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Health Resources and Services Administration (HRSA) Funding: Fact Sheet

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. Health Resources and Services Administration (HRSA) FY2016 Budget Request and Funding History: Fact Sheet Elayne J. Heisler Specialist in Health Services May 26, 2015 Congressional Research Service 7-5700 www.crs.gov R44054 c11173008 HRSA FY2016 Budget Request and Funding History: Fact Sheet . Agency Overview (HRSA) Funding: Fact Sheet
March 30, 2016 (R44054)

Agency Overview

The Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) is the federal agency charged with improving the health safety net by providing access to health care for those who are uninsured, isolated, or medically vulnerable. The agency currently awards funding to more than 3,000 grantees, including community-based organizations; colleges and universities; hospitals; state, local, and tribal governments; and private entities to support health services projects, such as training health care workers or providing specific health services.1 1 HRSA is organized into five bureaus: (1) Primary Care; (2) Health Workforce;22 (3) Maternal and Child Health; (4) HIV/AIDS; and (5) Healthcare Systems. In addition to these bureaus, HRSA has 10 offices. Some offices focus on specific populations or health care issues (e.g., Office of Women’ Women's Health, Office of Rural Health Policy), while others provide agency-wide support or technical assistance to HRSA's regional offices (e.g., Office of Planning, Analysis and Evaluation; Office of Regional Operations). This fact sheet focuses on the agency's funding; a number of specific HRSA programs are described in more detail in other CRS reports.3 Funding Sources 3 Funding Sources HRSA has four major sources of funding, described here in order of magnitude: (1) discretionary appropriations, (2) mandatory funds directly appropriated from the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) and extended in subsequent legislation, (3) Public Health Service (PHS) Program Evaluation Set-Aside funds,44 and (4) user fees. HRSA receives its discretionary appropriation through the Labor, Health and Human Services, and Education appropriations act.55 HRSA also began receiving mandatory appropriations from the ACA to support specific programs.66 For example, the ACA established the Community Health Center Fund (CHCF) to support health centers and the National Health Service Corps.77 HRSA programs also receive transfers from the ACA-created Prevention and Public Health Fund (PPHF).88 In addition to mandatory and discretionary funding, HRSA programs receive funds from the PHS Program Evaluation Set-Aside and collect user fees. 1 See HRSA’s website at http://www.hrsa.gov. The Bureau of Health Workforce was created in May 2014 by combining the Bureau of Health Professions, which administered most of HRSA’s primary care training programs, and the Bureau of Clinician Recruitment and Service, which administered the NHSC, NURSE Corps, and the Faculty Loan Repayment Program. 2 3 See CRS Report R43930, Maternal and Infant Early Childhood Home Visiting (MIECHV) Program: Background and Funding; CRS Report R43911, The Community Health Center Fund: In Brief; CRS Report R43937, Federal Health Centers: An Overview; CRS Report R43177, Health Workforce Programs in Title VII of the Public Health Service Act; CRS Report R43920, National Health Service Corps: Changes in Funding and Impact on Recruitment; and CRS Report R42428, The Maternal and Child Health Services Block Grant: Background and Funding. 4 For more information, see CRS Report R43304, Public Health Service Agencies: Overview and Funding. For more information, see CRS Report R43967, Labor, Health and Human Services, and Education: FY2015 Appropriations. 6 These programs are described in CRS Report R41278, Public Health, Workforce, Quality, and Related Provisions in ACA: Summary and Timeline. 7 CRS Report R43911, The Community Health Center Fund: In Brief. 8 See Appendix C of CRS Report R43304, Public Health Service Agencies: Overview and Funding. 5 c11173008 Congressional Research Service 1 HRSA FY2016 Budget Request and Funding History: Fact Sheet . The President’s FY2016 budget request included new mandatory funding proposals that would have extended ACA funding that had been slated to end in FY2015. After the President’s FY2016 budget request was released, the PHS Program Evaluation Set-Aside and collect user fees. A number of ACA funding sources were set to expire in FY2015, but some were extended in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10).9 Table 1 presents enacted funding for HRSA in FY2011 through the amounts included in the FY2017 President's budget request (included amounts that are enacted for FY2016 and FY2016 under MACRA). Table 1. Health Resources and Services Administration (HRSA)

(Millions of Dollars, by Fiscal Year)

Bureau or Activity

2011

2012

2013

2014

2015

2016a FY2017 President's Budget Requesta

Primary Care

4,149

2,817

2,992

3,636

5,001

5,092

5,092

Health Centers

2,481

2,672

2,856

3,545

4,901

4,992

4,992

Discretionary (non-add)

(1,481)

(1,472)

(1,391)

(1,397)

(1,392)

(1,392)

(1,242)

CHCF Transfer (non-add)

(1,000)

(1,200)

(1,465)

(2,145)

(3,509)

(3,600)

(3,600)

New Mandatory Proposal (non-add)

(150)

Health Center Tort Claims

100

95

89

95

100

100

100

School Based Health Centers (ACA Sec. 4101(a))

50

50

47

Health Center Construction (ACA Sec. 10503(c))

1,500

Hansen's Disease Programsb

18

Health Workforce

1,357

1,086

1,001

1,043

1,058

1,228

1,273

National Health Service Corps (NHSC)

315

295

285

283

287

310

380

Discretionary (non-add)

(25)

(20)

CHCF Transfer (non-add)

(290)

(295)

(285)

(283)

(287)

(310)

(310)

New Mandatory Proposal (non-add)

(50)

Training for Diversityc

95

85

80

81

82

83

86

Primary Care Training and Enhancement

39

39

37

37

39

39

39

Interdisciplinary, Community-Based Linkagesd

72

73

62

72

73

129

105

PPHF Transfer (non-add)

(12)

(2)

Public Health Workforce Development

30

33

8

18

21

21

17

PPHF Transfer (non-add)

(20)

(25)

Nursing Workforce Developmente

242

231

218

224

232

229

229

Children's Hospital GME Payments

268

265

251

264

265

295

295

New Mandatory Proposal (non-add)

(295)

Teaching Health Center GME Payments (ACA Sec. 5508(c))

230

60

60

Other Health Workforce Programsf

41

35

34

37

39

41

41

National Practitioner Data Bank (User Fees)

24

28

27

27

19

21

21

Maternal and Child Health

1,128

1,208

1,193

1,220

1,254

1,250

1,250

Maternal and Child Health Block Grant

656

639

605

634

637

638

638

Healthy Start

104

104

98

101

102

104

104

Home Visiting (ACA Sec. 2951)

250

350

380

371

400

400

400

Family-to-Family Health Centers (ACA Sec. 5507)g

5

5

5

3

5

5

5

Other Maternal and Child Health Programsh

113

112

105

110

112

103

103

Ryan White HIV/AIDS

2,337

2,392

2,249

2,313

2,319

2,323

2,332

PHS Evaluation Fund (non-add)

(25)

(25)

(25)

(25)

(34)

Health Care Systems

87

101

95

103

103

103

119

Other Health Care Systems Programsi

82

96

91

75

76

76

76

Hansen's Disease Programs

18

17

17

17

17

17

340B Drug Pricing Programs/Office of Pharmacy Affairs

4

4

4

10

10

10

26

User Fees (non-add)

           

9

Rural Health

138

138

131

142

147

150

144

Other Activities

702

647

712

669

683

685

706

Family Planning

299

294

278

286

286

286

300

Program Management

162

160

151

153

154

154

157

Vaccine Injury Compensation Program Operations

6

6

6

6

8

8

9

Vaccine Injury Compensation Program Trust Fund

235

187

277

224

235

237

240

Total, Program Level

9,898

8,389

8,373

9,126

10,565

10,831

10,916

Less Funds From Other Sources

             

PHS Evaluation Set-Aside

25

25

25

25

34

User Fees

24

28

27

27

19

19

30

Trust Fund (Mandatory)

235

241

241

235

235

237

240

ACA Mandatory Funds: PPHF Transfers

20

37

2

ACA Mandatory Funds: CHCF Transfers

1,290

1,495

1,750

2,428

3,796

3,910

3,910

ACA Mandatory Funds: Other

2,035

405

432

374

405

465

465

Proposed New Mandatory Funds

           

495

Total, Discretionary Budget Authority

6,269

6,212

5,861

6,046

6,112

6,197

5,743

Sources: The funding amounts are from congressional budget justification documents and HHS's Budget in Brief, available at
P.L. 114-10) was enacted, which extended mandatory funding for the CHCF (which supports health centers and the National Health Service Corps), Teaching Health Centers, Maternal and Infant Home Visiting, and Family-to-Family Information Centers.9 Table 1 presents enacted funding for HRSA in FY2011 through FY2015. It also shows the President’s request for FY2016, and amounts enacted for FY2016 under MACRA. The FY2016 funding cycle is still in process. Table 1. Health Resources and Services Administration (HRSA) (Millions of Dollars, by Fiscal Year) Bureau or Activity Primary Care Health Centers Discretionary (non-add) CHCF Transfer (non-add) New mandatory proposal, non-add) Health Center Tort Claims School Based Health Centers (ACA Sec. 4101(a)) Health Center Construction (ACA Sec. 10503(c)) Hansen’s Disease Programsb Health Workforce National Health Service Corps (NHSC) Discretionary (non-add) CHCF Transfer (non-add) New mandatory proposal, (non-add) Training for Diversityc Primary Care Training and Enhancement Rural Physician Training Grants Interdisciplinary, Community-Based Linkagesd PPHF Transfer (non-add) Public Health Workforce Development PPHF Transfer (non-add) Nursing Workforce Developmente Children’s Hospital GME Payments 9 c11173008 2011 4,149 2,481 (1,481) (1,000) — 2012 2,817 2,672 (1,472) (1,200) — 2013 2,992 2,856 (1,391) (1,465) — 2014 3,636 3,545 (1,397) (2,145) — 2015 5,001 4,901 (1,392) (3,509) — 2016 req. 4,191 4,092 (1,392) — (2,700) 2016 Enacteda — — — (3,600) — 100 50 95 50 89 47 95 — 100 — 100 — — — 1,500 — — — — — — 18 1,357 315 — 1,086 295 — 1,001 285 — 1,043 283 — 1,058 287 — 1,799 810 — — — (25) (290) — — (295) — — (285) — — (283) — — (287) — (287) — (523) — (310) — 95 39 85 39 80 37 81 37 82 39 85 39 — — — — — — — 4 — 72 73 62 72 73 53 — — 30 (12) 33 (2) 8 — 18 — 21 — 17 — — (20) 242 (25) 231 — 218 — 224 — 232 — 232 — — 268 265 251 264 265 100f — CRS Report R43962, H.R. 2: The Medicare Access and CHIP Reauthorization Act of 2015. Congressional Research Service 2 HRSA FY2016 Budget Request and Funding History: Fact Sheet . Bureau or Activity GME Targeted Support (new mandatory proposal) Teaching Health Center GME Payments (ACA Sec.5508(c)) Other Health Workforce Programsg National Practitioner Data Bank (User Fees) Maternal and Child Health Maternal and Child Health Block Grant Healthy Start Home Visiting (ACA Sec. 2951) Home Visiting (New mandatory proposal)h Family-to-Family Health Centers (ACA Sec. 5507) Other Maternal and Child Health Programsj Ryan White HIV/AIDS PHS Evaluation Fund (nonadd) Health Care Systems Health Care Systems Programsk Hansen’s Disease Programs 340B Drug Pricing Programs User fee (non-add) Rural Health Other Activities Family Planning Program Management Vaccine Injury Compensation Program Operations Total, Program Level Less Funds From Other Sources PHS Evaluation Set-Aside User Fees ACA Mandatory Funds: PPHF Transfers ACA Mandatory Funds: CHCF Transfers ACA Mandatory Funds: Other New Mandatory Proposals for FY2016 Total, Discretionary Budget Authority c11173008 Congressional Research Service 2011 — 2012 — 2013 — 2014 — 2015 — 2016 req. 400f 2016 Enacteda — 230 — — — — — 60 41 35 34 37 39 39 — 24 28 27 27 19 20 — 1,128 656 1,208 639 1,193 605 1,220 634 1,254 637 1,352 637 — — 104 250 104 350 98 380 101 371 102 400 102 — — 400 — — — — — 500 — 5 5 5 3 5 2.5i 5 113 112 105 110 112 112 — 2,337 (25) 2,392 (25) 2,249 (25) 2,313 (25) 2,319 — 2,323 — — — 87 82 101 96 95 91 103 75 103 76 118 76 — — — 4 — 138 467 299 162 6 18 4 — 138 460 294 160 6 17 4 — 131 436 278 151 6 17 10 — 142 446 286 153 6 17 10 — 147 448 286 154 7.5 17 25 (7.5) 128 465 300 157 7.5 — — — — — — — — 9,663 8,202 8,097 8,902 10,330 10,375 — 25 24 20 25 28 37 25 27 2 25 27 — — 19 — — 28 — — — — 1,290 1,495 1,750 2,428 3,796 3,796 3,910 2,035 405 432 374 405 2.5 470 — — — — — 4,123 — 6,269 6,212 5,861 6,046 6,112 6,225 N/A 3 HRSA FY2016 Budget Request and Funding History: Fact Sheet . Sources: The funding amounts are from congressional budget justification documents and HHS’s Budget in Brief, available at http://www.hhs.gov/budget/. budget/; and from P.L. 114-10. Note: Individual amounts may not add to subtotals or totals due to rounding. a. a. Shows funds appropriated in Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). b. ). The appropriations process for FY2016 is ongoing; therefore, remaining amounts and totals are not yet available. b. Beginning in FY2012, the Hansen's Disease Programs appears under Health Care Systems. c. c. Training for Diversity includes Centers for Excellence, Scholarships for Disadvantaged Students, Faculty Loan Repayment, and the , and the Health Careers Opportunity Program. d. d. Interdisciplinary, Community-Based Linkages include Area Health Education Centers, Geriatric Programs, and Mental and Behavioral Health Education and Training, and Clinical Training for Interdisciplinary Practice. e. Nursing Workforce Development include NURSE Corps; Advanced Nursing Education; Nursing Workforce Diversity; Nurse Education, Practice, Quality and Retention; Nurse Faculty Loan Program; and Comprehensive Geriatric Education. f. The President’s FY2016 budget proposed new mandatory funding for Targeted Support for Graduate Medical Education, which would be used to provide additional support for the Children’s Hospital GME Payment Program and full support for the Teaching Health Center GME program. g. Other Health Workforce Programs include Health Care Workforce Assessment, Patient Navigator (FY2011 only), and Oral Health Training. h. The President’s FY2016 budget proposed new mandatory funds to extend and expand the home visiting program through FY2025, including $500 million for FY2016. i. and Mental and Behavioral Health Education and Training. FY2015 and FY2016 amounts reflect the Behavioral Health Workforce Education and Training Program (a component of the Mental and Behavioral Health Education and Training). These funds were appropriated to the Substance Abuse and Mental Health Services Administration, for a program that was administered by HRSA The FY2017 request proposes that this program be transferred to HRSA .In FY2017, the President's budget does not request funding for the Area Health Education Center program. e. Nursing Workforce Development include NURSE Corps; Advanced Nursing Education; Nursing Workforce Diversity; Nurse Education, Practice, Quality and Retention; Nurse Faculty Loan Program; and Comprehensive Geriatric Education. f. Other Health Workforce Programs include Health Care Workforce Assessment, Patient Navigator (FY2011 only), and Oral Health Training. g. P.L. 113-93 provided $2.5 million for this program for FY2015, which was repealed when P.L. 114-10 provided a full year of funding ($5 million) for this program for FY2015. j. h. Other Maternal and Child Health Programs include Autism and Other Developmental Disorders, Traumatic Brain Injury, Sickle Cell Services Demonstration, Universal Newborn Hearing Screening, Emergency Medical Services for Children, and Heritable Disorders. k. In FY2016, the Traumatic Brain Injury program was transferred to the Administration for Community Living, and, therefore was not funded under HRSA. i. Health Care Systems Programs include Organ Transplantation, National Cord Blood Inventory, C.W. Bill Young Cell Transplantation Program, and Poison Control Centers. Author Contact Information Elayne J. Heisler Specialist in Health Services eheisler@crs.loc.gov, 7-4453 c11173008 Congressional Research Service 4

Author Contact Information

[author name scrubbed], Specialist in Health Services ([email address scrubbed], [phone number scrubbed])

Acknowledgments

LaTiesha Cooper, Research Assistant, provided assistance with the tables included in this report.

Footnotes

1.

See HRSA's website at http://www.hrsa.gov.

2.

The Bureau of Health Workforce was created in May 2014 by combining the Bureau of Health Professions, which administered most of HRSA's primary care training programs, and the Bureau of Clinician Recruitment and Service, which administered the NHSC, NURSE Corps, and the Faculty Loan Repayment Program.

3.

See CRS Report R43930, Maternal and Infant Early Childhood Home Visiting (MIECHV) Program: Background and Funding; CRS Report R43911, The Community Health Center Fund: In Brief; CRS Report R43937, Federal Health Centers: An Overview; CRS Report R43177, Health Workforce Programs in Title VII of the Public Health Service Act; CRS Report R43920, National Health Service Corps: Changes in Funding and Impact on Recruitment; and CRS Report R42428, The Maternal and Child Health Services Block Grant: Background and Funding.

4.

For more information, see CRS Report R43304, Public Health Service Agencies: Overview and Funding (FY2010-FY2016).

5.

For more information, see CRS Report R44287, Labor, Health and Human Services, and Education: FY2016 Appropriations and CRS Report R44378, Department of Health and Human Services: FY2017 Budget Request.

6.

These programs are described in CRS Report R41278, Public Health, Workforce, Quality, and Related Provisions in ACA: Summary and Timeline.

7.

CRS Report R43911, The Community Health Center Fund: In Brief.

8.

See Appendix C of CRS Report R43304, Public Health Service Agencies: Overview and Funding (FY2010-FY2016).

9.

CRS Report R43962, The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10).