The U.S. DOGE Service is putting new curbs on billions of dollars in federal health-care grants, requiring government officials to manually review and approve previously routine payments — and paralyzing grant awards to tens of thousands of organizations, according to 12 people familiar with the new arrangements.
The effort, which DOGE has dubbed “Defend the Spend,” has left thousands of payments backed up, including funding for doctors’ and nurses’ salaries at federal health centers for the poor. Some grantees are waiting on payments they expected last week.
Federal officials also have been instructed to use a website run by DOGE to approve grant payments, according to an email sent by defendthespend [at] hhs.gov and obtained by The Washington Post.
Typically, an organization that has been awarded a grant does not receive the funding up front. The money is held in a secure account managed by the government, and an organization will request “drawdowns” — tranches of money periodically throughout the year — to cover expenses such as salaries or research costs.
Under Defend the Spend, organizations must now include a justification for each transaction. Federal officials then review the justification before deciding whether to approve the payment.
The process has been abruptly instituted at the National Institutes for Health, the Administration for Children and Families, and other parts of HHS, with inconsistent instructions on how to proceed, said the people familiar with the arrangements, who, like others, spoke on the condition of anonymity because of fear of reprisal. They also described immediate backlogs in processing payments.
HHS said in a statement that the DOGE effort would not threaten “support for critical programs” and was intended to root out fraud and abuse. “The era of rubber stamping is over,” the HHS statement said.
DOGE engineers also recently inserted themselves into the government’s long-established process to alert the public about potential federal grants and allow organizations to apply for funds. The group — which is backed by billionaire Elon Musk and stocked with young engineers and Musk allies — has said it is focused on cutting wasteful spending and making the government more efficient.
But the new initiative is creating holdups, staffers who award grants at the health agencies said in interviews. They described a hurried, uncertain process to roll out Defend the Spend, which involves fields added to Payment Management Services, a centralized system that processed nearly 500,000 transactions and more than $850 billion in payments last year. A DOGE engineer was given access to the system on Jan. 22 and was made an administrator, according to a Trump administration court filing last month.
Lambert here: So far as I can tell, Payment Management Services is not written in COBOL.
Until this month, grantees had to provide progress reports and quarterly reports for federal review, but government staffers did not examine every single “drawdown” of funds requested, said one HHS employee.
Thousands of such “drawdowns” take place every day, the employee said. The DOGE system has imposed an extreme workload on government staff, the employee said.
Among those immediately suffering consequences are federal health centers, which provide services for low-income people and those who lack insurance, the employee said. Those centers rely on regular drawdowns for their operational expenses, such as doctors’ and nurses’ salaries and basic medical supplies.
If the funding delay continues much longer, the situation will grow dire for such centers, imperiling their ability to assist the poor, the employee said.
Lambert here: That’s not a bug. It’s a feature.
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