Contents

• Agency Overview
• Funding Sources
• The FY2020 President's Budget Request

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 products.

HRSA's funding sources include—in order of magnitude—discretionary appropriations, mandatory funding, the Vaccine Injury Compensation Program Trust Fund, and user fees. For FY2019, the agency's program funding level was $11.99 billion. Of that amount, $6.85 was from the agency's discretionary appropriation. For FY2020, the President's budget requests $5.85 billion in discretionary appropriations, an amount that would be approximately $1.0 million less than in the FY2019 appropriation. The FY2020 budget request proposed reducing funding for programs in most HRSA bureaus, with the largest reductions for programs administered by the Health Workforce Bureau. The President's FY2020 budget request includes proposals to continue the agency's mandatory funding sources at their current funding levels; under the President's budget, the FY2020 program funding level would be $11.02 billion.

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 children and individuals with Human Immunodeficiency Virus/Acquired Immunity Deficiency Syndrome (HIV/AIDS). HRSA also supports the health care workforce; oversees organ, bone marrow, and umbilical 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. These funds support health services projects, such as training health care workers and 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 FY2020 President's budget request—HRSA has four major sources of funding, described 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), (3) the Vaccine Injury Compensation Program Trust Fund; and (4) user fees.

HRSA receives its discretionary appropriations through the Labor, HHS, and Education and Related Agencies (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 also receives mandatory appropriations through the LHHS Appropriations Act from the Vaccine Injury Compensation Program Trust Fund to pay claims associated with vaccine-related injury or death.⁶ Finally, 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.⁷

Funding for a number of HRSA's mandatory ACA programs was extended through November 21, 2019, by the Continuing Appropriations Act, 2020, and the Health Extenders Act of 2019 (P.L. 116-59). The FY2020 President's budget request proposes to continue mandatory funding for these programs at current levels. Previously, these programs had been extended in the Bipartisan Budget Act of 2018 (BBA 2018, P.L. 115-123), which generally included funding for FY2018 and FY2019.⁸ Many of these programs received funding extensions for FY2016 and FY2017 in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10).⁹ Legislation has been introduced that would extend some of these funding sources for a longer duration, but no further extension legislation has been enacted as of the date of this report's publication.

The figures below show the agency's funding distribution in FY2019 and the FY2020 President's request. The President's budget proposes a new user fee that would increase user fees as a percentage of total funding that the agency would receive in FY2020. It also requests smaller levels of discretionary funding. Amounts of mandatory funding provided would generally remain the same. As such, mandatory funding as a percentage of the agency's total funding would increase under the President's FY2020 budget.

Figure 1. Composition of HRSA Funding Sources, FY2019 Enacted and FY2020 Proposed

Source: CRS analysis of HRSA Budget Justification data. The mandatory share of HRSA funding includes mandatory amounts from the Vaccine Injury Compensation Trust Fund. (These amounts are typically excluded, by convention, from totals in the HRSA budget justification, but have been included here in order to match totals in Table 1.)

The FY2020 President's Budget Request

Table 1 presents enacted funding for HRSA in FY2015-FY2019, along with the FY2020 President's budget request. Although appropriations for HRSA have increased over time, the FY2018 funding levels represented a larger increase over the preceding year than funding levels provided in prior years. The FY2018 increases were generally sustained or further expanded in FY2019. In particular, the FY2019 appropriations bill included increases for a number of Bureau of Health Workforce Programs, including increased discretionary funds for the National Health Service Corps and funding for a new Graduate Medical Education program to support medical schools in states with predicted primary care shortages. In addition, the FY2019 appropriations act sustained funding increases that began in FY2018 for Rural Health programs and included a funding increase from $100 million to $120 million for the Rural Communities Opioids Response program, which began in FY2018. The program supports activities that aim to increase access to opioid treatment and prevention services in rural areas.¹⁰

They FY2020 President's budget request represents a decrease from FY2019 funding for a number of HRSA programs and activities. Specifically, it would eliminate funding for a number of Bureau of Health Workforce Programs, such as those that support training in primary care and oral health. It would also eliminate funding for a number of Maternal and Child Health Bureau Programs, such as those that focus on pediatric mental health and screening for maternal depression and programs related autism and developmental disorders. The FY2020 budget request would maintain funding for behavioral health workforce development, but it proposes reductions in funding for Maternal Child Health Block Grants. The President's budget request also calls for decreased or no funding for a number of Rural Health Programs—for example, it requests less funding for telehealth programs and for rural health outreach grants, and no funding for Rural Flexibility Grants, State Offices of Rural Health, and Rural Residency Training. The budget request would maintain funding for Radiation Exposure Screening and Education Programs, Black Lung Programs, and for the Rural Communities Opioid Response program.

The President's budget requests $70 million for the HIV/AIDS Bureau as part of the Administration's larger Ending the HIV Epidemic Initiative. These funds would be used to provide areas with high HIV rates with additional expertise, technology, and resources.¹¹ These funds would be for the HIV/AIDs Bureau, in addition to funding amounts requested to support the Ryan White HIV/AIDS program.

Table 1 presents funding levels for selected programs and totals for each of HRSA's bureaus. The table presents enacted funding levels for FY2015-FY2019. FY2020 appropriations have not yet been enacted, but the table displays amounts requested in the FY2020 President's budget.

Author Contact Information

Footnotes