Department of Health and Human Services (HHS)

45 CFR Part 3 — Regional Organization

—OPTIONAL--

Notice of Proposed Rulemaking

Regional Office Staffing Requirements for HHS Field Operations

Rescinding outdated regional staffing mandates lets HHS modernize how it shows up in the field—without cutting capacity. Instead of keeping people tied to legacy office structures based on decades-old maps, this approach redirects funding into flexible, state-led programs that actually meet today’s public health needs. It gives HHS the ability to respond faster, reach underserved communities more effectively, and get out from under a system that’s outlived its usefulness.

Office of Regional Operations Department of Health and Human Services 200 Independence Avenue, SW Washington, D.C. 20201

regionalops@hhs.gov

Under 45 CFR Part 3, HHS maintains a formalized 10-region structure with expectations for fully staffed regional offices. This setup dates back to the mid-20th century and has been criticized as outdated and inflexible. Recent litigation—like State of Washington v. HHS—has pointed out how downsizing these offices can disrupt federally supported programs, from tobacco prevention to disease surveillance. But the real issue is this: fixed regional staffing rules lock HHS into a structure that doesn’t always match where the needs are. Public health threats move fast. Infrastructure changes. States vary in capacity. A one-size-fits-all field model doesn’t cut it anymore. This proposal doesn’t reduce federal support—it restructures how that support gets delivered. Instead of staffing buildings by mandate, HHS would reinvest in a “Flexible Partnership Model,” offering grants to states and territories that maintain strong collaboration with CDC. Surveillance, coordination, and emergency response stay covered—but with more flexibility and accountability built in. This isn’t a downsizing. It’s a modernization. The future of public health isn’t locked in office space—it’s distributed, data-driven, and rooted in state and local systems. With the right partnerships, we can keep the capacity—and improve the response.

• Eliminates inflexible mandates tied to outdated geographic assumptions • Enables HHS to redeploy staff and funds based on actual need, not legacy infrastructure • Preserves essential functions through conditional state grants under a Flexible Partnership Model • Supports CDC-state collaboration in surveillance and emergency preparedness • Modernizes field operations without reducing national public health capacity

Delete Subpart A (§§ 3.1–3.3) of 45 CFR Part 3, which requires the establishment and maintenance of regional offices. Insert new § 3.1: “HHS shall allocate annual savings resulting from the elimination of regional office staffing mandates into a Flexible Partnership Model. Under this model, grants shall be awarded to state public health agencies that demonstrate active collaboration with the Centers for Disease Control and Prevention (CDC) on disease surveillance and response activities.”

Robert F Kennedy JR.

Secretary, Department of Health and Human Services