The Trump administration’s new political review process for HHS funding is causing significant delays in the release of critical grants, impacting public health programs across the country. States and health organizations are waiting for millions in grants to expand essential services, but the new review process is slowing down the distribution of these funds.
The process begins with an AI screening that flags certain keywords, followed by a financial review and political approval at multiple levels, including the White House’s Office of Management and Budget (OMB). This new system is causing unprecedented backlogs, putting key public health programs at risk and straining states and local organizations that rely on federal dollars.
The Impact of Delays on Public Health Programs
The delays are having a significant impact on public health programs. The Centers for Disease Control and Prevention (CDC) has been delayed in posting around 30 grants totaling approximately $728 million. At the Substance Abuse and Mental Health Services Administration (SAMHSA)more than half of its projected $700 million worth of grants this year has been held up.
Lori Tremmel FreemanCEO of the National Association of County and City Health Officials (NACCHO)expressed concern about the delays. “If we start to see these delays extended because of these approvals, things will have to stop,” she said. “There’s no off-ramp. It just stops.” State and local health departments typically receive around 25% of their funding from federal grants, and delaying that money will quickly lead to cuts in service.
The longer-term impacts of these delays are concerning. “The longer-term impacts of that is people won’t be as healthy,” Tremmel Freeman said. “They won’t be able to get what they need.” The delays are making it difficult for clinics to plan annual budgets and provide stability to workers whose salaries are reliant on the grants.
The New Review Process
The new review process involves a nine-step procedure that starts with an AI review and ends at the White House budget office. Every funding notice “must pass through political review at multiple levels to ensure alignment with Agency priorities,” according to internal documents obtained by NOTUS.
A former senior career staffer at the CDC, who served under four administrations, noted that fewer than five or six grant notices in a year would typically get reviewed at the HHS level. Now, all of them are subject to review. A SAMHSA employee said the agency does not have “immediate access” to funds that Congress has already approved. Grant opportunities “have been held up and are waiting for department-level approval before we can move those out,” the employee said.
Potential grant recipients have reported that funding opportunities they had anticipated applying for and receiving were repeatedly delayed starting early this year. “Things keep getting stuck within the HHS approval process,” said Chuck Ingogliapresident and CEO of the National Council for Mental Wellbeing.
The Broader Implications
The changes are part of a larger trend across the administration. President Trump signed an executive order last year requiring more political oversight of federal grants. Last month, the OMB proposed codifying the mandate that senior political appointees review any potential award for compliance with “the president’s policy priorities” and that they avoid any diversity, equity, and inclusion initiatives.
The Interior Department has also added new layers of political review to its grants process, leading to a backlog of hundreds of millions of dollars in funds. The administration recently put an end to a similar system at the Federal Emergency Management Agency (FEMA) after bipartisan outrage over slowed disaster aid.
Several employees and grant recipients expressed concern that the administration is pressuring agencies to implement the proposed rule despite it not yet having any effect. “The rule is fundamentally about accountability and ensuring that we are able to have good oversight of the grant process and that it is in alignment with the administration’s agenda,” said Hal Duncanan OMB official.
Sen. Patty MurrayD-Wash., the top Democrat on the Senate Appropriations Committee, criticized the changes at HHS, saying they are politicizing federal grants and creating the kind of red tape Trump’s Department of Government Efficiency sought to eliminate. “It’s undermining America’s edge in research, holding up funding for front-line responders, and denying resources and services to communities because of politics,” Murray said.
Emily Hilliardan HHS spokesperson, dismissed the notion that delays or politics have had any negative repercussions. All grant funding opportunities “follow the standard review and approval process,” Hilliard said. “Once finalized, HHS will release remaining notices of funding opportunities for Fiscal Year 2026.”
