Breakdown: The Hospital Preparedness Program and the FY2026 Budget Threat

In April 2025, a leaked version of the FY2026 HHS budget proposal revealed potential cuts and structural changes that could significantly impact the Hospital Preparedness Program (HPP)—a cornerstone of the nation’s health emergency readiness infrastructure. The full leaked document can be accessed here: Leaked FY2026 HHS Budget Proposal (PDF).

What Is the Hospital Preparedness Program?

HPP was created in the wake of the 9/11 terrorist attacks and the 2001 anthrax mailings, which exposed critical gaps in hospital readiness. During 9/11, New York City hospitals struggled to manage the surge in patients. Communication breakdowns between healthcare providers, emergency services, and government responders delayed coordination. The anthrax attacks later revealed the absence of biopreparedness—from limited infection control training to inadequate PPE stockpiles and a lack of system-wide coordination. These failures highlighted the urgent need for sustained federal investment in hospital surge capacity and infrastructure.

At the time, most hospitals had no formal connection to emergency management or public health systems. Few had contingency plans or the ability to expand operations during a crisis. HPP was launched in 2002 as the only federal funding stream specifically designed to strengthen healthcare system readiness.

Administered by the Administration for Strategic Preparedness and Response (ASPR), the program provides grants to states, territories, and healthcare coalitions to improve capacity across hospitals, EMS, long-term care facilities, and public health partners.

Crucially, HPP doesn’t just support hospitals. It funds regional healthcare coalitions—networks that include health systems, long-term care providers, behavioral health organizations, EMS, emergency managers, and public health departments. These coalitions assess local risks, develop regional response plans, and build the relationships and systems necessary to act together when disaster strikes.

Emergencies such as wildfires, mass shootings, and disease outbreaks don’t impact a single sector—they strain the entire continuum of care. HPP ensures that communication systems, protocols, and personnel are in place before the crisis, so the response is coordinated and fast.

HPP funds are used to:

• Build and sustain healthcare coalitions

• Support interoperable communication systems

• Conduct joint training and exercises

• Develop surge plans and alternate care sites

• Strengthen continuity of operations and evacuation procedures

These investments have significantly improved local and regional response capabilities, positioning healthcare systems to act cohesively during emergencies.

What the Budget Proposal Signals

The leaked FY2026 budget states: "The Budget eliminates the Hospital Preparedness Program Cooperative Agreement." This direct language confirms the administration’s intent to terminate the program in its current form. The proposed elimination is part of a broader restructuring of emergency preparedness responsibilities across HHS, including the absorption of ASPR into the Centers for Disease Control and Prevention (CDC).

In FY2025, HPP received $302 million. It is unclear whether any of this funding would be reallocated under CDC or if its core functions would be preserved in a new form. Historically, CDC-led preparedness has focused more on surveillance and public health capacity than on system-wide emergency readiness. (FY2025 ASPR Budget Justification)

Why HPP Matters

HPP-supported coalitions were essential during the COVID-19 pandemic. They coordinated patient transfers between hospitals, activated alternate care sites, distributed PPE, and helped facilities manage unprecedented ICU demand. Without these coalitions, regional responses would have been slower, fragmented, and far less effective.

HPP builds the infrastructure and partnerships needed for systems to perform under stress. It ensures that hospitals don’t operate in isolation and that healthcare response is integrated with emergency management, public health, and community partners.

In addition to pandemic response, HPP plays a central role in:

• Strengthening rural and underserved healthcare systems

• Supporting equitable distribution of emergency resources

• Developing systems for patient tracking, evacuation, and real-time communication

State-Level Funding Overview

HPP funding reaches 62 jurisdictions, including all 50 states, U.S. territories, and major cities such as New York City and Los Angeles. Each jurisdiction tailors its coalition structure to reflect its unique risks and healthcare landscape.

The ASPR Health Care Readiness Near You portal provides public data for each jurisdiction, including:

• Annual funding levels

• Coalition accomplishments

• Highlights of preparedness investments

Examples include:

• Virginia: Supports six regional coalitions that coordinated the state’s vaccine rollout and multi-agency COVID-19 response.

• California: Funds its Medical and Health Operational Area Coordinators (MHOAC), a statewide coordination network for disaster medical response.

• Texas: Invests in the Texas Emergency Medical Task Force, a scalable rapid response capability for surge events.

These programs reflect the flexibility and impact of HPP across different healthcare systems and regions.

Return on Investment

Research compiled by ASPR TRACIE and summarized in its technical assistance brief on healthcare preparedness ROI suggests that every dollar invested in hospital preparedness can lead to significant savings in avoided emergency response and recovery costs. While specific ROI figures vary, the evidence supports a strong economic case for maintaining federal investment in readiness. The coalitions and systems it supports allow hospitals to respond faster, reduce duplication, and minimize disruptions to care.

According to ASPR’s 2022 performance data, over 90% of coalitions met key benchmarks in communication, patient tracking, and coordination during preparedness drills. These metrics demonstrate that HPP funding translates directly into functional readiness.

States also leverage HPP dollars to secure matching grants and local contributions—amplifying the program’s impact through cost-sharing and long-term planning.

Final Thought

The Hospital Preparedness Program is one of the most effective and underrecognized components of U.S. disaster readiness. It has strengthened hospitals, connected healthcare systems, and ensured that communities don’t have to face emergencies alone.

Eliminating this program—especially without a clear replacement—would undermine two decades of progress. As disasters become more frequent and complex, protecting healthcare system preparedness should be a national priority.

Click here to see how Health Response Alliance can support your readiness efforts.