Trump administration cuts to CMS staff raise concerns from Democratic lawmakers

Democrats are pushing back on Trump administration cuts to CMS’ 6,700-employee staff, which they say may adversely affect the functioning of the U.S. healthcare system.

On March 5, senior Senate Democrats wrote Stephanie Carlton, acting administrator, CMS, about “efforts to fire employees across” CMS in response to an executive order implementing a workforce optimization initiative. They said the firings stem from a Jan. 20 executive order, titled Restoring Accountability to Policy-Influencing Positions within the Federal Workforce, and the staff reduction “circumvents congressional authority.”

“According to reports, firings have taken place across the agency, in partnership with Elon Musk’s Department of Government Efficiency (DOGE) and are expected to continue in the coming weeks,” wrote Sens. Ron Wyden (D-Ore.), ranking member of the Finance Committee and Angus King (I-Maine). “We are concerned that these firings will have a direct and negative impact on the health care of millions of Americans.”

The senators wrote that they understand CMS has been directed to make additional staffing reductions.

“Before any further reductions take place, Congress needs a full understanding of the actions that have been taken to date,” they wrote.

Similarly, senior House Democrats wrote Carlton on March 10 “regarding the Trump Administration’s arbitrary and reckless purge of executive branch workers at federal health agencies, including” CMS.

They said Musk “forced agency officials to eliminate thousands of jobs that are critical to ensuring 160 million Americans receive high-quality and safe health care through the very programs President Trump has vowed to protect—including individuals who work on Medicare and Medicaid.”

They cited a February report in Politico that an unspecified number of CMS employees were let go amid firings of 3,600 probationary employees across HHS. They reportedly included staff at the Centers for Medicare and Medicaid Innovation and an office that “oversees Obamacare.”

“We are deeply concerned that this arbitrary and unilateral firing of federal health staff will only harm the health and well-being of families, children, and older Americans across the country, while risking instability to the entire U.S. health system,” wrote the Democrats, including Rep. Frank Pallone (D-N.J.), ranking member of the Energy and Commerce Committee, which oversees CMS.

Scope of firings

The letters cited various published news reports to identify where the firings have occurred at CMS, including:

• Officials working on a pilot program in Medicaid to improve maternal health outcomes
• CMMI employee working on improving care for Medicare Advantage enrollees
• 80 employees at the Center for Consumer Information and Insurance Oversight
• Staff working to prevent fraud, waste and abuse

CMS did not respond to requests to confirm the total number of staff released but STAT cited a senior CMS official, who said at least 300 employees were let go, which is nearly 5% of its 6,700-member workforce.

The Democrats alleged DOGE targeted “probationary employees,” which include workers recently hired, promoted, or transferred between agencies, because they have fewer protections than employees who have completed their probationary period. They also asserted Trump’s own political appointees were unaware of who and why staff were fired by DOGE.

Why undertaken

The administration’s executive order cited by both letters said, “In recent years, however, there have been numerous and well-documented cases of career federal employees resisting and undermining the policies and directives of their executive leadership.  Principles of good administration, therefore, necessitate action to restore accountability to the career civil service, beginning with positions of a confidential, policy-determining, policy-making or policy-advocating character.”

It cited previous internal federal polling to that found:

• 41% of civil service supervisors were confident they could remove an employee who engaged in insubordination or serious misconduct
• 26% of supervisors were confident that they could remove an employee for poor performance

The executive order directed the creation of a new employment category of federal staff, which would shift their employment to at-will and allow termination without cause — which is common in the private sector.

CMS is composed of six centers and oversees Medicare, Medicaid the Children’s Health Insurance Program, and the Affordable Care Act (ACA) Marketplaces, and distributes more than $1.5 trillion in payments annually, according to its FY24 fiscal report.

Many federal firings by DOGE have been challenged in court and some have been reversed by federal judges. For example, on March 14, HHS moved to reinstate about 15 attorneys who had been dismissed, who worked on the backlog of Medicare appeals.

The House Democrats asked for details from CMS on firings and plans for future terminations by mid-March. The Senate Democrats also asked for a written response, as well as in-person briefing on the issue with senior CMS staff.