The Trump administration’s decision to fire 10,000 workers across U.S. health agencies looks set to disrupt the flow of millions of dollars in grants and deprive Americans with disabilities of critical services they depend on, according to advocates and federal workers.

The cuts, ostensibly to reduce redundancies and increase efficiency, have gutted entire agencies under the Department of Health and Human Services, and closed divisions across several agencies that explicitly deal with disability. What’s left, current and former employees say, may not be enough for the federal government to care for vulnerable populations, and imperil numerous services for aging populations, people with mental illness, and Medicare recipients. 

The “reduction in force,” pushed for by the U.S. DOGE Service led by billionaire Elon Musk, did not take into account the needs of people with disabilities and will lead to avoidable chaos and cause anxiety among those already vulnerable, advocates told STAT Tuesday.

“People with disabilities are at risk. This isn’t just about shifting funding. They are taking away a federal agency that is for and about people with disabilities and those who are aging,” said Jill Jacobs, executive director of the National Association of Councils on Developmental Disabilities. “They are saying our priorities, and what matters to us, doesn’t matter to them.”

In a notice published on the HHS website last week, the agency outlined the proposed cuts, but refused to share more details in advance of the notices that went out Tuesday morning. Many federal employees lined up in the cold outside offices in Maryland, only to be turned away, now badge-less and bereft of a job. An Administration for Community Living employee called it a “funeral.”

“No one knows where it’s going to end, whether it’s going to include other parts. We don’t know how deep things are going to go. It’s just awful,” an employee at the Substance Abuse and Mental Health Services Administration who was placed on administrative leave told STAT. “It’s like taking a hacksaw to something, it’s a very crude way to do [these cuts]. It’s premeditated only in terms of numbers.”

While the Trump administration has already proposed or made cuts to the Social Security Administration, Medicaid, and the Department of Education, Tuesday’s actions — including the dismantling of the ACL, which acts as a federal education, policy and grantmaking hub for disability — feel more personally targeted at people with disabilities.

“It feels like a specific attack on people with disabilities and an attack on science and research and data,” said Anjali Forber-Pratt, director of research at the American Association on Health & Disability.

Former HHS employees penned a letter about the mass firings, writing, “what is happening now is not a restructuring — it is a calculated dismissal of 10,000 public servants. Entire agencies…are being dismantled or buried inside a hollow new entity. The promise is savings. The reality is the abandonment of people who rely on us most: the sick, the vulnerable, the poor.”

The ACL received the harshest cuts, according to current and former workers. The agency acts as an information hub about critical services for older adults and people with disabilities, and also doles out grants to aid those efforts. The agency lost roughly half of its 200-plus employees, including most of its leadership, sources estimated, including public affairs and policy teams as well as all of the regional offices that communicate with organizations in the field to ensure that the grants and services reach the intended populations. 

Most notably, the cuts also impacted the workers that disburse the grants. The agency was allocated $2.6 billion annually. Several sources said that funding for the remainder of the fiscal year, approved after several delays last month, had not yet been distributed before budget staff were fired. Amid confusion about if there were enough workers left to ensure that money reaches the people and organizations that need it, advocates said the disruptions are particularly worrisome for organizations like Meals on Wheels, which rely on federal reimbursements to pay the drivers that deliver meals to seniors.

“The uncertainty really creates chaos and makes matters worse for local Meals on Wheels providers who are already operating at razor-thin margins,” said Jenny Young, the chief membership officer and chief of staff for Meals on Wheels America.

It’s unclear what will happen to the agency’s remaining branches. Last week’s HHS press release stated that the ACL’s “critical programs” would be folded into other agencies, but remaining employees have not received guidance. The chaos took many of the organizations that rely upon ACL by surprise, too. 

“The reductions imposed on ACL should be suspended to allow for a full accounting of the impact they may have on key deliveries of service such as nutrition,” said Bob Blancato, executive director of the National Association of Nutrition and Aging Services Programs. “The aging network was never consulted about this. There absolutely will be consequences with the size of this callous action.”

According to employees who remain at the agency, the State Health Insurance Assistance Program — which funds state programs that help more than 1.8 million Medicare beneficiaries and their families navigate a Byzantine system — will most likely be ported over to the Centers for Medicare and Medicaid Services, but it’s unclear. The agency has only sent out 33% of the SHIP grants it was supposed to allocate for this fiscal year, according to a source familiar with the work.

Remaining ACL employees worry that their work for people with disabilities will be deprioritized as they get organizationally buried in other agencies. Other proposed landing spots for the leftovers — including the Office of the Assistant Secretary for Planning and Evaluation — also saw heavy reductions in workforce Tuesday. 

At the Centers for Disease Control and Prevention, sources indicated that the Disability and Health Promotion Branch in the National Center on Birth Defects and Developmental Disabilities were affected, in addition to other key disability officials at the agency. Several areas of the Substance Abuse and Mental Health Services Administration were also affected, including the firing of the Director of the Center for Mental Health Services.

The instability worries Tim Smolen, who runs Washington’s SHIP program. He says his constituents are already struggling with the chaos surrounding the federal government. Calls from people worried about losing their benefits have been picking up in recent weeks.

“It’s a palpable sense of anxiety, this uncertainty,” said Smolen. “It’s become this whitewater, this turbulence, that people are having a very difficult time navigating.”

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