Under the President’s budget proposal released Thursday, the Department of Health and Human Services would receive a 17.9 percent decrease in funding. It’s one of the largest departments in the government and slashing the budget is the lowest funding for the agency in about 20 years.

The sum excludes funding for Medicare and Medicaid insurance, which was noticeably absent from the budget description. Currently, this funding totals about $1 trillion. Head Start and Temporary Assistance for Needy Families were also absent from the budget, as was the Office of the National Coordinator for Health IT.

But not all health-related organizations will see cuts. Trump’s budget winners are:

• Substance Abuse and Mental Health Services Administration: SAMHSA will receive a budget increase of $500 million to aid in substance abuse treatment activities, expand opioid misuse prevention efforts and increase treatment and recovery service access.
• Direct health care services: Clinics like community health centers, Ryan White HIV/AIDS providers and the Indian Health Service will be supported by the budget, but the exact amount wasn’t noted.
• Centers for Disease Control and Prevention: The agency will receive a new $500 million block grant to “increase state flexibility and focus on the leading public health challenges specific to each state.”
• Health Care Fraud and Abuse Control: The agency will continue to receive funding as it “strengthens the integrity and sustainability of Medicare and Medicaid by investing in activities to prevent fraud, waste, and abuse and promote high quality and efficient healthcare.” The exact amount wasn’t included.
• Public health, emergency preparedness and prevention programs: The budget said it will reform these key programs, including the addition of a new Federal Emergency Response Fund to rapidly respond to public health outbreaks, such as Zika.

The budget’s biggest losers are:

• The National Institutes of Health: Funding cuts for NIH make up more than a third of the total HHS budget reductions. Funding will be slashed to $25.9 billion - an 18 percent or $5.8 billion reduction. NIH will undergo a ‘major reorganization,’ of its institutes and centers. The budget also seeks to reduce “administrative costs and rebalance federal contributions to research funding.”
• The Agency for Healthcare Research and Quality: The HHS agency will become part of NIH.
• Fogarty International Center: The NIH program designed to build partnership between U.S. health research organizations and other countries will be terminated.
• FDA: The budget stated $2 billion in fees will be collected from the industry by FDA - double the amount in the last budget. Blaming budget constraints, industries that benefit from FDA approval “can and should pay for its share.” It also said it would speed up drug and other product approval. Neither funding nor how it would accomplish these goals were not specified.
• Health professions and nursing training programs: $403 million will be eliminated from these programs, as it lacks “evidence that they significantly improve the nation’s health workforce.”
• HHS preparedness grants: These will be restructured to “reduce overlap and administrative costs and direct resources to States with the greatest need.”
• Low Income Home Energy Assistance program: This program is eliminated in the budget.
• Community Services Block Grant: This program is eliminated in the budget.