The Department of Government Efficiency implemented additional protocols for reviewing and approving health care grants in key agencies across the Department of Health and Human Services. The initiative, called “Defend the Spend,” requires grantees to justify each transaction they are seeking to have reimbursed by their grants and officials must then review and  manually approve each transaction before federal funds are released. The new requirements have caused significant delays and left thousands of payments backed up, including funding for doctors’ and nurses’ salaries at federal health centers that serve low-income communities.