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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
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).
Table 1. Health Resources and Services Administration (HRSA)
(Millions of DollarsBudget Authority in Millions, by Fiscal Year)
Bureau or Activity |
2011 |
2012 |
2013 |
2014 |
2015 |
2016a |
FY2017a
FY2018 President's Budget Request |
|||
Primary Care |
4,149 |
2,817 |
2,992 |
3, |
5,001 |
5,092 |
4,997 5,089 |
|||
Health Centers |
2, |
2, |
2, |
3, |
4,901 |
4,992 | 4,992
|
|||
Discretionary |
(1, |
(1, |
(1, |
(1, |
(1, |
(1, |
(1, |
|||
CHCF Transfer (non-add) |
(1,000) |
(1,200) |
(1,465) |
(2,145) |
(3,509) |
(3,600) |
(3, | |||
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 Programs |
18 |
— |
— |
— |
— |
— |
— |
— |
||
Health Workforce |
1,357 |
1,086 |
1, |
1,043 |
1,058 |
1, |
1, 771 |
|||
National Health Service Corps (NHSC) |
315 |
295 |
285 |
283 |
287 |
310 | 380
310b |
|||
Discretionary (non-add) |
(25) |
— |
— |
— |
— |
— |
(20) — |
|||
CHCF Transfer |
(290) |
(295) |
(285) |
(283) |
(287) |
(310) (289) |
(310) |
|||
New Mandatory Proposal (non-add) |
— |
— |
— |
— |
— |
— |
(50) — |
|||
39 |
95 |
85 |
80 |
81 |
82 |
83 |
86 |
|||
Primary Care Training and Enhancement 33 |
39 |
39 |
37 |
37 |
39 |
39 |
39 |
|||
Interdisciplinary, Community-Based Linkages |
72 |
73 |
62 |
72 |
73 |
79 |
105 |
|||
PPHF Transfer (non-add) |
— |
(12) |
(2) |
— |
— |
— |
— |
— |
||
Public Health Workforce Development 3 |
30 |
33 |
8 |
18 |
21 |
21 |
17 |
|||
PPHF Transfer (non-add) |
(20) |
(25) 8 |
— |
— |
— |
— |
— |
|||
(20) |
242 |
231 |
218 |
224 |
232 |
229 |
229 |
|||
Children's Hospital GME Payments |
268 |
265 |
251 |
264 |
265 |
295 229 |
|
|||
New Mandatory Proposal (non-add) 268 |
— |
— |
— |
— |
— |
— |
(295) |
|||
Teaching Health Center GME Payments (ACA Sec. 5508(c)) |
230 |
— |
— |
— |
— |
60 |
60 | |||
| 41
|
Patient Navigator
|
5 — |
35 |
34 |
37 |
39 |
41 |
41 |
|
National Practitioner Data Bank (User Fees) |
24 |
28 |
27 |
27 |
19 |
21 |
21 18 |
|||
Maternal and Child Health |
1,128 |
1,208 |
1,193 |
1,220 |
1,254 |
1,250 |
1,2 1,200 |
|||
Maternal and Child Health Block Grant |
656 |
639 |
605 |
634 |
637 |
638 |
638 667 |
|||
Healthy Start |
104 |
104 |
98 |
101 |
102 |
104 |
104 128 |
|||
Home Visiting (ACA Sec. 2951) |
250 |
350 |
380 |
371 |
400 |
400 |
400 |
|||
Family-to-Family Health Centers (ACA Sec. 5507) |
5 |
5 |
5 |
3 |
5 |
5 |
5 |
5b
|||
Other Maternal and Child Health Programs |
113 |
112 |
105 |
110 |
112 |
103 |
103 |
— |
||
Ryan White HIV/AIDS |
2,337 |
2,392 |
2,249 |
2,313 |
2,319 |
2,323 |
2, 2,260 |
|||
PHS Evaluation Fund (non-add) |
(25) |
(25) |
(25) |
(25) |
— |
— |
(34) — |
|||
Health Care Systems |
87 |
101 |
95 |
103 |
103 |
103 |
119 99 |
|||
Other Health Care Systems Programs |
82 |
96 |
91 |
75 |
76 |
76 |
77 |
|||
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 | |||
User Fees (non-add) |
9 |
|||||||||
Rural Health |
138 |
138 |
131 |
142 |
147 |
150 |
144 74 |
|||
Other Activities |
702 |
647 |
712 |
669 |
683 |
685 |
706 715 |
|||
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 |
8 |
|||
Vaccine Injury Compensation Program Trust Fund |
235 |
187 |
277 |
224 |
235 |
237 |
240 268 |
|||
Total, Program Level |
9,898 |
8, |
8, |
9,126 |
10,565 10,795 |
10, |
10, |
|||
Less Funds From |
||||||||||
PHS Evaluation Set-Aside |
25 |
25 |
25 |
25 |
— |
— |
34 — |
|||
User Fees |
24 |
28 |
27 |
27 |
19 |
21 |
30 |
|||
Trust Fund (Mandatory) |
235 |
241 |
241 |
235 |
235 |
237 |
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, |
|||
ACA Mandatory Funds: Other |
2,035 |
405 |
432 |
374 |
405 |
465 |
465 | |||
Proposed New Mandatory Funds |
495 |
|||||||||
Total, Discretionary Budget Authority |
6,269 |
6, |
5, |
6, |
6,112 |
6, 6,202 |
5, |
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.
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.
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
Acknowledgments
LaTiesha Cooper, Research Assistant, provided assistance with the tables included in this report.