Health departments around the country have noticed there's something strange happening with funding from the Centers for Disease Control and Prevention: It's not showing up on schedule and there's been no communication about why.
The federal public health agency doles out most of the money it receives from Congress to state and local health departments, which then contract with local organizations. That's how public health work gets funded in the U.S.
According to two CDC staff members with knowledge of the agency's budget, the CDC has yet to receive its full funding for the 2025 fiscal year. NPR agreed not to name the staff members because they were not authorized to speak to the media.
Both CDC staffers say the funding is now months late, and it will soon be too late to disperse the agency's grants that local health departments are waiting on. In the interim, the CDC has been operating with just 30-days of funding at a time. The staffers say this amounts to impounding the agency's funding. One of them called it "rescission by inertia."
The Department of Health and Human Services did not answer NPR's questions for this story or respond to a request for comment on that characterization.
A big change from the usual process
"Most state health departments get most of their funding from the feds — in Alabama's case, we get more than two thirds of our funding from federal grants, predominantly CDC," says Dr. Scott Harris, who runs Alabama's health department and is the president of the Association of State and Territorial Health Officials. "Less than 10% of our money comes from state dollars."
"Nothing really can happen if we don't know that we're going to get the money — if there's no notice of award," Harris explains.
This year, the CDC's notices of award are just not arriving on schedule. "For example, one of our cardiovascular grants expires at the end of this month," he says "We don't have any notice of award, so it's really risky for us to incur a bunch of costs over the next several weeks doing work in this program, not knowing if we have the ability to get reimbursed."
Harris says he's heard from state health departments across the country who are in the same situation with CDC funding being mysteriously delayed.
Grants related to HIV prevention work in many states expired at the end of May with no information about future funding. In Ohio, that meant the state's HIV hotline and the delivery of free test-at-home-kits were abruptly halted. The San Antonio AIDS Foundation had to pause its testing services. And in Charlotte, North Carolina, the funding delays led to job losses at the local health department, explains Mecklenburg County Health Commissioner Raynard Washington.
"The majority of those six people that we sent home at the beginning of June were disease investigation specialist staff — contact tracers for HIV, syphilis and other STIs," Washington says, referring to sexually transmitted infections.
"The result on the ground is that our other staff that we have that do that work have to take on more workload, and then very often we end up getting behind," he says. Getting behind could mean that people who have potentially been exposed to something don't know it, he adds. "The ultimate risk is that they are also then exposing other people and then the chain just continues from there to grow."
Funding for more grants will expire soon, says Dr. Philip Huang, director of Dallas County Health and Human Services in Texas. Huang says the state health department just warned them that if they don't receive notices of award for some immunization and emergency preparedness grants they would have to pause the activities funded by those grants.
"[That] is extremely distressing to us because we have like 60 staff on those grants and significant funding that are affected," he says.
Washington adds that North Carolina has not received a new notice of award for the breast and cervical cancer screening program either.
The CDC is operating with an "eyedropper" monthly budget
In March, President Trump signed a continuing resolution for fiscal year 2025, which included $9 billion for the CDC.
"Once [a budget] is passed and signed by the president, there is always a lag," explained one of the CDC staff members who spoke to NPR who is a senior leader at the agency. There's an "apportionment" process to give each agency its money, which usually takes between 45 and 60 days.
During this period, to be able to make payroll and keep up with regular bills, the CDC is given money in 30-day increments.
This year? "Forty-five days came and went. Sixty days came and went, more and more time came and went — no word, no information," the CDC senior leader explains. "We keep asking — where's our money? Where's the money that's been approved by Congress?"
Without a pot of money to distribute out to various centers and divisions, the CDC can't send out the notice of awards that state and local health departments need to be able to continue their work and know they will be reimbursed for it.
Month after month of funding in 30-day increments is like receiving money "with an eyedropper," the senior leader adds.
HHS did not answer NPR's questions about the reasons for these funding delays at the CDC by publication time.
The staffers at the CDC say they are running out of time to be able to spend the agency's 2025 funds before the end of the fiscal year in September because of all the steps involved in getting funding out the door.
"The money just doesn't flow from one account or the other — people have to actually do the manual work of connecting the funds that are provided to the actual accounts at the appropriate levels," the other CDC staffer explains.
"If they can delay until the end of September, then that's it," the staffer adds. "Those projects are not going to happen. That money goes straight back to Treasury."
That's why both CDC staffers who spoke with NPR say this amounts to impounding the agency's funding.
"At this point, it is absolutely our assumption that it is being done intentionally to grind us to a halt," the senior leader says.
HHS did not respond to a request for comment on that characterization.
HIV funds showed up late, but uncertainty remains
This week, state health departments received word that the End the HIV Epidemic grants that expired at the end of May were finally being awarded.
There was no explanation for the delay, says Washington, the health commissioner in Charlotte, N.C.
"Now I have to go figure out if the staff that we laid off are willing to come back to work," he says. "If they're not willing, then we have to start hiring, have to train — we've lost months of work because of administrative delays."
And the delays continue, he says. There's been no communication about what might happen with the many grants that expire on Monday, as June ends. "Throughout this experience, we've just been told, 'We don't have any answers,'" he says. "That's the hard part when you're trying to plan."
Harris of Alabama agrees. "We have to get paid to do these things, whether it's tobacco prevention or diabetes work or public health preparedness or whatever it is," he says. "We can't really do it without the funding."
Copyright 2025 NPR
