GAO Report: HHS Emergency Preparedness Programs Lack Coordination
Summary
The GAO has released a report highlighting a lack of coordination between the Department of Health and Human Services' (HHS) Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP). The report notes that HHS awarded nearly $900 million in FY2024 to states and localities for these programs but lacks formal mechanisms for coordination, potentially leading to inefficiencies and reduced preparedness.
What changed
The Government Accountability Office (GAO) has issued a report (GAO-26-107507) identifying significant coordination gaps between two key Department of Health and Human Services (HHS) emergency preparedness programs: the Public Health Emergency Preparedness (PHEP) program and the Hospital Preparedness Program (HPP). In fiscal year 2024, HHS allocated approximately $900 million through these programs to support public health departments and healthcare systems, respectively. However, the GAO found that the agencies administering these programs lack formal mechanisms, such as joint exercises or written agreements, to coordinate their efforts. This lack of coordination hinders HHS's ability to effectively manage these programs and support jurisdictions in preparing both public health and healthcare systems for emergencies, a critical lesson reinforced by the COVID-19 pandemic.
The GAO also noted that HHS does not systematically collect or analyze data on jurisdictions' capabilities and gaps in meeting national public health and healthcare preparedness standards. The report recommends that HHS implement formal coordination mechanisms and improve data collection to better assess and enhance national preparedness. While this report does not impose new direct compliance obligations, it signals a critical area for improvement that could lead to future policy changes or funding requirements for recipients of PHEP and HPP funds. Regulated entities, particularly state and local public health agencies and healthcare coalitions, should be aware of these findings as they may influence future HHS guidance, funding priorities, and performance expectations.
What to do next
- Review GAO report GAO-26-107507 for detailed findings and recommendations.
- Assess current interagency coordination efforts with healthcare systems for emergency preparedness.
- Incorporate lessons learned from the COVID-19 pandemic into preparedness planning and exercises.
Source document (simplified)
GAO-26-107507 Published: Feb 23, 2026. Publicly Released: Feb 23, 2026.
Fast Facts
The Department of Health and Human Services awarded about $900 million to states and localities in fiscal year 2024 through two emergency preparedness programs. One helps public health departments prepare for threats, and the other helps health care systems—which include hospitals.
Coordination between public health departments and health care systems is vital for responding to public health emergencies. But HHS is missing opportunities to coordinate between these two programs. For example, funding recipients from both programs could be required to conduct joint training and exercises.
Our recommendations address this and other issues we found.
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Highlights
What GAO Found
The U.S. Department of Health and Human Services (HHS) leads the federal public health and medical preparedness for, response to, and recovery from public health emergencies. HHS awarded almost $900 million in fiscal year 2024 to states and other jurisdictions to help them prepare for a range of public health threats and emergencies through two programs. First, the Public Health Emergency Preparedness (PHEP) program supports jurisdictions’ public health systems, which includes public health agencies at all government levels. Second, the Hospital Preparedness Program (HPP) supports health care systems, which include a community’s health care organizations such as hospitals. Jurisdictions distribute HPP funds to health care coalitions—made up of health care and other entities to support preparedness. HHS requires jurisdictions and health care coalitions to complete activities. These include exercises to help ensure that jurisdictions are prepared to respond to public health threats, such as infectious diseases and extreme weather events (e.g., hurricanes).
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The two HHS agencies that administer these programs lack a formal mechanism, such as joint exercises, written agreements, or working groups, to coordinate them. Coordinating these preparedness programs could allow HHS to better manage them and support jurisdictions as they prepare both their public health and health care systems to respond to public health threats and emergencies. Lessons learned from the COVID-19 pandemic have demonstrated the importance of coordination between these systems, such as between state health departments and hospitals, if jurisdictions are to be effectively prepared. Additionally, officials from selected jurisdictions said that greater interagency coordination could help reduce resource inefficiencies associated with implementation of PHEP and HPP.
Further, HHS does not collect or analyze information on jurisdictions’ ability to meet the 15 public health and four health care preparedness capabilities and any related gaps. According to HHS documentation, it identified these capabilities to serve as national guidance. The capabilities describe skills and abilities jurisdictions need to effectively respond to, and recover from, public health threats and emergencies. For example, they include providing mass medical care and laboratory testing at scale for emerging pathogens. Collecting and analyzing such information would help HHS understand the extent to which jurisdictions are prepared to respond to public health threats and emergencies and whether any changes are needed.
Why GAO Did This Study
The United States faces ongoing risks from future public health threats, such as infectious diseases; extreme weather events; and biological, chemical, nuclear, and radiological events. In fiscal year 2024, HHS, through PHEP, provided $654 million, and through HPP, provided $240 million, to jurisdictions to aid preparedness for such threats.
The CARES Act includes a provision for GAO to examine public health preparedness and response efforts related to the COVID-19 pandemic. This report examines, among other objectives, the extent to which HHS agencies (1) coordinate PHEP and HPP and (2) collect and analyze information on jurisdictions’ capabilities.
GAO reviewed HHS documentation, including notices of funding opportunity, templates, and examples of documents submitted by eight selected jurisdictions. GAO also interviewed officials from HHS and the eight selected jurisdictions. GAO selected these jurisdictions to include variation among geographic location, percent of the population living in a rural setting, and public health governance structure.
Recommendations
GAO is making five recommendations, including that HHS establish a mechanism to coordinate PHEP and HPP; and that it collect and analyze information on jurisdictions’ preparedness capabilities and any related gaps. HHS concurred with our recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
| --- | --- | --- |
| Department of Health and Human Services | The Assistant Secretary for Preparedness and Response and the Director of CDC should develop a mechanism, or mechanisms, to coordinate PHEP and HPP by, for example, taking into consideration GAO's Leading Practices to Enhance Interagency Collaboration and Address Crosscutting Challenges. (Recommendation 1) | Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information. |
| Department of Health and Human Services | The Director of CDC should provide information to jurisdictions on how the required PHEP activities support the development of the public health preparedness capabilities. (Recommendation 2) | Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information. |
| Department of Health and Human Services | The Assistant Secretary for Preparedness and Response should provide information to jurisdictions on how the required HPP activities support the development of the health care preparedness capabilities. (Recommendation 3) | Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information. |
| Department of Health and Human Services | The Director of CDC should collect and analyze information on jurisdictions' ability meet the public health preparedness capabilities and identify any related gaps in partnership with jurisdictions. (Recommendation 4) | Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information. |
| Department of Health and Human Services | The Assistant Secretary for Preparedness and Response should collect and analyze information on jurisdictions' ability to meet health care preparedness capabilities and identify any related gaps in partnership with jurisdictions. (Recommendation 5) | Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information. |
See All 5 Recommendations
Full Report
GAO Contacts
Mary Denigan-Macauley Director Health Care deniganmacauleym@gao.gov
Media Inquiries
Sarah Kaczmarek Managing Director Office of Public Affairs media@gao.gov
Public Inquiries
Topics
Health Care National preparedness Public health Health care Public health emergencies Hospital preparedness Health care systems Disease control Homeland security Interagency relations Emergency management
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