Health Resources and Services Administration (HRSA) FY2019 Budget Request and Funding History: Fact Sheet

Health Resources and Services Administration (HRSA) FY2019 Budget Request and Funding History: Fact Sheet

Health Resources and Services Administration (HRSA) FY2019 Budget Request and Funding History: Fact Sheet

June 28, 2018 (R45245)
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Contents

Agency Overview

Funding Sources

Tables

Table 1. Health Resources and Services Administration (HRSA)

Summary

The Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) provides health care to individuals who are geographically isolated and/or economically or medically vulnerable. The agency's programs target specific populations including pregnant women and their children and individuals with HIV/AIDs.

HRSA is organized into five bureaus: (1) Primary Care; (2) Health Workforce; (3) Maternal and Child Health; (4) HIV/AIDS; and (5) Healthcare Systems. In addition to these bureaus, HRSA has 11 offices. Some offices focus on specific populations or health care issues (e.g., Office of Women's Health, Federal 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.

The Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) provides health care to individuals who are geographically isolated and/or economically or medically vulnerable. The agency's programs target specific populations including pregnant women and their children and individuals with HIV/AIDs.

HRSA is organized into five bureaus: (1) Primary Care; (2) Health Workforce; (3) Maternal and Child Health; (4) HIV/AIDS; and (5) Healthcare Systems. In addition to these bureaus, HRSA has 11 offices. Some offices focus on specific populations or health care issues (e.g., Office of Women's Health, Federal 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.

Health Resources and Services Administration (HRSA) FY2019 Budget Request and Funding History: Fact Sheet

Agency Overview

The Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) provides health care to individuals who are geographically isolated and/or economically or medically vulnerable. The agency's programs target specific populations including pregnant women and their children and individuals with HIV/AIDs. HRSA also supports the health care workforce, oversees organ, bone marrow, and cord blood donation, and compensates individuals harmed by vaccination. HRSA 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; (3) Maternal and Child Health; (4) HIV/AIDS; and (5) Healthcare Systems. In addition to these bureaus, HRSA has 11 offices. Some offices focus on specific populations or health care issues (e.g., Office of Women's Health, Federal 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.²

Funding Sources

For the time period discussed in this fact sheet—FY2015 through the FY2019 President's budget request—HRSA has three 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 (3) user fees.

HRSA receives its discretionary appropriations through the Labor, HHS, and Education (LHHS) appropriations act.³ HRSA began receiving mandatory appropriations from the ACA to support specific programs in FY2010.⁴ For example, the ACA established the Maternal, Infant, and Early Childhood Home Visiting Program.⁵ HRSA has the authority to collect user fees for specified activities; the authority to expend these fees is provided in annual LHHS appropriations acts. In prior years, some HRSA programs have received funds from the Public Health Service (PHS) Program Evaluation Set-Aside.⁶

A number of ACA funding sources expired or were set to expire in FY2018, but they were extended in the Bipartisan Budget Act of 2018 (BBA 2018, P.L. 115-123).⁷ Many of these programs had previously received funding extensions for FY2016 and FY2017 in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10).⁸ BBA 2018 was enacted three days before the FY2019 President's budget request was released, and the request was not revised to reflect FY2019 mandatory appropriations that were provided in the BBA 2018. In some cases, the President's budget requested discretionary funding, rather than mandatory funding, for programs that had received mandatory FY2019 appropriations in BBA 2018.⁹ These cases are noted in Table 1 below, which reflects FY2019 amounts as requested in the President's budget, rather than as appropriated in BBA 2018 (where applicable).

Table 1 presents enacted funding for HRSA in FY2015-FY2018, along with the amounts included in the FY2019 President's budget request. Although appropriations for HRSA have increased over time, the FY2018 appropriation represents a larger increase than in prior years. In particular, the FY2018 appropriation included increases for a number of Bureau of Health Workforce Programs, including discretionary funds for the National Health Service Corps, which had been funded entirely with a transfer from the mandatory Community Health Center Fund in recent years. In addition, the FY2018 appropriation increased funding for Rural Health programs, including $100 million for a new "Rural Opioids Community Response" program, which will support activities that aim to increase access to opioid treatment in rural areas.¹⁰

The FY2019 President's request represents a decrease from FY2018 levels for a number of HRSA programs and activities. However, final FY2018 appropriations had not been enacted during the period in which the FY2019 President's request was being formulated. Although the total request for HRSA is less than the FY2018 program level funding, it would reflect an increase in discretionary funds compared with FY2018 and earlier years, because some programs that had received mandatory appropriations would instead be funded with discretionary appropriations. The President's budget for FY2019 would generally maintain funding levels for the Ryan White HIV/AIDS Bureau and the Health Systems Bureau. It would also maintain funding for the Title X Family Planning Program. The President's FY2019 budget proposes to reduce or eliminate funds for a number of Health Workforce, Maternal and Child Health, and Rural Health Bureau programs; as noted, a number of these programs received funding increases in FY2018.

The table presents funding levels for selected programs and totals for each of HRSA's bureaus.

Table 1. Health Resources and Services Administration (HRSA)

(Budget Authority in Millions, by Fiscal Year)

Bureau or Activity

2015

2016

FY2017

FY2018

FY2019 President's Budget Request

Primary Care

5,001

5,092

4,999

5,452

5,092

Health Centers

5,001

5,091

4,998

5,451

4,991

Discretionarya (non-add)

(1,392)

(1,392)

(1,387)

(1,511)

(4,991)b

CHCF Transfer (non-add)

(3,509)

(3,600)c

(3,511)c

(3,800)d

—b

Precision Medicine Initiativee (non-add)

—

—

—

(25)d

—

Health Center Tort Claims (non-add)

100

100

100

115

100

Free Clinics

0.1

0.1

1.0

1.0

1.0

Health Workforce

1,093

1,178

1,200

1,516

477

National Health Service Corps (NHSC)

287

310

289

415

310

Discretionary (non-add)

—

—

—

(105)

(310)f

CHCF Transfer (non-add)

(287)

(310)c

(289)c

(310)d

—f

Training for Diversityg

82

82

83

88

0

Primary Care Training and Enhancement

39

39

39

49

0

Oral Health

34

36

37

41

0

Interdisciplinary, Community-Based Linkagesh

110

80

129

191

0

Health Care Workforce Assessment

5

5

5

6

5

Public Health Workforce Development

21

21

17

17

0

Nursing Workforce Developmenti

232

230

229

249

83j

Children's Hospital GME Payments

265

295

299

315

0

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

—k

60c

56c

127d

60l

National Practitioner Data Bank (User Fees)

19

21

19

19

19

Maternal and Child Health

1,256

1,250

1,239

1,293

1,136

Maternal and Child Health Block Grant

637

638

640

652

628

Healthy Start

102

104

118m

111

104

Home Visiting (ACA Sec. 2951)

400n

400c

372c

400d

400o

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

5p

5c

5c

6d

5q

Other Maternal and Child Health Programsr

112

103

103

125

0

Ryan White HIV/AIDS

2,319

2,323

2,313

2,319

2,260

Health Care Systems

103

103

104

112

117

Other Health Care Systems Programss

76

76

77

86

77

Hansen's Disease Programst

17

17

17

16

14

340B Drug Pricing Programs/Office of Pharmacy Affairs

10

10

10

10

10

340B Drug Pricing Program (User Fees)

—

—

—

—

16

Rural Health

147

150

156

291u

75

Other Activities

683

701

730

719

756

Family Planning

286

286

286

286

286

Program Management

154

154

154

155

152

Vaccine Injury Compensation (Program Operations)

8

8

8

9

9

Vaccine Injury Compensation Program (HRSA Claims)

235

253

282

268

308

Total, Program Level

10,601

10,796

10,740

11,701

9,912

Less Funds From Sources Other than the Discretionary Appropriation

User Fees

19

21

19

19

35

Vaccine Injury Compensation Claims (Mandatory)v

235

253

282

268

308

ACA Mandatory Funds: CHCF Transfers

4,202

4,375

4,232

4,668w

0x

Total, Discretionary Budget Authority

6,146

6,147

6,207

6,746

9,569

Sources: The funding amounts for FY2015-FY2017 and FY2019 request are from the HRSA congressional budget justification. Congressional budget justifications are available at http://www.hhs.gov/budget/. FY2018 discretionary amounts are from the joint explanatory statement accompanying the Consolidated Appropriations Act, 2018 (P.L. 115-141) (Congressional Record, March 22, 2018, https://www.congress.gov/crec/2018/03/22/CREC-2018-03-22-bk3.pdf) and mandatory amounts are from CRS's analysis of the Bipartisan Budget Act of 2018 (BBA 2018; P.L. 115-123).

Notes: Individual amounts may not add to subtotals or totals due to rounding. The FY2019 President's request level reflects amounts as requested by the President and does not account for mandatory funds appropriated for FY2019 in the BBA 2018. The FY2019 request level does not include HRSA's proposed share ($550 million) of an additional $10 billion in HHS-wide opioid-related funding requested in the President's budget.

a. Includes funding for Native Hawaiian Programs.

b. For FY2019, BBA 2018 appropriated $4.0 billion in mandatory funding for this program. However, the FY2019 President's budget, which was released just three days after BBA 2018 was enacted, requested $0 in mandatory appropriations and $4.991 billion in discretionary appropriations for this program.

c. These funds were appropriated in Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Amounts appropriated were reduced in FY2017 because of budget sequestration. See CRS Report R42050, Budget "Sequestration" and Selected Program Exemptions and Special Rules.

d. These funds were appropriated in BBA 2018.

e. BBA 2018, Section 50901(b), appropriated $25 million to HRSA for FY2018 to support the participation of health centers in the "All of Us Research Program," part of the National Institutes of Health Precision Medicine Initiative.

f. For FY2019, BBA 2018 appropriated $310 million in mandatory funding for this program. However, the FY2019 President's budget, which was released just three days after BBA 2018 was enacted, requested $0 in mandatory appropriations and $310 billion in discretionary appropriations for this program.

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

h. Interdisciplinary, Community-Based Linkages includes 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).

i. 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.

j. The FY2019 budget proposes funding for the NURSE Corps program, but does not propose funding for other Nursing Workforce Development programs.

k. ACA Section 5508(c) appropriated $230 million to support graduate medical education payments to teaching health centers to be used from FY2011 through FY2015.

l. For FY2019, BBA 2018 appropriated $126.5 million in mandatory funding for this program. However, the FY2019 President's budget, which was released just three days after BBA 2018 was enacted, requested $0 in mandatory appropriations and $60 million in discretionary appropriations for this program.

m. 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).

n. P.L. 113-93 provided $400 million for this program for the first half of FY2015. P.L. 114-10 extended the availability of these funds through all of FY2015.

o. For FY2019, BBA 2018 appropriated $400 million in mandatory funding for this program. However, the FY2019 President's budget, which was released just three days after BBA 2018 was enacted, requested $0 in mandatory appropriations and $400 million in discretionary appropriations for this program.

p. P.L. 113-93 provided $2.5 million for this program for FY2015, which was superseded by the full-year funding ($5 million) for this program for FY2015 enacted in P.L. 114-10.

q. For FY2019, BBA 2018 appropriated $6 million in mandatory funding for this program. However, the FY2019 President's budget, which was released just three days after BBA 2018 was enacted, requested $0 in mandatory appropriations and $5 million in discretionary appropriations for this program

r. Other Maternal and Child Health Programs includes Autism and Other Developmental Disorders, Traumatic Brain Injury, Sickle Cell Services Demonstration, Universal Newborn Hearing Screening, Emergency Medical Services for Children, and Heritable Disorders, Screening and Treatment for Maternal Depression and Pediatric Mental Health Access. The latter two programs are new in FY2018. In FY2016, the Traumatic Brain Injury program was transferred to the Administration for Community Living and, therefore, was not funded under HRSA.

s. Other Health Care Systems Programs includes Organ Transplantation, National Cord Blood Inventory, C.W. Bill Young Cell Transplantation Program, and Poison Control Centers.

t. Hansen's Disease Programs includes Hansen's Disease Center, Payments to Hawaii (for Hansen's Disease) and National Hansen's Disease Program—Buildings and Facilities.

u. In FY2018, funding for a number of rural health programs increased. In addition, two new rural health programs received funding: Rural Community Opioid Response and Rural Residency Programs. These programs received appropriations of $100 million and $15 million respectively.

v. By convention, mandatory funding for claims under the Vaccine Injury Compensation Trust Fund are not counted toward agency totals displayed in the HRSA's Congressional Budget Justification, but they are included in the agency totals shown in this fact sheet (where applicable).

w. Includes the $25 million appropriated in BBA 2018 to support health center participation in the "All of Us Research Program," part of the National Institutes of Health Precision Medicine Initiative.

x. For FY2019, BBA 2018 appropriated a total of $4.843 billion in mandatory funds to support programs created in the ACA. However, the FY2019 President's budget requested $0 in mandatory appropriations for these programs.

Author Contact Information

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

Footnotes

1.

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

2.

See CRS Report R43911, The Community Health Center Fund: In Brief; CRS Report R43937, Federal Health Centers: An Overview; CRS Report R44970, The National Health Service Corps; CRS Report 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; CRS Report R44970, The National Health Service Corps; CRS Report R44282, The Ryan White HIV/AIDS Program: Overview and Impact of the Affordable Care Act; CRS Report R44929, Maternal and Child Health Services Block Grant: Background and Funding; CRS In Focus IF10777, Maternal and Child Health (MCH) Services Block Grant; CRS Report R45181, Family Planning Program Under Title X of the Public Health Service Act; and CRS Report R44282, The Ryan White HIV/AIDS Program: Overview and Impact of the Affordable Care Act.

3.

For more information, see CRS Report R45083, Labor, Health and Human Services, and Education: FY2018 Appropriations.

4.

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

5.

CRS Report 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.

6.

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

7.

CRS Report R45136, Bipartisan Budget Act of 2018 (P.L. 115-123): CHIP, Public Health, Home Visiting, and Medicaid Provisions in Division E.

8.

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

9.

A subsequent letter from the director of the Office of Management and Budget confirmed that the President's budget continued to request that these programs be funded in FY2019 with discretionary funds. See Letter from Mick Mulvaney, Director Office of Management and Budget, to The Honorable Paul D. Ryan, Speaker of the House of Representatives, February 12, 2018, https://www.whitehouse.gov/wp-content/uploads/2018/02/Addendum-to-the-FY-2019-Budget.pdf.

10.

From joint explanatory statement accompanying the Consolidated Appropriations Act, 2018 (P.L. 115-141) available in the Congressional Record, March 22, 2018, https://www.congress.gov/crec/2018/03/22/CREC-2018-03-22-bk3.pdf, p. H2699.