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

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

March 30, 2016July 13, 2017 (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 granteesgrantees, 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

HRSA is organized into five bureaus: (1) Primary Care; (2) Health Workforce;2 (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'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

HRSA has four major sources of funding, described here in order of magnitude: (1) discretionary appropriations, (2) mandatory funds directly appropriated fromin 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,4 and (4) user fees. HRSA receives its discretionary appropriation through the Labor, Health and Human Services, and Education appropriations act.5 HRSA also began receiving mandatory appropriations from the ACA to support specific programs in FY2010.6 For example, the ACA established the Community Health Center Fund (CHCF) to support health centers and the National Health Service CorpsMaternal, Infant, and Early Childhood Home Visiting Program.7 HRSA programs also receive transfers from the ACA-created Prevention and Public Health Fund (PPHF).8 InFinally, in addition to mandatory and discretionary funding, HRSA programs receive or have received funds from 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 for FY2016 and FY2017.9 Funding for these programs is again set to expire at the end of FY2017 (i.e., September 30, 2017), but the President's budget for FY2018 includes proposed mandatory funding extensions for these programs.10 Table 1 presents enacted funding for HRSA in FY2011 through the amounts included in the FY2017FY2018 President's budget request (included amounts that are enacted for FY2016 and FY2016 under MACRA).

including mandatory funds enacted in MACRA for FY2016 and FY2017 and proposals to extend these funds for FY2018). The table presents funding levels for selected programs and totals for each of HRSA's bureaus. The President's budget would maintain funding for programs in HRSA's Bureau of Primary Care and Ryan White HIV/AIDs Bureaus and would maintain funding for the Title X Family Planning Program. It proposes to reduce or eliminate funds for a number of Health Workforce, Health Care Systems, and Rural Health Bureau programs.

Table 1. Health Resources and Services Administration (HRSA)

(Millions of DollarsBudget Authority in Millions, by Fiscal Year)

5b  

Bureau or Activity

2011

2012

2013

2014

2015

2016a

FY2017a FY2018 President's Budget Requestab

Primary Care

4,149

2,817

2,992

3,636

636

5,001

5,092

4,997

5,089

5,092

Health Centers

2,481

581

2,672

767

2,856

945

3,545

637

4,901

5,001

4,992

4,992

5,091

4,997

5,089

Discretionary c (non-add)

(1,481595)

(1,472567)

(1,391480)

(1,397492)

(1,392492)

(1,392489)

(1,242487) (1,489)

CHCF Transfer (non-add)

(1,000)

(1,200)

(1,465)

(2,145)

(3,509)

(3,600)

(3,600509) (3,600)b)

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

d

18

Health Workforce

1,357

1,086

1,001

004

1,043

1,058

1,228

177

1,273

203

771

National Health Service Corps (NHSC)

315

295

285

283

287

310

380

310

289

310b

Discretionary (non-add)

(25)

(20)

CHCF Transfer (non-add)

(290)

(295)

(285)

(283)

(287)

(310)

(289)

(310)

New Mandatory Proposal (non-add)

Training for Diversitye

95

85

80

81

82

82

(50)

83

Training for Diversityc

Primary Care Training and Enhancement

39

95

39

85

37

80

37

81

39

82

39

83

39

86

Primary Care Training and Enhancement

Oral Health

33

39

33

39

33

37

32

37

34

39

36

39

37

39

Interdisciplinary, Community-Based Linkagesd

f

72

73

62

72

73

79

129

105

PPHF Transfer (non-add)

(12)

(2)

Public Health Workforce Development

Health Care Workforce Assessment

3

30

3

33

3

8

5

18

5

21

5

21

5

17

5

PPHF Transfer (non-add)

Public Health Workforce Development

(20)

30

(25)

33

8

18

21

21

17

Nursing Workforce Developmente

PPHF Transfer (non-add)

(20)

242

(25)

231

218

224

232

229

229

Children's Hospital GME Payments

Nursing Workforce Developmentg

268

242

265

231

251

218

264

224

265

232

295

229

229

29583h

New Mandatory Proposal (non-add)

Children's Hospital GME Payments

268

265

251

264

265

295

300

(295)

295

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

230

60

60

Other Health Workforce Programsf

41

56 60b

Patient Navigator

5

35

34

37

39

41

41

National Practitioner Data Bank (User Fees)

24

28

27

27

19

21

21

19

18

Maternal and Child Health

1,128

1,208

1,193

1,220

1,254

1,250

1,250

38

1,200

Maternal and Child Health Block Grant

656

639

605

634

637

638

637

638

640

667

Healthy Start

104

104

98

101

102

104

104

118i

128

Home Visiting (ACA Sec. 2951)

250

350

380

371

400

400

400

372 400b

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

j

5

5

5

3

5

5

5

Other Maternal and Child Health Programsh

k

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

313

2,260

PHS Evaluation Fund (non-add)

(25)

(25)

(25)

(25)

(34)

Health Care Systems

87

101

118

95

112

103

103

103

119

104

99

Other Health Care Systems Programsil

82

96

91

75

76

76

77

76

Hansen's Disease Programs

d

18

17

17

17

17

17

14

340B Drug Pricing Programs/Office of Pharmacy Affairs

4

4

4

10

10

10

26

10

10

User Fees (non-add)

 

 

 

 

 

 

9

Rural Health

138

138

131

142

147

150

144

156

74

Other Activities

702

647

712

669

683

685

701

706

688

715

Family Planning

299

294

278

286

286

286

300

286

286

286

Program Management

162

160

151

153

154

154

157

154

154

152

Vaccine Injury Compensation Program Operations

6

6

6

6

8

8

8

9

Vaccine Injury Compensation Program Trust Fund

235

187

277

224

235

237

253

240

268

Total, Program Level

9,898

8,389

407

8,373

393

9,126

10,565

10,795

10,831

699

10,916

210

Less Funds From Other Sources

Sources Other than the Discretionary Appropriation
 

 

 

 

 

 

 

PHS Evaluation Set-Aside

25

25

25

25

34

User Fees

24

28

27

27

19

21

19

30

18

Trust Fund (Mandatory)

235

241

187

241

277

235

224

235

237

253

240

268

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

805 3,910b

ACA Mandatory Funds: Other

2,035

405

432

374

405

465

465

433 465b

Proposed New Mandatory Funds

 

 

 

 

 

 

495

Total, Discretionary Budget Authority

6,269

6,212

230

5,861

880

6,046

050

6,112

6,197

140

6,202

5,743

549

Sources: The funding amounts are from congressional budget justification documents and HHS's Budget in Brief,for FY2011-FY2015 and FY2018 are from the HRSA congressional budget justification. Congressional budget justifications are available at http://www.hhs.gov/budget/. FY2016 and FY2017 discretionary funding amounts are from the FY2017 HRSA Operating Plan at https://www.hrsa.gov/about/budget/operatingplan.html. Other HRSA funding amounts for FY2016 and FY2017 are from the FY2018 HRSA congressional budget justification.

Note: Individual amounts may not add to subtotals or totals due to rounding.

a. Shows funds appropriated in Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10).

b. Includes proposal for FY2018 mandatory funding for programs that currently receive mandatory funds through FY2017. c. Includes funding for Native Hawaiian Programs, Health Center Tort Claims, and Free Clinics Medical Malpractice. d. Beginning in FY2012, Beginning in FY2012, the Hansen's Disease Programs appears under Health Care Systems.

Hansen's Disease Programs include Hansen's Disease Center, Payments to Hawaii (for Hansen's Disease) and National Hansen's Disease Program—Buildings and Facilities. e

c. Training for Diversity includes Centers for Excellence, Scholarships for Disadvantaged Students, Faculty Loan Repayment, and the Health Careers Opportunity Program.

df. Interdisciplinary, Community-Based Linkages include Area Health Education Centers, Geriatric Programs, 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 g. 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.

gh. The FY2018 Budget proposes funding the NURSE Corps program, but does not propose funding for other Nursing Workforce Development programs. i. Includes $15 million appropriated in the Water Infrastructure Improvements for the Nation Act (P.L. 114-322 ). See CRS Report R44723, Overview of Further Continuing Appropriations for FY2017 (H.R. 2028). j. P.L. 113-93 provided $2.5 million for this program for FY2015, which was repealed when P.L. 114-10 provided asuperseded by the full year of funding ($5 million) for this program for FY2015.

enacted in P.L. 114-10.

hk. 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. In FY2016, the Traumatic Brain Injury program was transferred to the Administration for Community Living, and, therefore was not funded under HRSA.

il. Other 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

[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

CRS Report R44796, The ACA Prevention and Public Health Fund: In Brief.

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 R43911, The Community Health Center Fund: In Brief; CRS Report R43937, Federal Health Centers: An Overview; CRS ReportSee 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 FundingIn Focus IF10595, Maternal and Infant Early Childhood Home Visiting Program; CRS Report R43920, National Health Service Corps: Background, Funding, and Programs; CRS Report R44282, The Ryan White HIV/AIDS Program: Overview and Impact of the Affordable Care Act; CRS Report RL33644, Title X (Public Health Service Act) Family Planning Program; and CRS In Focus IF10051, Title X Family Planning Program.

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).

R43930, Maternal and Infant Early Childhood Home Visiting (MIECHV) Program: Background and Funding; CRS In Focus IF10595, Maternal and Infant Early Childhood Home Visiting Program.
8.
9.

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

10.

See CRS Insight IN10185, Congress Faces Calls to Address Expiring Funds for Primary Care.