Editor's note: This story will be updated. Check back for new analysis on the budget numbers.
On Friday, President Donald Trump released a document that outlines the ways he wants Congress to allocate money to federal health care programs.
The so-called skinny budget proposal contains less information than a draft of the budget that was leaked in late April. However, the total amount of cuts to healthcare agencies aligned with the proposals laid out in the leaked document
This is the first official look at the executive branch’s vision for healthcare spending after its massive reductions in force and reorganization of the Department of Health and Human Services.
Congress will ultimately set the discretionary funding levels for healthcare programs, and it does not have to follow the outline of the President.
“The administration is saying in their budget they want to give states the flexibility to decide how to spend money,” Jennifer said. “It’s sort of from the perspective that states know what their needs are… the other view as well is that could mean that some states may not spend money.”
Chrissie Juliano, executive director of Big Cities Health Coalition, said that shifting funding to states could create disparities in who gets funding. The effects will depend on the specifics of how the federal government shifts funding responsibilities to states. The primary areas that the budget proposes this is in some CDC grants and public health preparedness and responses initiatives.
“The best way to address local needs is to work with local health departments and their community partners to support the community’s resource needs, which includes not just funding, but also the type of subject matter expertise that is being decimated at the federal health agencies,” Juliano said. “Every level of government has a role to play in protecting and promoting the public’s health.”
The numbers outlined in the fiscal year 2026 budget request are for discretionary spending, which are the spending levels Congress sets each year through the appropriations process. The document does not include spending wishes for mandatory spending, which include Medicare and Medicaid.
“Mandatory is for programs that are in the law that basically say the federal government is going to pay for this program for whoever is eligible … even if it’s Medicaid and the cost of prescriptions goes up, we still cover it,” Jennifer Kates, Senior Vice President at KFF and Director of Global Health & HIV Policy, told Fierce Healthcare.
Kates continued: “Discretionary spending is a very different type of spending. It requires Congress to appropriate money every year for these programs and that money it appropriates, it may not be enough to cover everybody who needs the program, whereas if all of a sudden there were more people eligible for Medicaid, they would automatically get covered.”
Here are the top line numbers of President Trump’s FY2026 budget request. The numbers represent changes to the budgets of healthcare agencies compared to 2025 spending levels:
>Adds $500 million to the Make America Healthy Again Initiative
The new initiative, spearheaded by Health Secretary Robert F. Kennedy Jr., has its own budget line item in President Trump’s budget request. The request says that HHS’ MAHA Initiative will use the half billion outlay for “nutrition, physical activity, healthy lifestyles, over-reliance on medication and treatments, the effects of new technological habits, environmental impacts, and food and drug quality and safety,” the budget document says.
It also outlines an initiative whereby the federal government will send MAHA food boxes “that would be filled with commodities sourced from domestic farmers and given directly to American households.”
>Adds $5.4 billion to the Department of Veterans Affairs for medical care and electronic health record modernization.
>Subtracts $1.73 billion from the Health Resources and Services Administration
HRSA would see significant cuts under Trump’s preferred budget. The cuts he outlined include Ryan White HIV prevention efforts not related to medications and other programs like workforce training, maternal and child health programs, and family planning programs.
>Subtracts $3.5 billion from the Centers for Disease Control
Consolidates funding for Infectious Disease and Opioids, Viral Hepatitis, Sexually Transmitted Infections, and Tuberculosis programs into one grant program funded at $300 million. It also eliminates a slew of “unnecessary and duplicative programs.”
>Subtracts $17.97 billion from the National Institutes of Health
“NIH has broken the trust of the American people with wasteful spending, misleading information, risky research, and the promotion of dangerous ideologies that undermine public health,” the document says. It cites the COVID-19 lab leak theory and DEI-related grants as reasons for the massive cuts.
The document says it wants to refocus NIH into five entities: the National Institute on Body Systems Research; the National Institute on Neuroscience and Brain Research; the National Institute of General Medical Sciences; the National Institute of Disability Related Research; and the National Institute on Behavioral Health.
It would eliminate funding for the National Institute on Minority and Health Disparities.
NIH would retain $27 billion for research, the budget document proposes.
>Subtracts $1.07 billion from the Substance Abuse and Mental Health Services Administration
>Subtracts $129 million from the Agency of Healthcare Research and Quality
>Subtracts $674 million from Centers for Medicare and Medicaid Services (CMS) Program Management
>Subtracts $240 million from Administration for Strategic Preparedness and Response (ASPR) Hospital Preparedness Program
>Subtracts $180 million from the new Administration for a Healthy America—Sexual Risk Avoidance Program and Teen Pregnancy Prevention Program, HHS Office on Women’s Health, HHS Office of Minority Health
The Federation of American Hospitals' President and CEO, Chip Kahn, cautioned Congress to move forward carefully to maintain the integrity of healthcare programs.
“With the release of the President’s budget and proposed changes to our country’s health infrastructure, it’s critical that Congress tread carefully as it considers drastic Medicaid cuts that would eliminate millions of Americans’ coverage and access to care," Kahn said in a statement. "The budget, Congress's proposed Medicaid cuts, and the impending expiration of the enhanced tax credits should be considered as a whole with the health of our communities, patients’ coverage, and hardworking Americans’ access to care at the forefront.”
United for Medical Research slammed the nearly $18 billion in cuts to the NIH.
"The cuts proposed to the National Institutes of Health budget are shocking and would be devasting to the NIH, researchers doing groundbreaking work, patients and families hoping for cures, and America’s economy," United for Medical Research said in a press release. "If they were to occur, the United States would be giving up our global leadership in biomedical research to competitor nations along with all the benefits our leadership brings to U.S. citizens, our economy, and our national security."
Association of American Medical Colleges (AAMC) likewise decried the proposed cuts to NIH as "stunningly impractical" and said it would rescind the nation's position as the leader in biomedical research. AAMC said a $1 billion cut to HRSA is shortsighted in light of the healthcare workforce shortage.
“If enacted, the preview of the president’s budget request released today would yield to cancer, Alzheimer’s, diabetes, and other health threats facing Americans by dismantling federal support for medical research, public health, and health professions education that keeps the country healthy," Chief Public Policy Officer of the AAMC Danielle Turnipseed said in a statement. "Retreating on health issues where we have made progress and where so many depend on their government to offer promising cures is not the American way."