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

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

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 in the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) and 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 Maternal, Infant, and Early Childhood Home Visiting Program.⁷ HRSA programs also receive transfers from the ACA-created Prevention and Public Health Fund (PPHF).⁸ Finally, 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) 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 FY2018 President's budget request (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.

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