The Trump administration announced Thursday that it would slash 10,000 jobs at the U.S. Department of Health and Human Services (HHS), including roles at the Centers for Medicare and Medicaid Services (CMS), which controls government health insurance programs crucial to the home health community.

The cuts are part of a dramatic restructuring of the agency spurred by President Donald Trump’s ‘Department of Government Efficiency’ initiative. Approximately 300 of the layoffs will impact CMS employees – a reduction of about 4% of the agency’s total workforce, according to the Wall Street Journal. The Trump administration says the CMS layoffs will focus on “reducing minor duplication across the agency.”

“This reorganization will not impact Medicare and Medicaid services,” a HHS fact sheet read.

While the Trump administration has insisted that it would protect Medicaid and Medicare, efforts to curb federal spending have been connected to potential Medicaid budget cuts. Home-based care leaders have been outspoken that Medicaid budget cuts could reduce access to critical home-based services.

In a video posted on HHS’s YouTube channel about the restructuring, HHS Secretary Robert Kennedy Jr. called the organization he now leads “inefficient as a whole”

“Our key services delivered through Medicare and Medicaid, the FDA and the CDC, and other agencies, will enter a new era of responsiveness and a new era of effectiveness …” Kennedy said. “This will be a painful period for HHS as we downsize from 82,000 full-time employees to around 62,000.”

HHS will also collapse its 28 divisions into 15 new divisions and redistribute several programs as part of the restructuring.

The Administration for Community Living (ACL), which operates programs geared toward older adults and people with disabilities, including some relating to home and community-based services, is among those set to be eliminated. CMS, the Administration for Children and Families and the Assistant Secretary for Planning and Evaluation will absorb its programs.

“Today, HHS announced a reorganization that would be devastating to the aging and disability communities, proposing to eliminate the Administration for Community Living and spread its programs out across a number of agencies. ACL’s programs are literally life sustaining — meals for older adults, in-home supports for disabled people and older adults aging in place and helping people return home from hospitals and nursing homes,” Alison Barkoff, former acting administrator and assistant secretary for aging at the ACL, wrote on LinkedIn.

“There has been so much announced in the last few weeks that hurt older adults and disabled people — cuts to the Social Security Administration, proposed cuts to Medicaid and SNAP, elimination of the Department of Education, and more,” Barkoff continued. “This is yet another.”

Along with wasteful spending, Kennedy cited increasing rates of chronic disease among the reasons to slash HHS’ workforce. The National Alliance for Care at Home (The Alliance) has previously lauded Kennedy’s focus on chronic disease. The Alliance declined Home Health Care News’ request for comment on the HHS layoffs.

HHS’ new strategy will focus on “safe, wholesome food, clean water and the elimination of environmental toxins.” The organizational overhaul will save $1.8 billion per year, according to the agency’s announcement.

Family caregiver advocacy group Caring Across Generations spoke out against the HHS reorganization in a statement released late Thursday.

“We are deeply worried that organizational changes and workforce reductions will only exacerbate our country’s patchwork care infrastructure that millions of families are already struggling from,” Nicole Jorwic, chief of campaigns and advocacy at Caring Across Generations, said. “Rather than fulfilling campaign promises to help families, President Trump is relentlessly continuing to pursue his political agenda even if that means causing continued harm to older adults, disabled people, caregivers and care workers.”

The CMS layoffs could directly limit patients’ access to care, according to Dr. Wayne A. I. Frederick, interim chief executive officer of the American Cancer Society and the American Cancer Society Cancer Action Network.

“Public servants at CMS help the almost 148 million people who have health insurance through Medicaid, including roughly 1 in 3 children with cancer, and Medicare nationwide,” Frederick said. “Reducing a workforce dedicated to providing health insurance coverage that makes it possible for individuals to see a doctor regularly, get cancer screenings and access cancer treatment or survivorship care could have life-threatening consequences.”

LeadingAge, an advocacy organization of nonprofit providers of aging services, urged HHS not to let older adults and the providers who serve them be “an afterthought.”

“Cutting the staff responsible for carrying out agency and department activities raises obvious questions: how will the work that our members rely on get done?” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement. “How will their ability to serve older adults and ensure quality care be impacted? And will today’s announcements limit older adults’ and families’ ability to access care and services?”