.
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).
|