Last week, the Department of Health and Human Services finally followed through on a plan it first outlined for several of its top officials nearly a year ago: It reassigned them to positions in the Indian Health Service.
Many of the officials who were sent the reassignments—a group that includes at least half a dozen top-ranking employees at the National Institutes of Health, the CDC, and other agencies—have been on administrative leave since last spring, when they were abruptly ousted from their roles without explanation, or any indication of how long their hiatus might last. So they were shocked last week when, with no preamble, they received phone calls, then a letter, informing them of their new role, and an April 8 deadline to decline or accept.
In most or all cases, accepting these new roles would represent a major career shake-up and force a move across the country: Many senior HHS officials are based in Maryland—where the FDA and the NIH are located—or near Atlanta, where the CDC is headquartered; the recent letters lay out reassignments to places such as Arizona, New Mexico, Oklahoma, North Dakota, and South Dakota. If the officials accept the reassignments, they’ll be expected to report for their new jobs no later than May 26. If they decline, the officials expect to be removed from federal service entirely.
I spoke with two of the letter recipients, along with several former HHS officials who were also placed on leave by the administration last spring; all of them requested anonymity to avoid professional repercussions. For several of the reassigned officials, April 1 will mark the one-year anniversary of when they were put on administrative leave, shortly after HHS initially proposed via email to reassign them to IHS. The two officials who recently received reassignments also told me that last week is the first time they’ve heard from HHS since May or June 2025, when they were asked to provide their CVs. After being left for so long in limbo, then given so little time to make this choice, some officials feel like HHS is pretending it didn’t ghost some of its highest-ranking, highest-paid employees for the better part of 12 months. “Honestly, it’s hilarious,” one official told me: HHS did do what it said it would. It just took a year to do it.
When reached for comment, Emily G. Hilliard, HHS’s press secretary, emphasized in an email that HHS was dedicated to improving the IHS and that “each executive who joins IHS will strengthen leadership capacity and support mission delivery.”
IHS is, unquestionably, in need of more staff, especially in its more rural and remote locations. For years, the agency’s vacancy rate has hovered around 30 percent (and, for certain roles, has climbed higher in some regions). Last spring, when dozens of HHS officials were initially put on administrative leave, Thomas J. Nagy Jr., HHS’s deputy assistant secretary for human resources, wrote to them in an email that American Indian and Alaskan Native communities deserve “the highest quality of service, and HHS needs individuals like you to deliver that service.” In January, the IHS also announced what it described as the “largest hiring initiative” in its history to address staffing shortfalls, noting that the effort had the full support of HHS Secretary Robert F. Kennedy Jr., who has described tribal health as a priority.
But the reassigned officials and the tribal-health experts I spoke with both questioned how well the new reassignments fit current IHS needs. The primary feature of the re-assignees, as a group, is that they were high-ranking officials with extensive experience in administrative leadership; many were running departments of hundreds of employees or more. Among those who received the proposed reassignment last spring were the directors of several NIH institutes, leaders of several CDC centers, a top-ranking official from the FDA tobacco-products center, a bioethicist, a human-resources manager, a communications director, and a technology-information officer. Meanwhile, IHS’s greatest need is for “hands-on clinical people,” such as physicians and nurses, David Simmons, the director of government affairs and advocacy at the National Indian Child Welfare Association, told me. “People in communications, HR, researchers? Those are not going to be the people who are going to be helpful on a daily basis,” Simmons said. “On some level, I have to ask the question: Why are they sending these kinds of people?”
Last week’s letters, also signed by Nagy, described new IHS positions, multiple of them located at small hospitals in some of the country’s most rural and remote regions, several officials told me. The roles come with titles such as “Chief of Staff” and “Senior Advisor,” but the letters don’t describe the specific responsibilities attached to those positions. I asked one official whether their credentials lined up in any way with their reassigned role. “Zero,” they told me. If senior-executive officials accept the reassignment, the letters say, they will keep their current salaries—a minimum of about $150,000, though many high-level reassigned officials make far more, two officials told me. The IHS will likely be responsible for the salaries of reassigned officials, one NIH official told me, even though its budget is a small fraction of the NIH’s; the official told me that, as far as they could tell, they would be making about as much as their new supervisors.
To build trust and effectively deliver care, health officials need to be deeply familiar with tribal communities’ needs and should have an understanding of the local culture, Simmons told me. In 2023, American Indians and Alaskan Natives had lower life expectancy at birth than any other racial and ethnic group in the United States; Native people are especially vulnerable to conditions such as asthma, diabetes, and substance-use disorder. Tribes also have a long history of being severely mistreated by the federal government. But the officials I spoke with told me that they were not aware of any reassigned individuals who identified as Native or had extensive background in working with such communities. Last year, Deb Haaland, a member of the Pueblo of Laguna and a Democratic candidate for governor of New Mexico, criticized the reassignment proposals as “shameful” and “disrespectful.” The experts I spoke with also weren’t aware of any attempts HHS had made since to thoroughly consult tribal leaders about these reassignments; in at least one case, when a reassigned official tried making contact with their new hospital, with their new hospital, their new supervisor expressed confusion about who the official was or why they were reaching out at all, three current and former HHS officials told me. (Hilliard did not address my questions about whether the IHS or tribal leaders had been consulted about the reassignments, how qualified the reassigned officials were to meet the agency’s needs, or why HHS made the reassignments now.)
Meanwhile, health experts across the country have felt the loss of these officials from top tiers of HHS, especially agencies that focus on public health. “At the local health department level, we depend on their expertise,” Philip Huang, the director of Dallas’s health department, told me.
What prompted HHS to finally end these officials’ administrative leave is unclear; many officials had wondered if their hiatus might stretch on indefinitely, until they themselves chose to resign, as many of their colleagues have. The action may have been triggered by guidance from the Office of Personnel Management, released after the officials were first put on leave and newly effective in 2026, that limits administrative leave connected to workforce reassignment to 12 weeks. The end of March coincides with that limit.
No matter the trigger, the officials I spoke with told me they feel roughly the same as they did a year ago: “They obviously don’t want us to take these jobs, and want us to leave on our own,” one official said. Firing federal officials is difficult, especially without clear cause, and none of the officials I spoke with could identify a valid reason that they or their colleagues had been in federal limbo since last spring. The officials I spoke with uniformly emphasized that filling IHS with qualified people is essential, but added that they didn’t fit the bill. And several officials told me they worry that, should many of the reassigned officials reject the government’s offer, IHS will have a harder time attracting the personnel it needs. HHS’s “goal is to get people out, and I think that has been the goal from the beginning,” another official told me. “It’s cruel and unkind and unprofessional.”
Some of the letter recipients still feel extreme pressure to accept their reassignment. One told me that they’re just weeks away from full retirement eligibility but can’t run out the clock before the acceptance deadline passes. “I might have to move,” the official said. And, as federal policy states, if HHS pays for any part of their relocation, they’ll have to remain in a federal job for at least a year. (Early-retirement options do exist, with fewer benefits; another official told me they’re taking this option, and accepting another job elsewhere.) Still, even as officials weigh their decision, they feel a new sense of finality: Their administrative leave is ending, and whatever hope they might have had of returning to the agencies they once worked at is extinguished.
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