The Trump Administration Is Holding Up Billions in HHS Funding

States and health organizations are waiting for $211 million in grants to grow their 988 suicide hotline capacities, $75 million to build out global disease outbreak response, $3 million to build treatment centers for opioid addiction and $95 million for programs that “improve the overall performance of the public health system.” And the list goes on.

The Trump administration is holding up billions in grant funding because of a new political review process that goes up through Health Secretary Robert F. Kennedy Jr. and the White House.

To get congressionally approved dollars out the door, all HHS funding opportunities must first clear an AI screening which flags certain keywords that the administration finds unacceptable, such as culture, harm reduction, gender and transgender. Then they’re sent to an HHS assistant secretary for financial review for approval before going to Kennedy’s office.

The final step is outside HHS altogether: The White House’s Office of Management and Budget must give a final sign-off before all funding opportunities are approved.

Internal documents, public records and interviews with a dozen current and former HHS employees and grant recipients all demonstrate the Trump administration’s new spending regime is leading to unprecedented delays in the release of funds.

The backlogs are putting key public health programs at risk and causing a strain on states and local organizations that rely on the federal dollars to carry out key health activities, these sources say.

“If we start to see these delays extended because of these approvals, things will have to stop,” said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials. “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, she said.

“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 process delayed the Centers for Disease Control and Prevention from posting around 30 grants, totalling around $728 million. At the Substance Abuse and Mental Health Services Administration, more than half of its projected $700 million worth of grants this year were held up.

The day after NOTUS reached out to HHS for comment on the backlog, the department began opening up a slew of those grants that had been repeatedly delayed since late last year for application. SAMSHA’s backlog is now down to $286 million in pending grants. CDC cut its backlog to $630 million.

Two HHS employees told NOTUS that the new review policy went into effect in fiscal 2026. The delays are impacting hundreds of states, municipalities and organizations.

A document obtained by NOTUS lays out the nine-step process for posting online notices of HHS funding opportunities, starting with the AI review and ending at the White House budget office. The document shows that every funding notice “must pass through political review at multiple levels to ensure alignment with Agency priorities,” steps that current and former department officials, as well as grant recipients, said marked a departure from the normal procedure.

One former senior career staffer at the CDC who served under four administrations said fewer than five or six grant notices in a year would typically get reviewed at the HHS level. Now, it’s all of them.

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 told NOTUS funding opportunities they had anticipated applying for and receiving were repeatedly delayed starting early this year, with staff citing the reviews as an explanation.

“Things keep getting stuck within the HHS approval process,” said Chuck Ingoglia, president and CEO of the National Council for Mental Wellbeing.

Dr. Philip Huang, director of the Dallas County Health and Human Services, said federal funding makes up 90% of his department’s budget. Lately, he said, there’s been a slowdown in grant opportunities. Very few were released between January and May.

“It’s really been very quiet,” Huang said, adding that his department has already gone through layoffs due to prior disruptions from federal funding under President Donald Trump.

One CDC employee briefed on the new process said it has allowed political appointees to preselect which entities are eligible for grants.

“They will say, ‘These applicants won’t make the cut,’ and we will have to go with that,” the employee said.

HHS earlier this year sought to terminate thousands of SAMHSA grants, but quickly walked back that decision after facing bipartisan pushback. The employee there said funding opportunity approvals typically would occur within the agency, but they now move up to HHS appointees and the secretary’s office. Individual centers within SAMHSA have been “caught off guard,” the staffer said, as the offices have dealt with “slow rolling” from department higher-ups.

“It is going even slower than it had last year,” the person said. “Things are stagnant. When you ask for an update, there is never really an update.”

The CDC employee said staff overseeing grants are taking care in their drafting of funding opportunities to ensure nothing can be construed as supporting diversity or other efforts that would offend the Trump administration. They are telling applicants to do the same.

“[We] can’t just do the work, follow the science,” the employee said. “We have to make sure it’s done in a way that does not conflict or cause retaliation.”

The changes are part of a larger trend across the administration. Trump signed an executive order last year requiring more political oversight of federal grants. Last month, 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, as NOTUS first reported. The administration recently put an end to a similar system at the Federal Emergency Management Agency after bipartisan outrage over slowed disaster aid.

Several employees and grant recipients expressed concern 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,” Hal Duncan, an OMB official, told lawmakers on Tuesday during a confirmation hearing to be the agency’s deputy director.

Sen. Patty Murray (D-Wash.), the top Democrat on the Senate Appropriations Committee, told NOTUS the changes at HHS 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. “Putting a Trump-appointed goon in front of every basic grant that is otherwise ready to go is nothing short of self-sabotage.”

Emily Hilliard, an 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.”

In the meantime, health programs reliant on federal funds are growing concerned they won’t be able to serve their communities. Ingoglia, the National Council for Mental Wellbeing president, said he’s most worried about delays to a bucket of funds that help behavioral health clinics reach more patients. It’s one of the larger and more significant programs to help expand access to mental health and substance abuse services to Americans, especially those who can’t afford it.

“The communities — providers, local municipalities etc. – are just waiting,” said one former senior HHS official who still works in the HHS grant space. That person described the delays caused by the reviews as unprecedented and said the backlogs are having significant downstream impacts.

The delays are making it hard for clinics to plan annual budgets and provide stability to workers whose salaries are reliant on the grants, mental health leaders say.

The nonprofit group Community Health Resources, which operates 34 clinics around Connecticut, plans to seek a renewal of two federal grants which brought in $8 million over the past four years.

By this time in the year, the group would typically have already applied for the grants, which are supposed to go out the door in October once the previous grants expire Sept. 30.

“It creates an awful lot of anxiety for the staff who are being paid out of those grants, so it is more likely they start looking for other jobs,” said the group’s president and CEO, Heather Gates.

That anxiety has extended to career federal workers, who are seeing Trump’s political reach as a sign of long-term volatility in government spending. The number of political appointees has grown in government; CDC went from one — its director — to now more than a dozen.

Their presence and the tightened grip on federal spending will replace expertise with politics and neutral decision making with the whims of the president, said Dr. Deb Houry, former CDC chief medical officer who resigned from the agency last fall.

“We don’t want year-to-year changes to grants and cancellations of grants based on who is in the administration,” she said.