Nursing home surveys – already an area of trouble given chronic underfunding – are set to fall into deeper turmoil amid massive workforce cuts and restructuring planned at the Department of Health and Human Services (HHS).

Chiquita Brooks-LaSure, former chief of the Centers for Medicare and Medicaid Services (CMS), expressed skepticism that the Trump administration’s staff cuts to federal health agencies won’t impact health programs – including those that aid nursing home residents.

Notably, nursing home surveys will likely be affected by impending cuts and a federal hiring freeze, Brooks-LaSure said during a press conference on Friday. She is currently a senior fellow at the progressive think tank The Century Foundation.

“One of the reasons why I talk so much about my concerns around nursing homes is really [it’s] the part of the agency that is responsible for doing surveys—that has been underfunded,” said Brooks-LaSure. “If you’re going to ask the agency to do more, like take on responsibilities from some of the public health sister agencies that might be going away, you have to make sure that you’re sufficiently providing the resources, or else it will pull from Medicare and Medicaid.”

The Department of Health and Human Services announced 300 jobs, or about 4% of the workforce at CMS, would be cut as part of restructuring plans led by HHS Secretary Robert F. Kennedy Jr. The CMS cuts are part of a reduction in the HHS workforce from 82,000 to 62,000 full-time employees.

HHS also plans to consolidate regional field offices, shrinking them from 10 per region to 5, which could impact surveys and their timely completion and reporting.

Nursing home advocates, such as LeadingAge, have voiced concerns in recent days that the closure of regional offices will likely hinder CMS’ ability to conduct surveys – a process already plagued by delays given a shortage of surveyors. The cuts could also affect certifications, provider compliance, and addressing of disputed citations. 

While Secretary Kennedy said the HHS budget and staff increased sharply under the Biden administration, Brooks-LaSure countered that many of these divisions were chronically underfunded for years and deserve more attention, not less.

In addition to survey concerns, Brooks-LaSure said oversight of Medicare Advantage plans, state Medicaid benefits and enforcing nursing home regulations were also in jeopardy with the staff cuts.

Federal workers stationed at regional offices are responsible for such oversight, she said. While Republicans said they are seeking out fraud and abuse, staff cuts could do the opposite when it comes to cracking down on certain business practices by Medicare Advantage plans, she said.

Overall, Brooks-LaSure said the current administration’s claim that workforce reductions won’t impact Medicare or Medicaid is extremely dubious considering many fired workers influence the rollout of the Medicare and Medicaid programs.

Hiring and firing of government staff, as well as modernizing out-of-date systems, should be easier, she said. But the administration’s “cavalier way” of executing massive staff cuts, and with limited transparency, is worrisome, added Brooks-LaSure.

“I think it’s on them to prove that the claim is true,” said Brooks-LaSure. “There’s just no way that there isn’t incredibly long-term harm to the people who depend on CMS programs.”