The Secretary of Health and Human Services runs the federal department responsible for the country’s public health agencies, health insurance programs, and social service grants, advises the President on health policy, and holds broad legal authority to act during national health emergencies. The role oversees more than 80,000 employees and roughly $94.7 billion in discretionary spending for fiscal year 2026, plus far larger mandatory spending on Medicare and Medicaid.1HHS.gov. Fiscal Year 2026 Budget in Brief
Advising the President and Serving in the Cabinet
As a Cabinet member, the Secretary is the President’s primary advisor on health policy, welfare programs, and income security, translating public health data into policy recommendations that shape the executive branch’s domestic agenda. The Secretary also represents the United States at international health forums, including the World Health Assembly, the decision-making body of the World Health Organization.2HHS.gov. Joint Statement on International Health Regulations Amendments
The position sits 12th in the presidential line of succession, after the Secretary of Labor, under the Presidential Succession Act at 3 U.S.C. § 19.3USAGov. Order of Presidential Succession4Office of the Law Revision Counsel. 3 USC 19 – Vacancy in Offices of Both President and Vice President; Officers Eligible to Act
Overseeing the Federal Health Agencies
The Secretary directly oversees the country’s leading health science and regulatory agencies, including the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health.5HHS.gov. HHS Agencies and Offices The Secretary sets high-level objectives for each one. That includes directing research priorities at NIH, which had a proposed program budget of $27.9 billion for fiscal year 2026.6National Institutes of Health. Office of Budget
The FDA evaluates new medications, regulates medical devices, and monitors food safety. The CDC tracks and responds to infectious disease outbreaks. The Secretary generally has the authority to overrule the FDA Commissioner and the CDC Director, though this has happened only rarely in practice.
Running Medicare, Medicaid, and Social Service Programs
One of the Secretary’s most consequential responsibilities is overseeing the Centers for Medicare and Medicaid Services, which administers health coverage for more than 150 million Americans enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program.7Centers for Medicare and Medicaid Services. Artificial Intelligence at CMS The Secretary establishes payment rates for healthcare providers, sets quality standards for hospitals and nursing facilities, and works to maintain the fiscal health of the Medicare Trust Funds. Facilities that fail to meet federal quality standards can lose eligibility for program reimbursement or face civil monetary penalties.
The federal government matches a share of each state’s Medicaid expenditures, at rates that typically range from 50 percent to 83 percent depending on the state’s per capita income.
Medicaid Demonstration Waivers
The Secretary holds a distinctive power to approve or deny state requests for experimental Medicaid programs known as Section 1115 demonstration waivers. Under 42 U.S.C. § 1315, the Secretary can waive standard Medicaid requirements for state projects that, in the Secretary’s judgment, are likely to promote the objectives of the Medicaid program.8Office of the Law Revision Counsel. 42 USC 1315 – Demonstration Projects CMS will not make a final decision on any application until at least 45 days after public notice, to allow for public comment.9eCFR. Subpart G – Section 1115 Demonstrations The Secretary can withdraw a waiver if the project is no longer advancing those statutory objectives, or terminate a demonstration if the state has materially failed to comply with its terms.
Social Services and Child Welfare
The human services side of the department runs through agencies including the Administration for Children and Families and the Administration for Community Living.5HHS.gov. HHS Agencies and Offices The Secretary oversees billions of dollars in grants for Head Start, the Foster Care program, and the Social Services Block Grant, which funds local efforts to prevent child abuse and neglect and to provide support services for older adults.
Acting During National Health Emergencies
The Secretary holds some of the federal government’s most powerful emergency authorities. Under 42 U.S.C. § 247d, the Secretary can declare a public health emergency when a disease, disorder, bioterrorist attack, or other health threat poses a danger to the public.10Office of the Law Revision Counsel. 42 USC 247d – Public Health Emergencies Each declaration lasts 90 days and expires automatically unless the Secretary renews it.
Emergency Use Authorizations
During a public health emergency, the Secretary can authorize the emergency use of drugs, devices, or biological products that have not yet received full regulatory approval. Under 21 U.S.C. § 360bbb-3, the Secretary may issue an emergency use authorization after consulting with the Assistant Secretary for Preparedness and Response and senior officials at NIH and CDC.11Office of the Law Revision Counsel. 21 USC 360bbb-3 – Authorization for Medical Products for Use in Emergencies This authority enables the rapid distribution of vaccines, diagnostic tests, and treatments before the full approval process is complete. The Secretary can also deploy medical supplies from the Strategic National Stockpile whenever the Secretary determines it necessary to protect public health; a formal emergency declaration is not required.
Medicare and Medicaid Waivers
A public health emergency declaration unlocks the Secretary’s authority under Section 1135 of the Social Security Act (42 U.S.C. § 1320b-5) to temporarily waive or modify certain Medicare, Medicaid, and CHIP requirements.12Office of the Law Revision Counsel. 42 USC 1320b-5 – Authority to Waive Requirements During National Emergencies These waivers can relax provider licensing rules so doctors licensed in one state can practice in another, ease hospital conditions of participation so facilities can expand capacity, and suspend certain transfer requirements that would otherwise restrict how emergency patients are moved between hospitals.
Liability Protections Under the PREP Act
The Secretary can also issue declarations under the Public Readiness and Emergency Preparedness Act that shield certain individuals and organizations from lawsuits. Under 42 U.S.C. § 247d-6d, the Secretary may publish a declaration in the Federal Register providing broad immunity from liability for anyone involved in the development, manufacture, distribution, or administration of covered medical countermeasures such as vaccines or antiviral treatments.13Office of the Law Revision Counsel. 42 USC 247d-6d – Targeted Liability Protections for Pandemic and Epidemic Products and Security Countermeasures The only exception to this immunity is for willful misconduct. A PREP Act declaration can cover specific populations, geographic areas, and time periods, and the Secretary can amend or extend it as conditions change.
Trust Responsibilities to Tribal Nations
The Secretary carries a distinct legal obligation to American Indian and Alaska Native communities. Under the Indian Health Care Improvement Act, Congress declared a national policy to ensure the highest possible health status for these populations and to provide the resources necessary to achieve it.14Office of the Law Revision Counsel. 25 USC Chapter 18 – Indian Health Care The Secretary oversees the Indian Health Service, which delivers health care to members of federally recognized tribes.
Before the department takes any action that would significantly affect Indian tribes, its policy requires consultation with tribal leaders throughout all stages of the process.15HHS.gov. HHS Tribal Consultation Policy When the department proposes a regulation that imposes substantial compliance costs on tribes or preempts tribal law, it must include a written summary in the Federal Register describing the consultation, the tribal concerns raised, and how those concerns were addressed. The department must also report the outcome of any consultation to affected tribes within 90 calendar days of a final decision.
How the Secretary Is Appointed and Paid
The President nominates the Secretary, and the nominee must be confirmed by the Senate under the Constitution’s advice and consent process. Before nomination, the candidate goes through background investigations by the FBI, the IRS, and the Office of Government Ethics, and must file a public financial disclosure report. Two Senate committees typically hold hearings: the Committee on Health, Education, Labor, and Pensions and the Finance Committee. The Finance Committee, which has jurisdiction over Medicare and Medicaid, votes on whether to advance the nomination to the full Senate floor, where a simple majority is required for confirmation.
Once confirmed, the Secretary earns an Executive Level I salary, which is $253,100 per year in 2026.16OPM.gov. Salary Table No. 2026-EX The Secretary serves at the pleasure of the President and can be removed at any time.