 Seal of the U.S. Department of Health & Human Services | |
 Flag of the U.S. Department of Health & Human Services | |
 Hubert H. Humphrey Building, Department Headquarters | |
| Department overview | |
|---|---|
| Formed | April 11, 1953 (as Department of Health, Education, and Welfare) May 4, 1980 (as United States Department of Health & Human Services) |
| Preceding agencies |
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| Jurisdiction | Federal government of the United States |
| Headquarters | Hubert H. Humphrey Building Washington, D.C., U.S. |
| Employees | 79,540 (2015) |
| Annual budget | $1.286 trillion (2020) |
| Department executives |
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| Website | HHS.gov |
The United States Department of Health and Human Services (HHS), also known as the Health Department, is a cabinet-level executive branch department of the U.S. federal government with the goal of protecting the health of all Americans and providing essential human services. Its motto is "Improving the health, safety, and well-being of America". Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).
HHS is administered by the Secretary of Health and Human Services, who is appointed by the president with the advice and consent of the United States Senate. The position is currently held by Xavier Becerra, who was confirmed as secretary on March 18th, following his nomination by President Joe Biden. The United States Public Health Service (PHS) is the main division of the HHS and is led by the Assistant Secretary for Health.
The United States Public Health Service Commissioned Corps, the uniformed service of the PHS, is led by the Surgeon General who is responsible for addressing matters concerning public health as authorized by the secretary or by the Assistant Secretary of Health in addition to his or her primary mission of administering the Commissioned Corps.
History
Federal Security Agency
The Federal Security Agency (FSA) was established on July 1, 1939, under the Reorganization Act of 1939, P.L. 76-19. The objective was to bring together in one agency all federal programs in the fields of health, education, and social security. The first Federal Security Administrator was Paul V. McNutt. The new agency originally consisted of the following major components: (1) Office of the Administrator, (2) Public Health Service (PHS), (3) Office of Education, (4) Civilian Conservation Corps, and (5) Social Security Board.
By 1953, the Federal Security Agency's programs in health, education, and social security had grown to such importance that its annual budget exceeded the combined budgets of the Departments of Commerce, Justice, Labor, and Interior and affected the lives of millions of people. Consequently, in accordance with the Reorganization Act of 1949, President Eisenhower submitted to the Congress on March 12, 1953, Reorganization Plan No. 1 of 1953, which called for the dissolution of the Federal Security Agency and elevation of the agency to Cabinet status as the Department of Health, Education, and Welfare. The plan was approved on April 1, 1953, and became effective on April 11, 1953.
Unlike statutes authorizing the creation of other executive departments, the contents of Reorganization Plan No. 1 of 1953 were never properly codified within the United States Code, although Congress did codify a later statute ratifying the Plan. Today, the Plan is included as an appendix to Title 5 of the United States Code. The result is that HHS is the only executive department whose statutory foundation today rests on a confusing combination of several codified and uncodified statutes.
Department of Health, Education, and Welfare
The Department of Health, Education, and Welfare (HEW) was created on April 11, 1953, when Reorganization Plan No. 1 of 1953 became effective. HEW thus became the first new Cabinet-level department since the Department of Labor was created in 1913. The Reorganization Plan abolished the FSA and transferred all of its functions to the secretary of HEW and all components of the agency to the department. The first secretary of HEW was Oveta Culp Hobby, a native of Texas, who had served as commander of the Women's Army Corps in World War II and was editor and publisher of the Houston Post. Sworn in on April 11, 1953, as secretary, she had been FSA administrator since January 21, 1953.
The six major program-operating components of the new department were the Public Health Service, the Office of Education, the Food and Drug Administration, the Social Security Administration, the Office of Vocational Rehabilitation, and St. Elizabeth's Hospital. The department was also responsible for three federally aided corporations: Howard University, the American Printing House for the Blind, and the Columbia Institution for the Deaf (Gallaudet College since 1954).
Department of Health & Human Services
The Department of Health, Education, and Welfare was renamed the Department of Health & Human Services (HHS) in 1979, when its education functions were transferred to the newly created United States Department of Education under the Department of Education Organization Act. HHS was left in charge of the Social Security Administration, agencies constituting the Public Health Service, and Family Support Administration.
In 1995, the Social Security Administration was removed from the Department of Health & Human Services, and established as an independent agency of the executive branch of the United States Government.
The 2010 United States federal budget established a reserve fund of more than $630 billion over 10 years to finance fundamental reform of the health care system.
Organization
Internal structure
The Department of Health & Human Services is led by the United States Secretary of Health and Human Services, a member of the United States Cabinet appointed by the President of the United States with the consent of the United States Senate. The secretary is assisted in managing the department by the Deputy Secretary of Health and Human Services, who is also appointed by the president. The secretary and deputy secretary are further assisted by seven assistant secretaries, who serve as top departmental administrators.
As of January 20, 2018, this is the top level of the organizational chart. HHS provides further organizational detail on its website.
Several agencies within HHS are components of the U.S. Public Health Service (PHS), as noted below.
- Secretary, deputy secretary, and chief of staff
- The Executive Secretariat (ES)
- Office of Intergovernmental and External Affairs (IEA)
- Headquarters Staff
- Regional Offices
- Office of Human Resources
- Office of Health Reform (OHR)
- Office of the Secretary
- Office of the Assistant Secretary for Administration (ASA)
- Office of Business Management
- Equal Employment Opportunity Office
- Office of Human Resources
- Program Support Center
- Office of the Chief Information Officer
- Office of the Assistant Secretary for Financial Resources (ASFR)
- Office of Budget
- Office of Finance
- Office of Grants
- Office of Acquisitions
- Office of the Assistant Secretary for Health (OASH)
- Office of the Surgeon General
- Office of Disease Prevention and Health Promotion
- Office of Human Research Protections
- Office of Infectious Disease
- Office of Minority Disease
- Office of Population Affairs
- Office of Research Integrity
- Office of Women's Health
- Office of the Assistant Secretary for Legislation (ASL)
- Office of the Assistant Secretary for Planning and Evaluation (ASPE)
- Office of the Assistant Secretary for Preparedness and Response (ASPR) – PHS component
- Office of the Assistant Secretary for Public Affairs (ASPA)
- Office for Civil Rights (OCR)
- Departmental Appeals Board (DAB)
- Office of the General Counsel (OGC)
- Office of Global Affairs (OGA) – PHS component
- Office of Inspector General (OIG)
- Office of Medicare Hearings and Appeals (OMHA)
- Office of the National Coordinator for Health Information Technology (ONC)
- Office of the Assistant Secretary for Administration (ASA)
- Operating Divisions
- Administration for Children and Families (ACF)
- Administration for Community Living (ACL)
- Agency for Healthcare Research and Quality (AHRQ) – PHS component
- Agency for Toxic Substances and Disease Registry (ATSDR) – PHS component
- Centers for Disease Control and Prevention (CDC) – PHS component
- Centers for Medicare & Medicaid Services (CMS)
- Food and Drug Administration (FDA) – PHS component
- Health Resources and Services Administration (HRSA) – PHS component
- Indian Health Service (IHS) – PHS component
- National Institutes of Health (NIH) – PHS component
- Substance Abuse and Mental Health Services Administration (SAMHSA) – PHS component
Office of Inspector General
The Office of Inspector General, U.S. Department of Health and Human Services (OIG) investigates criminal activity for HHS. The special agents who work for OIG have the same title series "1811" as other federal criminal investigators, such as the FBI, HSI, ATF, DEA and Secret Service. They receive their law enforcement training at the U.S. Department of Homeland Security's Federal Law Enforcement Training Center in Glynco, Georgia. OIG Special Agents have special skills in investigating white collar crime related to Medicare and Medicaid fraud and abuse. Organized crime has dominated the criminal activity relative to this type of fraud.
HHS-OIG investigates tens of millions of dollars in Medicare fraud each year. In addition, OIG will continue its coverage of all 50 states and the District of Columbia by its multi-agency task forces (PSOC Task Forces) that identify, investigate, and prosecute individuals who willfully avoid payment of their child support obligations under the Child Support Recovery Act.
HHS-OIG agents also provide protective services to the Secretary of HHS, and other department executives as necessary.
In 2002, the department released Healthy People 2010, a national strategic initiative for improving the health of Americans.
With the passage of the Fraud Enforcement and Recovery Act of 2009, and the Affordable Care Act of 2010, the Office of the Inspector General has taken an emboldened stance against healthcare related non-compliance, most notably for violations of Stark Law and the Anti-Kickback Statute.
In 2015, the OIG issued a fraud alert as a warning to hospitals and healthcare systems to monitor and comply with their physician compensation arrangements.
Recent years have seen dramatic increases in both the number and the amounts of Stark Law violation settlements, prompting healthcare experts to identify a need for automated solutions that manage physician arrangements by centralizing necessary information with regard to physician–hospital integration. Contract management software companies such as Meditract provide options for health systems to organize and store physician contracts. Ludi Inc introduced DocTime Log, an SaaS solution that specifically addresses this growing concern, automating physician time logging in compliance with contract terms to eliminate Stark Law and Anti-Kickback Statute violations.
According to a report released by the OIG in July 2019, more than 80 percent of the 4,563 U.S. hospice centers that provide care to Medicare beneficiaries surveyed from 2012 to 2016 have at least one deficiency and 20 percent have at least one "serious deficiency".
From January 2020, Christi Grimm became the principal deputy inspector general. She assumed the duties of an acting inspector general, because the inspector general post was empty. In April 2020, Grimm released a report which surveyed the state of hospitals in late March during the COVID-19 pandemic in the United States. The hospitals reported "severe shortages of testing supplies", "frequently waiting 7 days or longer for test results", which extended the length of patient stays and strained resources, and "widespread shortages of PPE". President Trump called the report "wrong" and questioned Grimm's motives. Later he called the report "Another Fake Dossier!" In May 2020, Trump nominated Jason Weida to be the permanent inspector general, pending confirmation by the U.S. Senate. According to a department spokeswoman, Grimm will remain as principal deputy inspector general.
Former operating divisions and agencies
- Social Security Administration, made independent in 1995.
- Health Care Financing Administration, renamed to Centers for Medicare and Medicaid Services
Relationship with state and local health departments
There are three tiers of health departments, the federal health department, state health department and local health department. In relation with state and local government, the federal government provides states with funding to ensure that states are able to retain current programs and are able to implement new programs. The coordination between all three health departments is critical to ensure the programs being implemented are well structured and suited to the corresponding level of health department. The health department at state level needs to safeguard good relations with legislators as well as governors in order to acquire legal and financial aid to guarantee the development and enhancements of the programs. Assemblies are set up to guide the relationships between state and local health departments. The state sets up the regulations and health policies whereas the local health departments are the ones implementing the health policies and services.
As of 2018, there are ten regional offices that have separated the states in groups of four to eight. These offices directly work with the state departments, local governments, and tribal councils. The directors from each regional office are appointed directly by the active president. The following individuals run each regional office.
- Region 1: John McGough
- Region 2: Dennis González
- Region 3: Matt Baker
- Region 4: Renee Ellmers
- Region 5: Douglas O'Brien
- Region 6: Mervin Turner
- Region 7: Jeff Kahrs
- Region 8: Brian Shiozawa
- Region 9: Lois G. Griffith
- Region 10: John R. Graham
Budget and finances
The Department of Health and Human Services was authorized a budget for fiscal year 2020 of $1.293 trillion. The budget authorization is broken down as follows:
| Program | Budget Authority (in millions) |
|---|---|
| Food and Drug Administration | $3,329 |
| Health Resources and Services Administration | $11,004 |
| Indian Health Service | $6,104 |
| Centers for Disease Control and Prevention | $6,767 |
| National Institutes of Health | $33,669 |
| Substance Abuse and Mental Health Services Administration | $5,535 |
| Agency for Healthcare Research and Quality | $0 |
| Centers for Medicare & Medicaid Services | $1,169,091 |
| Administration for Children and Families | $52,121 |
| Administration for Community Living | $1,997 |
| Departmental Management | $340 |
| Non-Recurring Expense Fund | $-400 |
| Office of Medicare Hearings and Appeals | $186 |
| Office of the National Coordinator | $43 |
| Office for Civil Rights | $30 |
| Office of Inspector General | $82 |
| Public Health and Social Services Emergency Fund | $2,667 |
| Program Support Center | $749 |
| Offsetting Collections | $-629 |
| Other Collections | $-163 |
| TOTAL | $1,292,523 |
The FY2020 budget included a $1.276 billion budget decrease for the Centers for Disease Control, and a $4.533 billion budget decrease for the National Institutes of Health. These budget cuts, along with other changes since 2019, comprised a total decrease of over $24 billion in revised discretionary budget authority across the entire Department of Health and Human Services for Fiscal Year 2020.
Additional details of the budgeted outlays, budget authority, and detailed budgets for other years, can be found at the HHS Budget website.
Programs
The Department of Health & Human Services' administers 115 programs across its 11 operating divisions. The United States Department of Health & Human Services (HHS) aims to "protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves." These federal programs consist of social service programs, civil rights and healthcare privacy programs, disaster preparedness programs, and health related research. HHS offers a variety of social service programs geared toward persons with low income, disabilities, military families, and senior citizens. Healthcare rights are defined under HHS in the Health Insurance Portability and Accountability Act (HIPAA) which protect patient's privacy in regards to medical information, protects workers health insurance when unemployed, and sets guidelines surrounding some health insurance. HHS collaborates with the Office of the Assistant Secretary for Preparedness and Response and Office of Emergency Management to prepare and respond to health emergencies. A broad array of health related research is supported or completed under the HHS; secondarily under HHS, the Health Resources & Service Administration houses data warehouses and makes health data available surrounding a multitude of topics. HHS also has vast offering of health related resources and tools to help educate the public on health policies and pertinent population health information. Some examples of available resources include disease prevention, wellness, health insurance information, as well as links to healthcare providers and facilities, meaningful health related materials, public health and safety information.
Some highlights include:
- Health and social science research
- Preventing disease, including immunization services
- Assuring food and drug safety
- Medicare (health insurance for elderly and disabled Americans) and Medicaid (health insurance for low-income people)
- Health information technology
- Financial assistance and services for low-income families
- Improving maternal and infant health, including a Nurse Home Visitation to support first-time mothers
- Head Start (pre-school education and services)
- Faith-based and community initiatives
- Preventing child abuse and domestic violence
- Substance abuse treatment and prevention
- Services for older Americans, including home-delivered meals
- Comprehensive health services for Native Americans
- Assets for Independence
- Medical preparedness for emergencies, including potential terrorism
- Child support enforcement
The Health Insurance Portability and Accountability Act (HIPAA)
This program is to ensure the accountability of medical professionals to respect and carry-out basic human health rights, under the act of the same name. In the United States, the government feels that it is essential for the American people to understand their civil duty and rights to all of their medical information. That includes: health insurance policies or medical records from every doctor or emergency visit in one's life. Through Health & Human services one is able to file a complaint that their HIPAA rights have been violated or a consultant that will be able to decide if their rights were violated.
Social Services
This branch has everything to do with the social justice, wellness, and care of all people throughout the United States. This includes but is not limited to people who need government assistance, foster care, unaccompanied alien children, daycares (headstart included), adoption, senior citizens, and disability programs. Social services is one of (if not) the largest branch of programs underneath it that has a wide variety throughout the United States at a state and local level.
Prevention and Wellness
The prevention and wellness program's main idea is to give the American people the ability to live the healthiest and best lifestyle physically that they can. They are the ones who deal with vaccines and immunizations, which fight from common diseases to deadly ones. The nutrition & fitness program that are the basics of healthy eating and regular exercise. Health screenings & family health history which are crucial in the knowledge of each individual's health and body. A severely important one especially in today's society is mental health & substance abuse in where they help people with mental illness and drug abuse. Lastly, they help with environmental health where people are researching and studying how our environments both physical and metaphorically have a short and long term effect on our health and wellness.
Strengthening Communities Fund
In June 2010, the Department of Health & Human Services created the Strengthening Communities Fund as part of the American Recovery and Reinvestment Act. The fund was appropriated $50 million to be given as grants to organizations in the United States who were engaged in Capacity Building programs. The grants were given to two different types of capacity builders:
- State, Local and Tribal governments engaged in capacity building: grants will go to state local and tribal governments to equip them with the capacity to more effectively partner with faith-based or non-faith based nonprofit organizations. Capacity building in this program will involve education and outreach that catalyzes more involvement of nonprofit organizations in economic recovery and building up nonprofit organization's abilities to tackle economic problems. State, Local and Tribal governments can receive up to $250,000 in two year grants
- Nonprofit Social Service Providers engaged in capacity building: they will make grants available to nonprofit organizations who can assist other nonprofit organizations in organizational development, program development, leadership, and evaluations. Nonprofits can receive up to $1 million in two year grants
Biodefense
HHS plays a role in protecting the United States against bioterrorism events. In 2018, HHS released a new National Biodefense Strategy required by passage of the 2016 Biodefense Strategy Act. The Biodefense Strategy required implementation of a biodefense strategy after a 2015 Blue Ribbon Study Panel on Biodefense report found that the 2009 National Strategy for Countering Biological Threats was inadequate in protecting the U.S. The strategy adopted these five central recommendations: creating a single centralized approach to biodefense; implementing an interdisciplinary approach to biodefense that brings together policy makers, scientists, health experts, and academics; drawing up a comprehensive strategy to address human, plant, and animal health; creating a defense against global and domestic biological threats; and creating a proactive policy to combat the misuse and abuse of advanced biotechnology.
HHS also runs the Biodefense Steering Committee, which works with other federal agencies including the Department of State, Department of Defense (DOD), U.S. Food and Drug Administration, Department of Homeland Security (DHS), and the Environmental Protection Agency. HHS specifically oversees Project BioShield, established in 2003 and operating since 2004, and its development and production of genetically based bio-weapons and vaccines. HHS together with DHS are authorized under the Homeland Security Act of 2002 to deploy the weapons and vaccines produced by Project BioShield on the US general public under martial law during "emerging terrorist threats" or public health emergencies. Both HHS and DHS have similar authorities through state-based legislation adopted from Model State Emergency Health Powers Act provisions.
Criticisms and controversies
In 2016, a published US Senate report revealed that several dozen unaccompanied children from Central America, some as young as fourteen years old, were released from custody to traffickers where they were sexually assaulted, starved or forced to work for little or no pay. The HHS sub agency Office of Refugee Resettlement (ORR) released approximately 90,000 unaccompanied children during 2013–2015 but did not track their whereabouts or properly screen families accepting these children.
To prevent similar episodes, the Homeland Security and Health & Human Services Departments signed a memorandum of understanding in 2016, and agreed to establish joint procedures within one year for dealing with unaccompanied migrant children. As of 2018 they have failed to do so. Between October and December 2017, officials from ORR tried to contact 7,635 children and their sponsors. From these calls, officials learned that 6,075 children remained with their sponsors. Twenty-eight had run away, five had been removed from the United States and fifty-two had relocated to live with a non sponsor. However, officials have lost track of 1,475 children. ORR claims it is not legally liable for the safety and status of the children once released from custody.
HHS is evidenced to be actively coercing and forcing bio-substances such as antipsychotics on migrating children without consent, and under questionable medical supervision. Medical professionals state that wrongly prescribed antipsychotics are especially dangerous for children, and can cause permanent psychological damage. Medical professionals also state DHS and HHS incarceration and separation policies are likewise causing irreparable mental harm to the children.
Children are also dying in HHS custody. The forced drugging, deaths, and disappearances of migrating Mexican and Central American children might be related to DHS falsely labeling them and their families as 'terror threats' before HHS manages their incarcerations. Despite a federal court order, the DHS separation practices started by Obama and mandated by the Trump administration's "zero-tolerance" policy have not been halted, and HHS has not stopped forcing drugs on the children it incarcerates.
Freedom of Information Act processing performance
In the latest Center for Effective Government analysis of 15 federal agencies which receive the most Freedom of Information Act (FOIA) requests published in 2015 (using 2012 and 2013 data, the most recent years available), the DHHS ranked second to last, earning an F by scoring 57 out of a possible 100 points, largely due to a low score on its particular disclosure rules. It had deteriorated from a D- in 2013.
