March 10, 2025

The Honorable Stephanie Carlton
Acting Administrator
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

Re: Reckless Firing of Centers for Medicare & Medicaid Services Staff

Dear Acting Administrator Carlton,

We write regarding the Trump Administration’s arbitrary and reckless purge of executive

branch workers at federal health agencies, including the Centers for Medicare & Medicare
Services (CMS), under the Executive Order, Implementing the President’s “Department of
Government Efficiency” Workforce Optimization Initiative.1 On Friday, February 14, 2025, the
so-called United States DOGE Service (“DOGE”), under the direction and advisement of
unelected, unconfirmed billionaire Elon Musk, forced agency officials to eliminate thousands of
jobs that are critical to ensuring 160 million  Americans receive high-quality and safe health care
through the very programs President Trump has vowed to protect—including individuals who
work on Medicare and Medicaid.2 We are deeply concerned that this arbitrary and unilateral
firing of federal health staff will only harm the health and well-being of families, children,
and older Americans across the country, while risking instability to the entire U.S. health
system.

As you know, CMS is composed of six centers and oversees Medicare, Medicaid, the

Children’s Health Insurance Program, and the Affordable Care Act (ACA) Marketplaces,
distributing more than $1.5 trillion in payments annually.3 Its staff work efficiently—keeping
administrative costs to less than one percent of its total obligations—while overseeing quality
and patient safety initiatives; protecting consumers from fraud, waste, and abuse; lowering
prescription drug costs; and ensuring the hospitals, nursing homes, and other providers on which
our children, parents, grandparents, and neighbors depend provide quality health care.4 As such,

1 www.whitehouse.gov/presidential-actions/2025/02/implementing-the-presidents-department-of-government-
efficiency-workforce-optimization-initiative/
2 https://www.politico.com/newsletters/politico-pulse/2025/02/18/hhs-workforce-purge-continues-00204610
3 https://www.cms.gov/files/document/cms-financial-report-fiscal-year-2024.pdf
4 https://www.cms.gov/files/document/fy2025-cms-congressional-justification-estimates-appropriations-
committees.pdf

The Honorable Stephanie Carlton
March 10, 2025
Page 2

haphazard cuts to the CMS workforce jeopardize patient safety and lead to disrupted care,
increased fraud, interrupted payments for providers, and diminished safety of the nation’s health
care facilities.

The Administration has claimed that these cuts to the federal workforce were methodical
and transparent, deceptively justifying firing employees because their “performance has not been
adequate.” The truth is that DOGE targeted “probationary employees,” which include workers
recently hired, promoted, or transferred between agencies because they have fewer protections
than employees who have completed their probationary period.5 Alarming reports have emerged
of  indiscriminate firings, including of veterans—and in some cases, Trump’s own political
appointees were unaware of who and why staff were fired by DOGE.6 The Administration’s
narrative of poor performance is a flimsy cover for its reckless actions, given that many impacted
public servants received stellar performance reviews as recently as last month, were recently
promoted, or had not yet even had an appraisal.3 These actions were taken with no consideration
or regard for performance.

These firings are precisely what the President threatened after he took the oval office—

retribution. On January 21, 2025, the President wrote on Truth Social, “My Presidential
Personnel Office is actively in the process of identifying and removing over a thousand
Presidential Appointees from the previous Administration, who are not aligned with our vision to
Make America Great Again.”7 In the hours prior, on January 20, 2025, the President issued an
executive order, Restoring Accountability to Policy-Influencing Positions within the Federal
Workforce, aimed at making it easier to fire government employees.8 The President and DOGE
have continued to double down on similar rhetoric and initiatives, disparaging employees seen as
undermining the President’s agenda, and promising that these firings of probationary employees
are just the start. On February 26, 2025, the Director of the White House Office of Management
and Budget (OMB) directed agencies to further reduce the federal workforce.9 We believe that
the OMB memorandum will result in unlawful termination of staff without any analysis of the
impact the elimination of these roles would have on the agency’s ability to serve its mission—
and the American people.

To date, the Trump Administration has failed to provide the public information related to
the number of firings by position type and the duties these terminated employees were fulfilling
on behalf of American taxpayers. Put plainly, these opaque staffing cuts endanger the
agency’s mission to enhance the health and well-being of Americans. Despite claims that
these cuts exempted staff working on Medicare and Medicaid, DOGE clearly targeted staff at

5 https://www.washingtonpost.com/nation/2025/02/17/trump-fires-federal-workers-performance/
6 https://www.politico.com/news/2025/02/16/mass-firings-health-agencies-00204570
7 https://www.cnn.com/2025/01/21/politics/trump-touts-political-firings-and-retribution-and-installs-loyalists-at-key-
posts/index.html
8 https://www.whitehouse.gov/presidential-actions/2025/01/restoring-accountability-to-policy-influencing-positions-
within-the-federal-workforce/
9 https://www.opm.gov/policy-data-oversight/latest-memos/guidance-on-agency-rif-and-reorganization-plans-
requested-by-implementing-the-president-s-department-of-government-efficiency-workforce-optimization-
initiative.pdf.

The Honorable Stephanie Carlton
March 10, 2025
Page 3

CMS who work to keep our federal health programs safe and operational and ensure that
everyone relying on these programs can access quality care when they need it.

On February 16, 2025, Politico reported that staff at the Center for Medicare and
Medicaid Innovation (CMMI) had been terminated—including one official who was working on
a pilot program in Medicaid to improve maternal health outcomes across 15 states.10, 11 These
staffing cuts come despite the United States facing a maternal health crisis and the highest rate of
maternal deaths of any high-income country.12 Over 80 percent of maternal deaths are likely
preventable—but gutting the federal workforce will only put more mothers at risk. Another
CMMI employee was working on improving care for Medicare Advantage enrollees, many of
whom struggle to access needed care in the face of excessive prior authorizations and care
denials.13 These actions are unconscionable and are in complete contradiction with any
Administration truly working to improve the lives and health of the American people.

DOGE also targeted the Center for Consumer Information and Insurance Oversight
(CCIIO), which oversees health coverage for millions of Americans enrolled in private insurance
and sets and enforces standards for health insurance.14 DOGE cut at least 80 CCIIO employees,
some of whom worked on protecting patients from surprise medical bills—a bipartisan effort
signed into law by Donald Trump in 2020.15, 16 Others worked on combating unscrupulous
brokers engaged in unauthorized enrollment schemes that harm Americans purchasing coverage
on their own.17 Cutting the staff working to prevent fraud, waste, and abuse starkly contradicts
the DOGE’s stated purpose and will harm CMS’s ability to protect patients across the country.

At a time when Americans need transparent government that works for them, these

unilateral and chaotic cuts to the federal health workforce are harmful to everyone—patients,
providers, taxpayers, and the hard-working individuals in the executive branch whose lives have
been needlessly upended. The Trump Administration is sabotaging the very programs that
millions of older adults, individuals with disabilities, children, and people purchasing coverage
on their own rely on each day—all to fulfill the misguided and ill-informed whims of Trump,
Musk, and his business interests.

Three weeks after these firings, Congress has not received any information about how
many staff who were fired were working on Medicare and Medicaid.  And it remains unclear
what, if any information, will be provided about DOGE’s continued actions. The American

10 https://www.politico.com/news/2025/02/16/mass-firings-health-agencies-00204570
11 https://www.fiercehealthcare.com/regulatory/mass-layoffs-hhs-cdc-cuts-1300-probationary-workers-reports-say
12 https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-
international-comparison
13 https://www.kff.org/medicare/issue-brief/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-
advantage-insurers-in-2023/
14 https://www.cms.gov/about-cms/leadership/center-consumer-information-insurance-oversight
15 https://www.politico.com/news/2025/02/16/mass-firings-health-agencies-00204570
16 https://www.cms.gov/marketplace/about/oversight/other-insurance-protections/consolidated-appropriations-act-
2021-caa
17 https://www.cms.gov/newsroom/press-releases/cms-update-actions-prevent-unauthorized-agent-and-broker-
marketplace-activity

The Honorable Stephanie Carlton
March 10, 2025
Page 4

people—and the Congress—have a right to know what is happening to the federal workforce
tasked with carrying out CMS’ critical taxpayer-funded responsibilities. Accordingly, we request
you immediately respond to the following questions in writing by March 17, 2025, at 5 p.m.

1.  How many CMS employees have been fired or put on administrative leave since January
20, 2025? How many of these employees were probationary and non-probationary?
Please provide a breakdown by center, position type, and justification for termination for
each category of employee in each center.

2.  How were CMS employees notified that they were being fired, and on what grounds?

Provide the method of communication and content of the message employees received.

3.  How were CMS managers notified about the firings of their staff? Provide the method of

communication and content of the message employees received.

4.  How were employees subject to the staff cuts identified and prioritized, and what role did
DOGE play in determining who would be fired? What, if any, technological changes has
DOGE made within CMS were used to identify employees to fire, and what metrics were
applied?

5.  Were CMS employees’ supervisors engaged for purposes of determining who should be
fired? If so, what information were supervisors asked to provide to DOGE, or what
communication did they receive regarding the firing process?

6.  Did CMS, or any DOGE operative, conduct any analysis prior to firings to determine the
immediate and long-term impacts staffing cuts would have on the programs and activities
those employees were tasked with administering?

a.  What were the findings of such analyses, and how did CMS or DOGE weigh

potential impacts in its decision-making?

7.  How was effectiveness in operationalizing each program or activity taken into

consideration when firing these employees?

a.  How will staff cuts in the Center for Clinical Standards and Quality impact
clinical, quality, and safety standards, as well as any upcoming survey and
certification efforts that keep people safe and ensure compliance with federal rules
and laws?

b.  How will staff cuts impact ongoing and planned CMMI models? Which models
have been paused or are being modified? When and how will model applicants
and participants be notified of any changes?

c.  How will staff cuts impact CCIIO’s work protecting consumers from

unscrupulous brokers engaged in unauthorized enrollment schemes and enforcing
provisions under the No Surprises Act that prevent patients from receiving
surprise bills?

The Honorable Stephanie Carlton
March 10, 2025
Page 5

8.  How will staff cuts impact CMS’ efforts to expand beneficiary access to the latest

breakthrough devices without diminishing CMS’ ability to determine whether these
technologies are appropriate for the Medicare population, given CMS’ commitment to
review five such devices each year?

9.  How many additional layoffs are planned, including those directed by OMB and the
Office of Personnel Management in the February 26, 2025, memorandum?18  What
specific guidance has been given to CMS for identifying additional employees to lay off?

10. How many of the positions that are now vacant will be permanently eliminated? What
steps is CMS taking to ensure that layoffs do not have adverse consequences for
providers, patients, and enrollees in programs administered by CMS?

11. Under 5 C.F.R. 315.803(a), prohibitionary employees can be terminated “if the employee
fails to demonstrate fully his or her qualifications for continued employment.”  Please
document the steps that the Department has taken to align recent terminations with these
requirements under law.

12. Under 5 CFR 315.803(b), prohibitionary employees who are terminated must be notified
in writing as to the “inadequacies of  performance of conduct.”  Please provide
copies of each letter documenting the inadequacies in each terminated employee’s
performance since the beginning of the prohibitionary period.  If multiple employees
were identified as having the same performance inadequacy, please provide the template
letter the Department sent and how many staff received the same letter.

13. Federal law prohibits the partisan dismissal of prohibitionary employees, and the Federal
circuit has identified a right to appeal termination decisions when the action was a result
of partisan politics.19,20  President Trump has called his efforts to purge career workers in
the government “retribution” and disparaged them for undermining his power.21,22  Given
this:

a.  What process has the Department of Health and Human Services put in place to

process appeals?

b.  How many appeals have been filed since the terminations began?

18 https://www.opm.gov/policy-data-oversight/latest-memos/guidance-on-agency-rif-and-reorganization-plans-
requested-by-implementing-the-president-s-department-of-government-efficiency-workforce-optimization-
initiative.pdf
19 5 CFR 315.806(b). See Stokes v. Aff, 761 F.2d 682 (probationary staff can appeal decisions when the action was a
result of partisan politics).
20 Letter from Mike Zamore, National Directory of Policy and Government Affairs; Kia Hamadancy, Senior Policy
Counsel; Monica Hopkins, Executive Director of the ACLU of the District of Columbia, American Civil Liberties
Union, to Sen. Rand Paul, Chair, Senate Homeland Security and Governmental Affairs Committee; Sen. Gary C.
Peters, Ranking Member, Senate Homeland Security and Governmental Affairs Committee; Rep. James Comer,
Chair, House Committee on Oversight and Accountability; Rep. Gerald E. Connolly, Ranking Member, House
Committee on Oversight and Accountability (Feb. 7, 2025).
21 https://www.c-span.org/clip/campaign-2024/former-pres-trump-i-am-your-justicei-am-your-retribution/5060238.
22 https://www.citizensforethics.org/reports-investigations/crew-investigations/trump-has-said-he-wants-to-destroy-
the-deep-state-56-times-on-truth-social/.

The Honorable Stephanie Carlton
March 10, 2025
Page 6

c.  How many terminations have been reversed and how many have been sustained?

14. Please provide copies of any memos, emails, or other communications used to justify
staff work and position changes or that discuss the impact of staffing changes on any
CMS activities.

15. Given the President’s statement at his March 6, 2025, cabinet meeting that the

Secretaries—not Elon Musk—are in charge of their Departments, will CMS staff affected
by Musk or DOGE-led firings be reinstated? 23 How many staff will be reinstated in each
Center, and how will leadership determine who is reinstated?

Thank you for your attention to this urgent matter. We look forward to your prompt

response.

Sincerely,

Richard E. Neal
Ranking Member
House Committee on Ways and Means

Frank Pallone, Jr.
Ranking Member
House Committee on Energy and Commerce

Lloyd Doggett
Ranking Member
House Committee on Ways and Means,
Health Subcommittee

Diana DeGette
Ranking Member
House Committee on Energy and
Commerce, Health Subcommittee

23 https://www.politico.com/news/2025/03/06/trump-cabinet-musk-025093

