Washington, D.C. — The federal agency that runs Medicare and Medicaid for more than 160 million Americans is trying to carry out one of the most ambitious regulatory agendas in its history — with roughly 1,000 fewer workers than it had two years ago.
A new report lays out the tension clearly: the Centers for Medicare & Medicaid Services lost around 300 employees in the Trump administration’s sweeping federal workforce cuts last year. Since then, voluntary departures and retirements have pushed the total deficit to about 1,000 positions compared to 2024 staffing levels, according to data from the Office of Personnel Management.
That’s a problem, because the agency’s workload hasn’t shrunk. If anything, it’s doubled.
More work, fewer hands
The CMS is now responsible for standing up the first-ever national Medicaid work requirement — a sweeping provision included in last summer’s “Big Beautiful Bill” that will require millions of adults enrolled through Medicaid expansion to report at least 80 hours of work, education, or volunteer time each month or lose their coverage.
Only two states, Arkansas and Georgia, have ever fully implemented anything like it. Georgia’s program alone cost more than $54 million in administrative spending over four and a half years, according to a Government Accountability Office report — and it enrolled far fewer people than a national rollout would involve.
On top of that, the agency is working to implement new restrictions on provider taxes and state-directed Medicaid payments, roll out an expanded health technology initiative, and maintain more aggressive fraud oversight across the country.
“At a time where they potentially have fewer resources, fewer people to do the work, they just have easily double the amount of work,” said Kelly Whitener, associate professor at Georgetown University’s McCourt School of Public Policy, who worked inside CMS during the Obama administration. “So it’s just an incredibly difficult environment.”
What’s already been lost
The roughly 300 positions eliminated at CMS included the agency’s entire Office of Minority Health — a team that identified underserved patients, developed quality measures used in regulations, and funded community health programs. That work has stopped entirely. Former staffers noted the irony that CMS launched a new Office of Rural Health Transformation to manage $50 billion in rural funding at the same time, but say it has a narrower reach and less experience with underserved populations.
Inside the agency, the mood is grim. Current and former employees — all speaking anonymously to avoid retaliation — described a workplace where morale has cratered and career paths have stalled.
“Morale is in the toilet,” one employee told industry reports. Another said their ability to be promoted had been “essentially eliminated” because the workers who were supposed to take over their tasks were let go in the layoffs.
A CMS spokesperson said leadership actively listens to staff concerns and has several wellness and culture initiatives underway.
Why nursing homes are watching
For skilled nursing operators, the stakes are direct. The CMS oversees everything from nursing home inspection schedules and quality star ratings to Medicaid reimbursement policy and fraud enforcement. When the agency is stretched thin, the downstream effects — slower rulemaking, delayed survey cycles, bottlenecked appeals — can ripple through every facility in the country.
The Medicaid work requirements alone could reshape how many dual-eligible residents nursing homes serve, as industry reports have warned that home care cuts could push vulnerable seniors into facility-based care. How smoothly CMS implements those changes will depend heavily on whether it can hold onto — and rebuild — a workforce already stretched to its limits.
CMS Administrator Dr. Mehmet Oz acknowledged the challenge at a recent industry conference, where he reportedly used the event as a recruiting trip. “Please come work at CMS,” he said from the stage.
Whether that pitch lands may determine how well the agency can keep up with everything it’s promised to deliver.
