft proposed budget includes the proposed restructuring of HHS agencies and divisions. The Make America Healthy Again Commission and Initiative proposes to realign and eliminate specific programs. For example, the Make America Healthy Again Commission and Initiative proposes eliminating and realigning HRSA and parts of the CDC in a new entity called “Primary Care and Health Centers.” This reorganization proposal would eliminate programs for family planning, traumatic brain injury, elderly falls, rural hospital flexibility grants, and more. Within Maternal and Child Health Programs, the Autism and Other Disorders programs, Healthy Start, and Universal Newborn Hearing Screening programs would all be eliminated. Each of these programs significantly impacts people with disabilities and older adults around the country.
- Eliminating Almost All Programs for Mental Health: The draft budget proposes that SAMHSA be renamed “Mental Health” within a completely new reorganization of HHS. This reorganization, if finalized, would eliminate nearly every mental health program SAMHSA currently supports. Democrat and Republican administrations and members of Congress alike have long supported and prioritized funding for mental health programs across demographic groups, including women, children, and families. More than 40 programs would be shuttered under this proposal, leaving only some programs for substance use treatment, the 998 hotline, and youth suicide prevention to remain.
- ACL Program Reorganization & DD Program Elimination: The Administration for Community Living (ACL) is an essential entity that oversees independent and community living programs for people with disabilities and older adults across the entire federal government. ACL, perhaps more than any other federal entity, makes real the promise of true integrated community living. The draft HHS budget proposes dismantling ACL and either moving or outright eliminating many of the programs that ACL operates. The draft HHS budget proposes removing nearly all programs authorized by the Developmental Disabilities Assistance and Bill of Rights Act (DD Act). Eliminating these programs means ending forms of legal assistance for disabled people, research on disability, development of new disability leaders and practitioners, and state leadership and technical assistance.
- That includes Protection and Advocacy (also known as P&A) programs – meaning organizations that provide free legal assistance and advocacy for people with disabilities, guard against abuse, ensure access and accountability in health care, education, employment, housing, transportation, voting, and within the juvenile and criminal justice systems. State Councils on Developmental Disabilities; Voting Access for People with Disabilities; University Centers for Excellence in Developmental Disabilities (UCEDDs); the National Institute of Disability, Independent Living, and Rehabilitation Research (NIDILRR); and the Limb Loss Removal Resource Center – all essential programs that would be eliminated.
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- One program the proposed budget would maintain but drastically change is grants for independent living. Currently housed within ACL, the draft budget proposes moving these grants to ACF. The proposal appears to suggest consolidating all “disability programs” within independent living grants in block-grant-style funding to states. This would boil down a complex and vast ecosystem of disability-related grant programs within independent living grants and would result in community living and independent living services becoming further varied for disabled people by state.
- Block-grant funding provides states with federal funds for a very broad scope of work. Block-grant funding doesn’t usually work for disability and healthcare programs because the needs of the disability community are too complex and nuanced.
- One program the proposed budget would maintain but drastically change is grants for independent living. Currently housed within ACL, the draft budget proposes moving these grants to ACF. The proposal appears to suggest consolidating all “disability programs” within independent living grants in block-grant-style funding to states. This would boil down a complex and vast ecosystem of disability-related grant programs within independent living grants and would result in community living and independent living services becoming further varied for disabled people by state.
- Remove Head Start and Other Children and Families Programs: The draft budget proposes removing programs under the Administration for Children and Families (ACF), including Head Start. Head Start is a critical program that provides free child care services for families with children from birth through age five. Head Start programs support children with disabilities and disabled parents. Head Start has been providing services to families since 1965. This proposed budget seeks to eliminate all federal funding for the program.
- Reorganization and Elimination of Programs at the National Institutes of Health (NIH): Historically, there has been bipartisan support for the National Institutes of Health (NIH) and the extensive medical and scientific research the NIH conducts. The draft proposed budget eliminates several institutes and centers within NIH and consolidates other programs. These changes would seriously impair and reduce the work carried out by NIH. The National Institute for Nursing Research, National Center for Complementary and Integrative Health, Fogarty International Center, and National Institute on Minority Health and Health Disparities are all eliminated in the proposed budget. The National Institute on Minority Health and Health Disparities is a critical source of data and research specific to the health and care barriers faced by the disability community. Further, all remaining institutes and centers that are not cut would be consolidated into only eight centers/institutes. This attack on NIH could cause serious harm to the future of scientific discoveries and health research, which would likely reduce the quality of life of people with disabilities and take away essential resources and information the disability community needs.
- Centers for Disease Control and Prevention (CDC) Reorganization and Sweeping Program Elimination: Similar to other components within HHS, the proposed draft budget presents a “reform” of the Centers for Disease Control and Prevention (CDC). The following programs would be eliminated: Prevention and Public Health Fund; National Center for Viral Hepatitis, STD, & TB Prevention; Lyme Disease, Prion Disease, Chronic Fatigue Syndrome, & Harmful Algal Bloom; National Center for Chronic Disease Prevention & Health Promotion; and Global Health Center. The Office for Preparedness and Response would be eliminated, establishing a new Center for Preparedness and Response. The Strategic National Stockpile is proposed to sell all surplus, and the Hospital Preparedness Program Cooperative Agreement, the Office of Medical Reserve Corps, and the HHS Coordination Operations Response Element would all be eliminated. If these programs are eliminated outright, the United States government will be unable to mount an appropriate response to future epidemics and pandemics.