The Department of Health and Human Services is run by the Secretary of Health and Human Services, a Cabinet member who reports directly to the President. As of 2026, that role is held by Robert F. Kennedy Jr., confirmed by the Senate in February 2025. Beneath him sits a Deputy Secretary, the administrators and directors of the department’s major sub-agencies, and an independent Inspector General.
What the Secretary Does
The Secretary sits atop the department’s chain of command and serves as the President’s primary advisor on public health, welfare, and social services. The position was originally established in 1953 as the Secretary of Health, Education, and Welfare; after Congress passed the Department of Education Organization Act in 1979, HHS began operating in its current form on May 4, 1980.1HHS.gov. HHS Historical Highlights
The job comes with an enormous budget. In fiscal year 2024, the department spent $1.72 trillion, and the proposed fiscal year 2026 budget includes $94.7 billion in discretionary spending alone.2HHS.gov. Fiscal Year 2026 Budget in Brief HHS spending accounts for nearly one out of every four federal dollars, covering Medicare and Medicaid, biomedical research at the National Institutes of Health, food and drug safety enforcement, and community assistance programs.
The Secretary also holds specific legal powers during emergencies. Under 42 U.S.C. ยง 247d, the Secretary can declare a public health emergency after consulting with relevant health officials. That declaration unlocks the Public Health Emergency Fund and allows the Secretary to issue grants, award contracts, and extend regulatory deadlines that affected individuals or organizations would otherwise be unable to meet.3Office of the Law Revision Counsel. 42 USC 247d – Public Health Emergencies
The Deputy Secretary
The Deputy Secretary serves as the department’s chief operating officer, focused on internal management rather than policy. That means overseeing human resources, information technology, and financial systems across the agency, and translating the Secretary’s broad goals into administrative tasks that keep tens of thousands of employees coordinated. Jim O’Neill was sworn in as Deputy Secretary on June 9, 2025.4HHS.gov. Jim O’Neill Sworn in as Deputy Secretary of Health and Human Services
Who Runs the Major Divisions
HHS contains several large sub-agencies. Each is led by a director or administrator who manages their own budget and staff while remaining accountable to the Secretary.
Centers for Medicare and Medicaid Services
The CMS Administrator oversees Medicare, Medicaid, and the Children’s Health Insurance Program, which together cover well over 100 million Americans. The Administrator also has authority to approve or deny state requests to waive certain federal Medicaid rules. Section 1115 of the Social Security Act allows the Secretary, acting through CMS, to grant waivers for experimental or demonstration projects believed to advance Medicaid’s goals.5Social Security Administration. Social Security Act Section 1115 CMS also reviews and approves state plan amendments as a condition of continued federal funding.6Medicaid and CHIP Payment and Access Commission. Administration
Food and Drug Administration
The FDA Commissioner leads the agency responsible for regulating food safety, pharmaceuticals, medical devices, tobacco products, and cosmetics. Martin Makary was confirmed by the Senate on March 25, 2025, as the 27th Commissioner of Food and Drugs.7U.S. Food and Drug Administration. Martin Makary
Centers for Disease Control and Prevention
The CDC Director oversees disease surveillance, outbreak response, and public health research. Until recently, the Secretary simply appointed the Director. A 2023 law made the CDC Director a Senate-confirmed position, with the requirement taking effect on January 20, 2025.8Office of the Law Revision Counsel. 42 USC 242c – Appointment and Authority of the Director of the Centers for Disease Control and Prevention Susan Monarez became the first Senate-confirmed CDC Director when she was sworn in on July 31, 2025.9Centers for Disease Control and Prevention. Secretary Kennedy Swears in Susan Monarez as CDC Director
Surgeon General
The Surgeon General holds a dual role as both a public health communicator and the head of the U.S. Public Health Service Commissioned Corps, a uniformed service that deploys during national emergencies.10HHS.gov. About the Office of the Surgeon General The Surgeon General is appointed from the Regular Corps for a four-year term by the President with Senate confirmation.11Office of the Law Revision Counsel. 42 USC 205 – Appointment and Tenure of Office of Surgeon General As of early 2026, the position remains without a confirmed occupant; nominee Casey Means has not yet secured enough Senate votes for confirmation.
The Inspector General
The HHS Office of Inspector General operates as an independent watchdog inside the department, tasked with rooting out waste, fraud, and abuse in HHS programs. The Inspector General is appointed by the President and confirmed by the Senate, but the law requires the selection be made without regard to political affiliation, based solely on integrity and demonstrated ability in fields like auditing, investigations, or public administration.
Federal law gives the office broad authority: access to all department records regardless of other confidentiality provisions, the power to conduct investigations and issue reports as the Inspector General sees fit, the ability to request information from federal, state, and local agencies, and subpoena power to compel the production of documents and data.13Office of the Law Revision Counsel. 5 USC 406 – Authority of Inspector General
How These Leaders Get Their Jobs
The Constitution’s Appointments Clause requires the President to nominate senior HHS officials and the Senate to confirm them before they can take office.12Cornell Law Institute. U.S. Constitution Annotated Article II Section II Clause II – Overview of the Appointments Clause Different Senate committees handle different HHS nominations. The Secretary goes through the Senate Finance Committee, which held the confirmation hearing for Robert F. Kennedy Jr. in early 2025.14Senate Committee on Finance. Hearing to Consider the Nomination of Robert F. Kennedy Jr. The Surgeon General and certain other health officials go through the Health, Education, Labor, and Pensions (HELP) Committee. The committee reviews the nominee’s background, financial disclosures, potential conflicts, and policy positions, then votes on whether to advance the nomination. A majority vote on the Senate floor completes the confirmation.
What the 2025 Restructuring Changes
On March 27, 2025, HHS announced a sweeping reorganization consolidating its 28 divisions into 15 and reducing the workforce from roughly 82,000 full-time employees to about 62,000.15HHS.gov. Fact Sheet – HHS Transformation to Make America Healthy Again Several of the changes directly affect who leads what:
- A new Administration for a Healthy America combines the Office of the Assistant Secretary for Health, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Agency for Toxic Substances and Disease Registry, and the National Institute for Occupational Safety and Health into one division focused on primary care, maternal health, mental health, and related areas.
- The Administration for Strategic Preparedness and Response transfers into the CDC, broadening the agency’s emergency-response role.
- A new Assistant Secretary for Enforcement oversees the Departmental Appeals Board, the Office of Medicare Hearings and Appeals, and the Office for Civil Rights.
- The Assistant Secretary for Planning and Evaluation merges with the Agency for Healthcare Research and Quality to form an Office of Strategy.
Some leadership positions referenced in older descriptions of HHS, such as the head of SAMHSA or the ASPR, no longer exist as standalone roles. The reorganization was still being implemented as of early 2026, so the department’s organizational chart may continue to shift.16HHS.gov. HHS Announces Transformation to Make America Healthy Again
Who Runs Things During a Vacancy
When a Senate-confirmed HHS official dies, resigns, or becomes unable to serve, the Federal Vacancies Reform Act governs who steps in temporarily. The President can designate an acting official from one of three categories:
- The first assistant already serving as the official’s top deputy, provided they held that role for at least 90 of the previous 365 days.
- Another Senate-confirmed official already serving elsewhere in the executive branch.
- A senior agency employee who has worked at the agency for at least 90 of the previous 365 days in a position paying at or above the GS-15 level.
These arrangements are temporary. The law imposes time limits to push the President toward submitting a permanent nominee, so Senate-confirmed positions are not indefinitely filled by unconfirmed officials.17Office of the Law Revision Counsel. 5 USC 3345 – Acting Officer