Important vintage note: every figure on this page comes from the FY2025 budget request, not enacted appropriations. A request is what the administration asked for; Congress decides the final numbers. We label it as such throughout.
Two departments in one
The Centers for Medicare and Medicaid Services (CMS) accounted for $1.6 trillion in total budget authority under the FY2025 request, the overwhelming majority of it mandatory spending on Medicare and Medicaid. CMS discretionary funding was only $4.3 billion, mostly program operations. That gap, $1.6 trillion total against $4.3 billion discretionary, is the whole story of HHS: mandatory benefit payments flow through automatically under authorizing law, while Congress votes each year on a comparatively small operating budget.
The discretionary side: research, children, and public health
Vintage: FY2025 budget request. Figures in billions.
| Operating division | FY2025 request | What it does |
|---|---|---|
| National Institutes of Health (NIH) | $46.4B | Biomedical research at hospitals, medical schools, and universities nationwide |
| Administration for Children and Families (ACF) | $31.4B | 56% to early childhood programs such as Head Start and the Child Care and Development Block Grant |
| CMS discretionary (program operations) | $4.3B | Running the Medicare and Medicaid machinery |
| Total HHS discretionary budget authority | $130.7B | Everything Congress decides annually across HHS |
Three things the numbers tell you
The mandatory tail wags the department. CMS’s $1.6 trillion in total budget authority is more than twelve times the entire $130.7 billion discretionary budget. Debates about HHS “spending” that focus on the annual appropriations are debating less than a tenth of the department’s money.
Research is the biggest thing Congress actually votes on. NIH’s $46.4 billion makes it the largest discretionary operating division: the money that funds biomedical research at hospitals and universities across the country is the largest single item in the annual HHS appropriations fight.
Most HHS dollars end up as payments for care. Whether through Medicare, Medicaid, or grants like Head Start, HHS is primarily a pass-through: money flows from the Treasury to providers, states, and researchers. Its own payroll is small relative to the flows it manages.
Where to see the detail
Agency Congressional Budget Justifications break every department’s request down by account and program, and are the single best source for what each bureau actually does with its money. For the award-level detail on NIH grants and other HHS spending, see USAspending.gov. The cash-out-the-door view of Medicare and Medicaid payments is in the Monthly Treasury Statement and our Follow the Money page.
Sources
- HHS FY2025 budget request figures: CRS R48060
- Grant and award detail: USAspending.gov