Department of Health and Human Services: FY2023 Budget Request
Department of Health and Human Services:
May 31, 2022
FY2023 Budget Request
Jessica Tollestrup
This report provides information about the FY2023 budget request for the U.S. Department of
Specialist in Social Policy
Health and Human Services (HHS). Historically, HHS has been one of the larger federal
departments in terms of budgetary resources. Estimates by the Office of Management and Budget
Karen E. Lynch
(OMB) indicate that HHS has accounted for at least 20% of all federal outlays in each year since
Specialist in Social Policy
FY1995. Most recently, HHS accounted for 22% of all federal outlays in FY2021. (FY2021
funding levels are generally considered final, whereas some FY2022 funding levels remain
estimates.)
Ada S. Cornell
Senior Research Librarian
The FY2023 President’s budget request was submitted to Congress on March 28, 2022. Under
this request, HHS would spend an estimated $1.649 trillion in outlays in FY2022. This would be
$23 billion (+1%) more than estimated HHS outlays in FY2022 and $182 billion (+12%) more
than actual HHS outlays in FY2021.
Mandatory spending typically comprises the majority of the HHS budget. Two mandatory spending programs—Medicare
and Medicaid—are expected to account for 84% of all estimated HHS outlays in FY2023, according to the President’s budget
request. Medicare and Medicaid are entitlement programs, meaning the federal government is required to make mandatory
payments to individuals, states, or other entities based on criteria established in authorizing law.
Proposed FY2023 HHS Outlays by Major Program and Spending Category
Source: Prepared by the Congressional Research Service (CRS) using data on page 17 of the FY2023 HHS Budget in Brief.
Notes: Percentages may not sum due to rounding. For mandatory spending, outlays reflect proposed law spending levels, not the
current services baseline.
While mandatory spending is controlled (but not always provided) by authorizing laws, all discretionary spending is
controlled and provided through the annual appropriations process. Discretionary spending accounts for about 8% of HHS
outlays in the FY2023 President’s budget request. Although discretionary spending represents a relatively small share of the
HHS budget, the department nevertheless receives more discretionary money than most federal departments. According to
OMB data, HHS accounted for just over 11% of all discretionary budget authority across the government in FY2021.
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Contents
About the U.S. Department of Health and Human Services (HHS) ................................................ 1
Context for the FY2023 President’s Budget Request ...................................................................... 2
Overview of the FY2023 HHS Budget Request ................................................................. 2
Budgetary Resources Versus Appropriations ............................................................................ 4
Mandatory and Discretionary Spending ............................................................................. 4
HHS in the Appropriations Process .................................................................................... 4
Proposed Law and Current Law Estimates for Mandatory Programs ................................. 5
User Fees and Other Types of Collections .......................................................................... 6
Scorekeeping and Display Conventions ............................................................................. 6
Sequestration ....................................................................................................................... 6
HHS Budget by Operating Division ................................................................................................ 7
Figures
Figure 1. Proposed FY2023 HHS Outlays by Major Program and Spending Category ................. 4
Figure 2. FY2023 President’s Request for HHS by Operating Division ......................................... 8
Tables
Table 1. FY2023 President’s Budget Request for HHS .................................................................. 3
Table 2. HHS Agencies by Appropriations Bill ............................................................................... 5
Table 3. HHS Budget by Operating and Staff Division ................................................................... 9
Appendixes
Appendix. HHS Operating Divisions: Missions and FY2022 Budget Resources .......................... 11
Contacts
Author Information ........................................................................................................................ 16
Congressional Research Service
Department of Health and Human Services: FY2023 Budget Request
About the U.S. Department of Health and Human
Services (HHS)
The mission of HHS is to “enhance the health and well-being of all Americans by providing for
effective health and human services and by fostering sound, sustained advances in the sciences
underlying medicine, public health, and social services.”1
HHS is currently organized into 11 main agencies, called operating divisions (listed below),
which are responsible for administering a wide variety of health and human services programs,
and conducting related research. In addition, HHS has a number of staff divisions within the
Office of the Secretary (OS). These staff divisions fulfill a broad array of management, research,
oversight, and emergency preparedness functions in support of the entire department.
HHS Operating Divisions
ACF
Administration for Children and Families
ACL
Administration for Community Living
AHRQ
Agency for Healthcare Research and Quality
ATSDR
Agency for Toxic Substances and Disease Registry
CDC
Centers for Disease Control and Prevention
CMS
Centers for Medicare & Medicaid Services
FDA
Food and Drug Administration
HRSA
Health Resources and Services Administration
IHS
Indian Health Service
NIH
National Institutes of Health
SAMHSA
Substance Abuse and Mental Health Services Administration
Eight of the HHS operating divisions are part of the U.S. Public Health Service (PHS). PHS
agencies have diverse missions in support of public health, including the provision of health care
services and supports (e.g., IHS, HRSA, SAMHSA); the advancement of health care quality and
medical research (e.g., AHRQ, NIH); the prevention and control of disease, injury, and
environmental health hazards (e.g., CDC, ATSDR); and the regulation of food and drugs (e.g.,
FDA).2
The three remaining HHS operating divisions—ACF, ACL, and CMS—are not PHS agencies.
ACF and ACL largely administer human services programs focused on the well-being of
vulnerable children, families, older Americans, and individuals with disabilities. CMS—which
accounts for the largest share of the HHS budget by far—is responsible for administering
Medicare, Medicaid, and the State Children’s Health Insurance Program (CHIP), in addition to
certain programs related to private health insurance.
1 Introduction to the HHS Strategic Plan FY2022-FY2026, https://www.hhs.gov/about/strategic-plan/2022-2026/
introduction/index.html.
2 For further information, see CRS Report R44916, Public Health Service Agencies: Overview and Funding (FY2016-
FY2018).
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(For a summary of each operating division’s mission and links to agency resources related to the
FY2023 budget request, see the Appendix.)
Context for the FY2023 President’s Budget Request
The “Overview” chapter of the HHS Budget in Brief (BIB) is the main source used for the budget
numbers in this report.3 Note that because FY2022 has not yet concluded, this report generally
refers to FY2022 funding levels as estimates, whereas amounts for earlier years are called actual
or final.
The Budget and Accounting Act of 1921 (P.L. 67-13), as amended, requires the President to
submit an annual consolidated federal budget to Congress at the beginning of each regular
congressional session, not later than the first Monday in February. Many of the proposals in the
President’s budget would require changes to laws that govern mandatory spending levels or
policies, which are typically established on a multiyear or permanent basis. Discretionary
spending, however, which is roughly one-third of the budget, is decided and controlled each fiscal
year through the annual appropriations process. While Congress is ultimately not required to
adopt the President’s proposals or recommendations, the submission of the President’s budget
typically initiates the congressional budget process and informs Congress of the President’s
recommended spending levels for agencies and programs.4
The President’s budget request for FY2023 was submitted on March 28, 2022, about seven weeks
after it was due. It was preceded by the enactment of FY2022 full-year annual appropriations
(P.L. 107-103) on March 15, 2022, more than six months into the fiscal year. The FY2022
funding amounts in the BIB overview tables and the tables at the front of each BIB chapter
generally reflect HHS estimates of full-year appropriations amounts. However, the amounts in
each of the FY2023 HHS congressional justifications generally are based on annualized estimates
of the continuing appropriations that were in effect at the time the budget was being prepared.
Thus, these may differ from the amounts in the BIB.
Overview of the FY2023 HHS Budget Request
Under the President’s budget request, HHS would spend an estimated $1.649 trillion in outlays5
in FY2023 (see Table 1).6 This is $23 billion (+1%) more than estimated HHS outlays in FY2022
and about $182 billion (+12%) more than actual HHS outlays in FY2021.
3 Other sources were consulted, including other chapters of the FY2023 HHS Budget in Brief (BIB), various volumes
of the FY2023 President’s budget published by OMB, and congressional budget justifications published by HHS
operating or staff divisions. However, each of the tables and figures in this report (except Table 2) was developed
using data from the “Overview” chapter of the FY2023 HHS BIB, available at https://www.hhs.gov/sites/default/files/
fy-2023-budget-in-brief.pdf.
4 For more information, see CRS Report R47019, The Executive Budget Process: An Overview.
5 Budget authority is the amount of funding a federal agency is legally authorized to commit or spend; an outlay occurs
when funds are actually expended from the Treasury. These terms are discussed in the “HHS Budget by Operating
Division” section of this report.
6 This does not account for expected reductions to nonexempt mandatory spending due to sequestration. For further
information, see OMB, OMB Report to the Congress on the BBEDCA 251A Sequestration for Fiscal Year 2023, March
28, 2022, https://www.whitehouse.gov/wp-content/uploads/2022/03/
BBEDCA_251A_Sequestration_Report_FY2023.pdf.
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Historical estimates by the Office of Management and Budget (OMB) indicate that HHS has
accounted for at least 20% of all federal outlays in each year since FY1995.7 Most recently, OMB
estimated that HHS accounted for nearly 22% of all federal outlays in FY2021, and projects that
it would account for nearly 29% of outlays if all proposals in the President’s FY2023 budget
request were enacted.8
Table 1. FY2023 President’s Budget Request for HHS
(dollars in billions)
FY2019
FY2020
FY2021
FY2022
FY2023
Actual
Actual
Actual
Estimate
Request
Budget Authority
1,284
1,722
1,676
1,573
1,765
Outlays
1,214
1,504
1,467
1,626
1,649
Sources: For FY2019 actual, see FY2021 HHS BIB, pp. 15-16, https://www.hhs.gov/sites/default/files/fy-2021-
budget-in-brief.pdf. For FY2020 actual, see FY2022 HHS BIB, pp. 10-11, https://www.hhs.gov/sites/default/files/fy-
2022-budget-in-brief.pdf. For FY2022 estimate and FY2023 request, see FY2023 HHS BIB, pp. 13-14,
https://www.hhs.gov/sites/default/files/fy-2023-budget-in-brief.pdf.
Notes: Budget authority is the amount of money a federal agency is legally authorized to commit or spend; an
outlay occurs when funds are actually expended from the Treasury. Amounts for FY2023 reflect all proposals in
the President’s budget for both mandatory and discretionary spending programs. In keeping with source
materials, amounts in this table reflect mandatory sequestration in FY2019-FY2022, but do not reflect estimated
effects of sequestration for FY2023.
Figure 1 displays proposed FY2023 HHS outlays by major program or spending category in the
President’s request. As this figure shows, mandatory spending typically accounts for the vast
majority of the HHS budget.9 Two mandatory spending programs—Medicare and Medicaid—are
expected to account for 84% of all estimated HHS spending in FY2023. Medicare and Medicaid
are entitlement programs, meaning the federal government is required to make mandatory
payments to individuals, states, or other entities based on criteria established in authorizing law.10
This figure also shows that discretionary spending accounts for about 8% of estimated FY2023
HHS outlays in the President’s request. Although discretionary spending represents a relatively
small share of total HHS spending, the department nevertheless receives more discretionary
funding than most federal departments. According to OMB data, HHS accounted for 11% of all
discretionary budget authority across the government in FY2021.11 The Department of Defense
was the only federal agency to account for a larger share of all discretionary budget authority in
that year (44%).
7 OMB Historical Tables of the FY2023 President’s Budget, Table 4.2, “Percentage Distribution of Outlays by Agency:
1962–2027,” https://www.whitehouse.gov/omb/historical-tables/.
8 Ibid.
9 The terms mandatory spending and discretionary spending are discussed in the “Budgetary Resources Versus
Appropriations” section of this report.
10 For more information on how these entitlement programs are financed, see CRS Report R40425, Medicare Primer;
and CRS Report R42640, Medicaid Financing and Expenditures.
11 OMB Historical Tables of the FY2023 President’s Budget, Table 5.5, “Percentage Distribution of Discretionary
Budget Authority by Agency: 1976–2027,” https://www.whitehouse.gov/omb/historical-tables/.
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Department of Health and Human Services: FY2023 Budget Request
Figure 1. Proposed FY2023 HHS Outlays by Major Program and Spending Category
Source: Prepared by the Congressional Research Service (CRS) based on data presented on page 17 of the
FY2023 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2023-budget-in-brief.pdf.
Notes: Percentages may not sum due to rounding. For mandatory spending, outlays reflect proposed law
spending levels, not the current services baseline.
Budgetary Resources Versus Appropriations
As previously mentioned, the HHS budget reflects funding from a broad set of budgetary
resources that includes, but is not limited to, the amounts provided to HHS through the annual
appropriations process. As a result, certain amounts shown in FY2023 HHS budget materials
(including amounts for prior years) will not match amounts provided to HHS by annual
appropriations acts and displayed in accompanying congressional documents. There are several
reasons for this, discussed briefly below.
Mandatory and Discretionary Spending
Mandatory spending makes up a large portion of the HHS budget. Whereas all discretionary
spending is controlled and provided through the annual appropriations process, all mandatory
spending is controlled by the program’s authorizing statute. In most cases, that authorizing statute
also provides the funding for the program (e.g., State Children’s Health Insurance Program).
However, the budget authority for some mandatory programs (including Medicaid), while
controlled by criteria in the authorizing statute, must still be provided through the annual
appropriations process; such programs are commonly referred to as appropriated entitlements or
appropriated mandatories. Certain budget documents may show only discretionary spending,
while others may also show some or all types of mandatory spending.
HHS in the Appropriations Process
The HHS budget request accounts for the department as a whole, while the appropriations process
divides HHS funding across three different appropriations bills. Most of the department’s
discretionary appropriations are provided through the Departments of Labor, Health and Human
Services, and Education, and Related Agencies (LHHS) Appropriations Act. However, funding
for certain HHS agencies and activities is provided in two other bills—the Departments of the
Interior, Environment, and Related Agencies Appropriations Act (INT) and the Agriculture, Rural
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Development, Food and Drug Administration, and Related Agencies Appropriations Act (AG).
Table 2 lists HHS agencies by appropriations bill. Each of these three appropriations acts
provides discretionary HHS funding. In some cases, these acts also provide the necessary funding
for appropriated mandatories at HHS. However, authorizing laws provide funding for other
mandatory spending programs.
Table 2. HHS Agencies by Appropriations Bill
Appropriations Bill
HHS Agencies Funded in the Bill
Agriculture, Rural Development, Food and Drug
Food and Drug Administration
Administration, and Related Agencies (AG)
Departments of the Interior, Environment, and Related
Indian Health Service
Agencies (INT)a
Agency for Toxic Substances and Disease Registry
Departments of Labor, Health and Human Services, and
Health Resources and Services Administration
Education, and Related Agencies (LHHS)
Centers for Disease Control and Prevention
National Institutes of Healtha
Substance Abuse and Mental Health Services
Administration
Agency for Healthcare Research and Quality
Centers for Medicare & Medicaid Services
Administration for Children and Families
Administration for Community Living
Office of the Secretary
Source: See CRS Report R40858, Locate an Agency or Program Within Appropriations Bills.
a. Funding for NIH comes primarily from the LHHS appropriations bil , with an additional amount for
Superfund-related activities provided as part of the INT appropriations bil .
Proposed Law and Current Law Estimates for Mandatory Programs
HHS budget materials may include two different estimates for mandatory spending programs
when appropriate: proposed law and current law. The proposed law estimates take into account
changes in mandatory spending proposed in the FY2023 HHS budget request. Such proposals
would generally need to be enacted into law to affect the budgetary resources ultimately available
to the mandatory spending program.12 HHS materials may also show a current law or current
services estimate for mandatory spending programs. These estimates assume that no changes will
be made to existing policies, and instead estimate mandatory spending for programs based on
criteria established in current authorizing law. The HHS budget estimates in this report reflect the
proposed law estimates for mandatory spending programs; readers should be aware that other
HHS, OMB, or congressional estimates might reflect current law instead.
12 For a list of some HHS legislative proposals for mandatory spending programs in the FY2021 President’s budget, see
pages 124-128 and 128-129 of Summary Table S-6 in OMB, Budget of the United States Government, Fiscal Year
2023, https://www.whitehouse.gov/wp-content/uploads/2022/03/budget_fy2023.pdf. This table lists mandatory
proposals (but not discretionary proposals) by federal department and shows the estimated dollar change from current
law levels should the proposal be enacted. (The table does not show the actual proposed funding level.) For additional
information, see the applicable operating division chapters of the HHS Budget in Brief or congressional justifications.
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User Fees and Other Types of Collections
In some cases, agencies within HHS have the authority to expend user fees and other types of
collections that effectively supplement their appropriations. In addition, agencies may receive
transfers of budgetary resources from other sources, such as from the Public Health Service
Evaluation Set-Aside (also referred to as the PHS Tap) or one of the mandatory funds established
by the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).13 Budgetary
totals that account for these sorts of resources in the HHS estimates are often referred to as being
at the program level. HHS agencies that have historically had notable differences between the
amounts in the appropriations bills and their program level include, for instance, FDA (due to
user fees) and AHRQ (due to transfers).14
Scorekeeping and Display Conventions
The Administration may choose to follow different conventions than those of congressional
scorekeepers for its estimates of HHS programs. For example, certain transfers of funding
between HHS agencies (or from HHS to other federal agencies) that occurred in prior fiscal years,
or are expected to occur in the current fiscal year, may be accounted for in the Administration’s
estimates but not necessarily in the congressional documents.
Sequestration
For FY2023, the Budget Control Act of 2011 (BCA; P.L. 112-25) provides a mechanism
(sequestration) to reduce mandatory spending in each of fiscal years between FY2013 and
FY2031.15 On March 28, 2022, concurrent with the release of the President’s budget submission,
President Biden issued the required FY2023 sequestration order, calling for nonexempt
mandatory spending to be reduced on October 1, 2022.16 Using its current law baseline, OMB
estimated that the FY2023 sequestration percentages would equal 2% of nonexempt Medicare
spending and 5.7% of other nonexempt nondefense mandatory spending, for a total government-
wide reduction in this category of spending of $24 billion in budget authority in FY2023.17 OMB
attributed the majority of this amount, roughly $20 billion, to HHS (mostly for reductions to
Medicare). Notably, however, the OMB estimate does not account for provisions in P.L. 117-71,
which effectively suspended Medicare sequestration through March 31, 2022.18 (OMB also
13 For further information, see CRS Report R44916, Public Health Service Agencies: Overview and Funding (FY2016-
FY2018).
14 The program level for each agency is listed in the table entitled “Composition of the HHS Budget Discretionary
Programs” in the FY2022 HHS BIB.
15 As originally enacted, mandatory sequestration was scheduled to run through FY2021, but this period has
subsequently been incrementally extended. For further information about sequestration, see CRS Report R42972,
Sequestration as a Budget Enforcement Process: Frequently Asked Questions.
16 Sequestration Order for Fiscal Year 2023 Pursuant to Section 251A of the Balanced Budget and Emergency Deficit
Control Act, as Amended, Federal Register, Vol. 87, No. 62, March 31, 2022, p. 18603, https://www.govinfo.gov/
content/pkg/FR-2022-03-31/pdf/2022-06939.pdf.
17 OMB, OMB Report to the Congress on the BBEDCA 251A Sequestration for Fiscal Year 2023, March 28, 2022,
https://www.whitehouse.gov/wp-content/uploads/2022/03/BBEDCA_251A_Sequestration_Report_FY2023.pdf. See
the report’s appendix for an itemized list of budget accounts that include mandatory spending subject to sequestration
in FY2023, the dollar amounts subject to sequestration (based on OMB’s current law baseline), the percentage by
which they would be reduced, and the dollar amount of the reduction. While the report displays reductions at the
account level, the sequester itself is implemented at the program, project, or activity level.
18 Ibid, p. 3. Since FY2020, the Medicare sequestration has been temporarily suspended through a series of laws,
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estimated an 8.3% reduction, totaling $1 billion, in nonexempt defense mandatory spending,
which does not affect HHS funds.)
By long-standing convention, HHS budget materials for FY2023 generally reflect sequestration
for mandatory spending programs in prior years (FY2019-FY2022), but do not reflect estimated
effects of mandatory sequestration for the budget year (FY2023). The numbers in this report
reflect this convention.
HHS Budget by Operating Division
Figure 2 provides a breakdown of the FY2023 HHS budget request by operating division. When
taking into account mandatory and discretionary budget authority (i.e., total budget authority),
CMS accounts for the largest share of the request: nearly $1.5 trillion. The majority of the CMS
budget request would go toward mandatory spending programs, such as Medicare and Medicaid.
Spending on Medicare and Medicaid is expected to increase relative to FY2022 levels under the
President’s request, both in terms of proposed law and current law estimates. However, when
looking exclusively at discretionary budget authority, funding for CMS is comparatively smaller,
accounting for $4.3 billion of the HHS discretionary request. Discretionary CMS funds primarily
support program operations and federal administrative activities, though some funds also go
toward efforts to reduce health care fraud and abuse.
The largest share of the HHS discretionary request would go to the PHS operating divisions:
roughly $81.5 billion in combined public health funding for FDA, HRSA, IHS, CDC, ATSDR,
NIH, SAMHSA, and AHRQ. Note that the estimates for IHS in Figure 2 reflect the President’s
budget proposal to fund the agency entirely with mandatory funds. Typically, IHS is funded
primarily with discretionary funds. In addition, the HHS request includes an $81.7 billion
proposal for new mandatory budget authority spread across four agencies—FDA, CDC, NIH, and
the Assistant Secretary for Preparedness and Response (an entity with significant public health
responsibilities located within the Office of the Secretary). The amount of this proposal is
comparable to the total discretionary BA proposed for all of the PHS operating divisions
combined.
NIH would receive the largest amount of discretionary budget authority of any single HHS
operating division: $49.0 billion. The majority of the proposed NIH budget would support
biomedical research performed by hospitals, medical schools, universities, and other research
institutions around the country.19
ACF would receive the second-largest discretionary funding level among the HHS operating
divisions: $33.3 billion. The majority of the discretionary ACF request (about 61%) would go to
early childhood care and education programs, such as Head Start and the Child Care and
Development Block Grant.20
starting with the enactment of the CARES Act on May 1, 2020 (P.L. 116-136). The act suspended the Medicare
sequestration from May 1, 2020, through December 31, 2020. Subsequent laws (P.L. 116-260, P.L. 117-7, and P.L.
117-71) extended this suspension through March 31, 2022.
19 FY2023 HHS BIB, p. 54.
20 Calculated by CRS based on data presented on pages 121-122 of the FY2023 HHS BIB.
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Figure 2. FY2023 President’s Request for HHS by Operating Division
Source: Prepared by the Congressional Research Service (CRS) based on data presented on pages 13-16 of the
FY2023 HHS Budget in Brief, https://www.hhs.gov/sites/default/files/fy-2023-budget-in-brief.pdf. The amounts
displayed as total budget authority include mandatory and discretionary funds. The HHS BIB sources the OMB
Budget Appendix for the total budget authority amounts shown above and cautions that these amounts
“potentially differ from the levels displayed” elsewhere in the BIB. HHS does not use the same disclaimer for the
discretionary budget authority levels shown in the BIB and above, meaning that the methodology used to
calculate and present these numbers may differ from that used by HHS in calculating total budget authority. For
this reason, the figure should be viewed as il ustrative.
Notes: Acronyms listed on page 1. Amounts for mandatory spending programs are based on the President’s
proposed law baseline, not the current services baseline. Amounts for discretionary spending programs have not
been adjusted to reflect the effects of proposed rescissions or other cancelations of budget authority. The
estimate for IHS reflects a proposal in the FY2023 President’s budget to transition that agency to being entirely
funded via mandatory spending. Amounts in this figure exclude funding for the HHS staff divisions within the
Office of the Secretary and estimates for several mandatory spending proposals that were listed separately from
the operating divisions in the HHS BIB.
Table 3 puts the FY2023 request for each HHS operating division and the Office of the Secretary
into context, displaying it along with estimates of funding provided over the four prior fiscal
years (FY2019-FY2022). These totals are inclusive of both mandatory and discretionary funding.
The amounts in this table are shown in terms of budget authority (BA) and outlays. BA is the
authority provided by federal law to enter into contracts or other financial obligations that will
result in immediate or future expenditures involving federal government funds. Outlays occur
when funds are actually expended from the Treasury; they could be the result of either new
budget authority enacted in the current fiscal year or unexpended budget authority that was
enacted in previous fiscal years. The rate at which outlays occur often is dependent on the
purpose of the funding and the timeline for which expenditures are to occur. (For example,
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outlays for salaries and expenses tend to happen at a more rapid rate than those for multiyear
projects.) In addition, as outlays over the course of a fiscal year may occur from funds enacted
over a series of fiscal years, they may be more or less than the amount of budget authority newly
enacted for that fiscal year. As a consequence, the BA and outlays in this table represent two
different ways of accounting for the funding that is provided to each HHS agency through the
federal budget process. For example, Table 3 shows $13.6 billion in FY2023 BA for HRSA, but
an estimated $15.8 billion in FY2023 HRSA outlays, reflecting the expected expenditure of funds
previously provided to the agency in addition to some that are expected to be newly enacted in
FY2023.
Amounts shown for the Office of the Secretary were calculated using funding levels in HHS BIBs
for the following staff divisions, accounts, or activities: Departmental Management (including
funding for the Pregnancy Assistance Fund, the Health Insurance Reform Implementation Fund,
transfers from the Patient-Centered Outcomes Research Trust Fund, and payments to the State
Response to the Opioid Abuse Crisis Account), Nonrecurring Expenses Fund, Office of Medicare
Hearings and Appeals, Office of the National Coordinator for Health Information Technology,
Office for Civil Rights, Office of Inspector General, Public Health and Social Services
Emergency Fund, Program Support Center (including retirement pay, medical benefits, and
miscellaneous trust funds), and certain collections credited to that office or the department. They
also include estimates for several mandatory spending proposals that were listed separately from
the operating divisions in the HHS BIB, such as the No Surprises Implementation Fund, Defense
Production Act Medical Supplies Enhancement, PrEP Delivery Program to End the HIV
Epidemic, and Mental Health Transformation Fund.
Table 3. HHS Budget by Operating and Staff Division
(mandatory and discretionary spending combined, dollars in millions)
FY2019
FY2020
FY2021
FY2022
FY2023
Operating Division
Actual
Actual
Actual
Estimatea
Request
FDA
Budget Authority (BA)
3,147
3,365
3,765
3,315
5,403
Outlays
2,831
2,963
3,303
4,729
4,102
HRSA
BA
12,000
14,399
21,733
12,196
13,614
Outlays
11,575
12,113
14,232
18,127
15,845
IHS
BA
5,939
7,393
13,794
7,413
9,973
Outlays
5,455
6,184
9,866
10,011
9,249
CDC (incl. ATSDR)b
BA
7,878
15,855
28,511
8,556
41,343
Outlays
7,736
8,721
11,269
15,826
21,197
NIH
BA
38,090
44,590
42,186
42,225
62,398
Outlays
34,914
36,387
38,868
41,610
43,825
SAMHSA
BA
5,700
6,174
13,674
5,960
10,562
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FY2019
FY2020
FY2021
FY2022
FY2023
Operating Division
Actual
Actual
Actual
Estimatea
Request
Outlays
4,328
5,206
5,910
8,250
10,456
AHRQ
BA
337
338
337
338
376
Outlays
322
333
329
335
358
CMSc
BA
1,144,763
1,328,620
1,296,727
1,418,723
1,493,654
Outlays
1,085,909
1,258,071
1,240,623
1,359,740
1,421,716
ACF
BA
61,735
67,349
122,521
69,741
73,931
Outlays
55,969
60,819
70,079
90,041
89,841
ACL
BA
2,139
3,403
4,221
2,234
2,958
Outlays
2,023
2,418
2,662
3,769
3,666
Office of the Secretaryd
BA
2,621
230,195
128,560
2,702
50,909
Outlays
3,110
111,055
69,753
73,918
28,878
Total, HHS
BA
1,284,349
1,721,681
1,676,029
1,573,403
1,765,121
Outlays
1,214,172
1,504,270
1,466,894
1,626,356
1,649,133
Sources: For FY2019 actual, see FY2021 HHS BIB, pp. 15-16, https://www.hhs.gov/sites/default/files/fy-2021-
budget-in-brief.pdf. For FY2020 actual, see FY2022 HHS BIB, pp. 10-11, https://www.hhs.gov/sites/default/files/fy-
2022-budget-in-brief.pdf. For FY2021 actual, FY2022 estimate, and FY2023 request, see FY2023 HHS BIB, pp. 13-
14, https://www.hhs.gov/sites/default/files/fy-2023-budget-in-brief.pdf.
Notes: Totals are as reported in HHS BIBs. The HHS BIBs source the Budget Appendix prepared by the Office
of Management and Budget for the BA amounts shown in these particular BIB tables. HHS cautions that these
amounts “potentially differ from the levels displayed in the individual Operating or Staff Division Chapters.”
Totals may not sum due to rounding and, in prior years, may reflect some adjustments for comparability.
Amounts for FY2023 reflect all proposals in the President’s budget for both mandatory and discretionary
spending programs. In keeping with source materials, amounts in this table reflect sequestration for mandatory
spending programs in FY2019-FY2022, but do not reflect estimated effects of mandatory sequestration for
FY2023.
a. FY2022 funding levels in the FY2023 BIB reflect amounts enacted in law (P.L. 117-103) for programs and
activities funded by the annual appropriations process. For mandatory spending provided outside the annual
appropriations process, funding levels generally reflect amounts provided by authorizing law. In cases where
ful -year funding has not yet been provided in authorizing law, these levels are based on annualized amounts
provided in the most recent short-term funding extension in effect at the time that the budget formulation
process was completed.
b. By HHS convention, the amounts shown for CDC include funding for ATSDR.
c. Per source materials, the budget authority for CMS includes non-CMS budget authority for Hospital
Insurance and Supplementary Medical Insurance for the Social Security Administration and the Medicare
Payment Advisory Commission (MedPAC).
d. Amounts shown for the OS include estimates for several mandatory spending proposals that were listed
separately from the operating divisions in the HHS BIB, such as the No Surprises Implementation Fund,
Defense Production Act Medical Supplies Enhancement, PrEP Delivery Program to End the HIV Epidemic,
and Mental Health Transformation Fund.
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Appendix. HHS Operating Divisions: Missions and
FY2022 Budget Resources
This appendix provides for each operating division a brief summary of its mission,21 the
applicable appropriations bill, the FY2023 budget request level, and links to additional resources
related to that request.
Food and Drug Administration (FDA)
The FDA mission is focused on regulating the safety, efficacy, and security of human foods,
dietary supplements, cosmetics, and animal foods; and the safety and effectiveness of human
drugs, biological products (e.g., vaccines), medical devices, radiation-emitting products, and
animal drugs. It also regulates the manufacture, marketing, and sale of tobacco products.22
Relevant Appropriations Bill:
Agriculture, Rural Development, Food and Drug Administration, and Related
Agencies (AG)
FY2023 Request:
BA: $5.403 billion
Outlays: $4.102 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 30), https://www.fda.gov/
media/157192/download
BIB chapter (p. 18), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=24
Health Resources and Services Administration (HRSA)
The HRSA mission is focused on “providing health care to people who are geographically
isolated and economically or medically vulnerable.”23 Among its many programs and activities,
HRSA supports health care workforce training; the National Health Service Corps; and the
federal health centers program, which provides grants to nonprofit entities that provide primary
care services to people who experience financial, geographic, cultural, or other barriers to health
care.
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $13.614 billion
21 The mission summaries below exclude the Office of the Secretary, which comprises multiple staff divisions whose
goals are to “provide leadership, direction, and policy guidance to the Department.” See HHS Strategic Plan FY2022-
2026, Introduction: About HHS, https://www.hhs.gov/about/strategic-plan/2022-2026/overview/index.html.
22 FDA, What Does FDA Do, https://www.fda.gov/about-fda/fda-basics/what-does-fda-do.
23 HRSA, About HRSA, https://www.hrsa.gov/about/index.html.
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Outlays: $15.845 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 19), https://www.hrsa.gov/
sites/default/files/hrsa/about/budget/budget-justification-fy2023.pdf
BIB chapter (p. 26), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=32
Indian Health Service (IHS)
The IHS mission is to provide “federal health services to American Indians and Alaska Natives”
and “raise the physical, mental, social, and spiritual health of American Indians and Alaska
Natives to the highest level.”24 IHS provides health care for approximately 2.6 million eligible
American Indians and Alaska Natives through a system of programs and facilities located on or
near Indian reservations, and through contractors in certain urban areas.
Relevant Appropriations Bill:
Departments of the Interior, Environment, and Related Agencies (INT)
FY2023 Request:
BA: $9.973 billion
Outlays: $9.249 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 19), https://www.ihs.gov/
sites/budgetformulation/themes/responsive2017/display_objects/documents/
FY2023BudgetJustificaton.pdf
BIB chapter (p. 35), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=41
Centers for Disease Control and Prevention (CDC) and Agency for
Toxic Substances and Disease Registry (ATSDR)
The CDC mission is focused on “disease prevention and control, environmental health, and health
promotion and health education.”25 CDC is organized into a number of centers, institutes, and
offices, some focused on specific public health challenges (e.g., injury prevention) and others
focused on general public health capabilities (e.g., surveillance and laboratory services).
In addition, the ATSDR is headed by the CDC director. For that reason, the ATSDR budget is
often shown within CDC. Following the conventions of the FY2023 HHS BIB, ATSDR’s budget
request is included in the CDC totals shown in this report. ATSDR’s work is focused on
preventing or mitigating adverse effects resulting from exposure to hazardous substances in the
environment.
24 IHS, Agency Overview, https://www.ihs.gov/aboutihs/overview/.
25 CDC, Official Mission Statements & Organizational Charts, https://www.cdc.gov/maso/pdf/cdcmiss.pdf.
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Department of Health and Human Services: FY2023 Budget Request
Relevant Appropriations Bills:
LHHS (CDC)
INT (ATSDR)
FY2023 Request (CDC and ATSDR combined):
BA: $41.343 billion
Outlays: $21.197 billion
Additional Resources Related to the FY2023 Request:
CDC Congressional Justification (all-purpose table on p. 32),
https://www.cdc.gov/budget/documents/fy2023/FY-2023-CDC-congressional-
justification.pdf
ATSDR Congressional Justification, https://www.cdc.gov/budget/documents/
fy2023/FY-2023-ATSDR-congressional-justification.pdf
BIB chapter (p. 42), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=48
National Institutes of Health (NIH)
The NIH mission is focused on conducting and supporting research “in causes, diagnosis,
prevention, and cure of human diseases” and “in directing programs for the collection,
dissemination, and exchange of information in medicine and health.”26 NIH is organized into 27
research institutes and centers, headed by the NIH Director.27
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $62.398 billion
Outlays: $43.825 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 25),
https://officeofbudget.od.nih.gov/pdfs/FY23/br/
Overview%20of%20FY%202023%20Presidents%20Budget.pdf
BIB chapter (p. 53), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=59
Substance Abuse and Mental Health Services Administration
(SAMHSA)
The SAMHSA mission is focused on reducing the “impact of substance abuse and mental illness
on America’s communities.”28 SAMHSA coordinates behavioral health surveillance to improve
26 NIH, Mission and Goals, https://www.nih.gov/about-nih/what-we-do/mission-goals.
27 NIH, Organization, https://www.nih.gov/about-nih/who-we-are/organization.
28 SAMHSA, About Us, https://www.samhsa.gov/about-us.
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Department of Health and Human Services: FY2023 Budget Request
understanding of the impact of substance abuse and mental illness on children, individuals, and
families, and the costs associated with treatment.
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $10.562 billion
Outlays: $10.456 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 15), https://www.samhsa.gov/
sites/default/files/samhsa-fy-2023-cj.pdf
BIB chapter (p. 61), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=67
Agency for Healthcare Research and Quality (AHRQ)
The AHRQ mission is focused on research to “make health care safer, higher quality, more
accessible, equitable, and affordable.”29 Specific AHRQ research efforts are aimed at reducing the
costs of care, promoting patient safety, measuring the quality of health care, and improving health
care services, organization, and financing.
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $0.376 billion
Outlays: $0.358 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 15), https://www.ahrq.gov/
sites/default/files/wysiwyg/cpi/about/mission/budget/2023/fy2023-cj.pdf
BIB chapter (p. 68), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=74
Centers for Medicare & Medicaid Services (CMS)
The CMS mission is focused on supporting “innovative approaches to improving quality,
accessibility, and affordability, while finding the best ways to use advanced technology to support
person-centered care.”30 CMS “administers the Medicare program and works in partnership with
state governments to administer Medicaid, the Children’s Health Insurance Program (CHIP), and
health insurance portability standards.”31 The President’s budget estimates that in FY2023, “over
29 AHRQ, About AHRQ, https://www.ahrq.gov/cpi/about/index.html.
30 CMS, Fiscal Year 2023 Justification of Estimates for Appropriations Committees, March 2023,
https://www.cms.gov/files/document/fy2023-cms-congressional-justification-estimates-appropriations-committees.pdf.
31 CMS, Press Kit, https://www.cms.gov/newsroom/press-kit.
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Department of Health and Human Services: FY2023 Budget Request
150 million Americans will rely on the programs CMS administers including Medicare,
Medicaid, the Children’s Health Insurance Program (CHIP), and the [Health Insurance]
Marketplaces.”32
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $1,493.654 billion
Outlays: $1,421.716 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 9), https://www.cms.gov/
files/document/fy2023-cms-congressional-justification-estimates-appropriations-
committees.pdf
BIB chapter (p. 74), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=80
Administration for Children and Families (ACF)
The ACF mission is focused on promoting the “economic and social well-being of children,
youth, families, and communities.”33 ACF administers a wide array of human services programs,
including Temporary Assistance for Needy Families (TANF), Head Start, child care, the Social
Services Block Grant (SSBG), and various child welfare programs.
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $73.931 billion
Outlays: $89.841 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 6), https://www.acf.hhs.gov/
sites/default/files/documents/olab/fy-2023-congressional-justification.pdf
BIB chapter (p. 129), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=125
Administration for Community Living (ACL)
The ACL mission is focused on maximizing the “independence, well-being, and health of older
adults, people with disabilities across the lifespan, and their families and caregivers.”34 ACL
32 CMS, Fiscal Year 2023 Justification of Estimates for Appropriations Committees, March 2023,
https://www.cms.gov/files/document/fy2023-cms-congressional-justification-estimates-appropriations-committees.pdf.
33 ACF, What We Do, https://www.acf.hhs.gov/about/what-we-do.
34 ACL, About ACL, https://acl.gov/about-acl.
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administers a number of programs targeted at older Americans and the disabled, including Home
and Community-Based Supportive Services and State Councils on Developmental Disabilities.
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $2.958 billion
Outlays: $3.666 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 18), https://acl.gov/sites/
default/files/about-acl/2022-02/FY2023_ACL-BudgetJustification.docx
BIB chapter (p. 138), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=144
Author Information
Jessica Tollestrup
Ada S. Cornell
Specialist in Social Policy
Senior Research Librarian
Karen E. Lynch
Specialist in Social Policy
Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or
material from a third party, you may need to obtain the permission of the copyright holder if you wish to
copy or otherwise use copyrighted material.
Congressional Research Service
R47122 · VERSION 1 · NEW
16
May 31, 2022
FY2023 Budget Request
Jessica Tollestrup
This report provides information about the FY2023 budget request for the U.S. Department of
Specialist in Social Policy
Health and Human Services (HHS). Historically, HHS has been one of the larger federal
departments in terms of budgetary resources. Estimates by the Office of Management and Budget
Karen E. Lynch
(OMB) indicate that HHS has accounted for at least 20% of all federal outlays in each year since
Specialist in Social Policy
FY1995. Most recently, HHS accounted for 22% of all federal outlays in FY2021. (FY2021
funding levels are generally considered final, whereas some FY2022 funding levels remain
estimates.)
Ada S. Cornell
Senior Research Librarian
The FY2023 President’s budget request was submitted to Congress on March 28, 2022. Under
this request, HHS would spend an estimated $1.649 trillion in outlays in FY2022. This would be
$23 billion (+1%) more than estimated HHS outlays in FY2022 and $182 billion (+12%) more
than actual HHS outlays in FY2021.
Mandatory spending typically comprises the majority of the HHS budget. Two mandatory spending programs—Medicare
and Medicaid—are expected to account for 84% of all estimated HHS outlays in FY2023, according to the President’s budget
request. Medicare and Medicaid are entitlement programs, meaning the federal government is required to make mandatory
payments to individuals, states, or other entities based on criteria established in authorizing law.
Proposed FY2023 HHS Outlays by Major Program and Spending Category
Source: Prepared by the Congressional Research Service (CRS) using data on page 17 of the FY2023 HHS Budget in Brief.
Notes: Percentages may not sum due to rounding. For mandatory spending, outlays reflect proposed law spending levels, not the
current services baseline.
While mandatory spending is controlled (but not always provided) by authorizing laws, all discretionary spending is
controlled and provided through the annual appropriations process. Discretionary spending accounts for about 8% of HHS
outlays in the FY2023 President’s budget request. Although discretionary spending represents a relatively small share of the
HHS budget, the department nevertheless receives more discretionary money than most federal departments. According to
OMB data, HHS accounted for just over 11% of all discretionary budget authority across the government in FY2021.
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Contents
About the U.S. Department of Health and Human Services (HHS) ................................................ 1
Context for the FY2023 President’s Budget Request ...................................................................... 2
Overview of the FY2023 HHS Budget Request ................................................................. 2
Budgetary Resources Versus Appropriations ............................................................................ 4
Mandatory and Discretionary Spending ............................................................................. 4
HHS in the Appropriations Process .................................................................................... 4
Proposed Law and Current Law Estimates for Mandatory Programs ................................. 5
User Fees and Other Types of Collections .......................................................................... 6
Scorekeeping and Display Conventions ............................................................................. 6
Sequestration ....................................................................................................................... 6
HHS Budget by Operating Division ................................................................................................ 7
Figures
Figure 1. Proposed FY2023 HHS Outlays by Major Program and Spending Category ................. 4
Figure 2. FY2023 President’s Request for HHS by Operating Division ......................................... 8
Tables
Table 1. FY2023 President’s Budget Request for HHS .................................................................. 3
Table 2. HHS Agencies by Appropriations Bill ............................................................................... 5
Table 3. HHS Budget by Operating and Staff Division ................................................................... 9
Appendixes
Appendix. HHS Operating Divisions: Missions and FY2022 Budget Resources .......................... 11
Contacts
Author Information ........................................................................................................................ 16
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Department of Health and Human Services: FY2023 Budget Request
About the U.S. Department of Health and Human
Services (HHS)
The mission of HHS is to “enhance the health and well-being of all Americans by providing for
effective health and human services and by fostering sound, sustained advances in the sciences
underlying medicine, public health, and social services.”1
HHS is currently organized into 11 main agencies, called operating divisions (listed below),
which are responsible for administering a wide variety of health and human services programs,
and conducting related research. In addition, HHS has a number of staff divisions within the
Office of the Secretary (OS). These staff divisions fulfill a broad array of management, research,
oversight, and emergency preparedness functions in support of the entire department.
HHS Operating Divisions
ACF
Administration for Children and Families
ACL
Administration for Community Living
AHRQ
Agency for Healthcare Research and Quality
ATSDR
Agency for Toxic Substances and Disease Registry
CDC
Centers for Disease Control and Prevention
CMS
Centers for Medicare & Medicaid Services
FDA
Food and Drug Administration
HRSA
Health Resources and Services Administration
IHS
Indian Health Service
NIH
National Institutes of Health
SAMHSA
Substance Abuse and Mental Health Services Administration
Eight of the HHS operating divisions are part of the U.S. Public Health Service (PHS). PHS
agencies have diverse missions in support of public health, including the provision of health care
services and supports (e.g., IHS, HRSA, SAMHSA); the advancement of health care quality and
medical research (e.g., AHRQ, NIH); the prevention and control of disease, injury, and
environmental health hazards (e.g., CDC, ATSDR); and the regulation of food and drugs (e.g.,
FDA).2
The three remaining HHS operating divisions—ACF, ACL, and CMS—are not PHS agencies.
ACF and ACL largely administer human services programs focused on the well-being of
vulnerable children, families, older Americans, and individuals with disabilities. CMS—which
accounts for the largest share of the HHS budget by far—is responsible for administering
Medicare, Medicaid, and the State Children’s Health Insurance Program (CHIP), in addition to
certain programs related to private health insurance.
1 Introduction to the HHS Strategic Plan FY2022-FY2026, https://www.hhs.gov/about/strategic-plan/2022-2026/
introduction/index.html.
2 For further information, see CRS Report R44916, Public Health Service Agencies: Overview and Funding (FY2016-
FY2018).
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(For a summary of each operating division’s mission and links to agency resources related to the
FY2023 budget request, see the Appendix.)
Context for the FY2023 President’s Budget Request
The “Overview” chapter of the HHS Budget in Brief (BIB) is the main source used for the budget
numbers in this report.3 Note that because FY2022 has not yet concluded, this report generally
refers to FY2022 funding levels as estimates, whereas amounts for earlier years are called actual
or final.
The Budget and Accounting Act of 1921 (P.L. 67-13), as amended, requires the President to
submit an annual consolidated federal budget to Congress at the beginning of each regular
congressional session, not later than the first Monday in February. Many of the proposals in the
President’s budget would require changes to laws that govern mandatory spending levels or
policies, which are typically established on a multiyear or permanent basis. Discretionary
spending, however, which is roughly one-third of the budget, is decided and controlled each fiscal
year through the annual appropriations process. While Congress is ultimately not required to
adopt the President’s proposals or recommendations, the submission of the President’s budget
typically initiates the congressional budget process and informs Congress of the President’s
recommended spending levels for agencies and programs.4
The President’s budget request for FY2023 was submitted on March 28, 2022, about seven weeks
after it was due. It was preceded by the enactment of FY2022 full-year annual appropriations
(P.L. 107-103) on March 15, 2022, more than six months into the fiscal year. The FY2022
funding amounts in the BIB overview tables and the tables at the front of each BIB chapter
generally reflect HHS estimates of full-year appropriations amounts. However, the amounts in
each of the FY2023 HHS congressional justifications generally are based on annualized estimates
of the continuing appropriations that were in effect at the time the budget was being prepared.
Thus, these may differ from the amounts in the BIB.
Overview of the FY2023 HHS Budget Request
Under the President’s budget request, HHS would spend an estimated $1.649 trillion in outlays5
in FY2023 (see Table 1).6 This is $23 billion (+1%) more than estimated HHS outlays in FY2022
and about $182 billion (+12%) more than actual HHS outlays in FY2021.
3 Other sources were consulted, including other chapters of the FY2023 HHS Budget in Brief (BIB), various volumes
of the FY2023 President’s budget published by OMB, and congressional budget justifications published by HHS
operating or staff divisions. However, each of the tables and figures in this report (except Table 2) was developed
using data from the “Overview” chapter of the FY2023 HHS BIB, available at https://www.hhs.gov/sites/default/files/
fy-2023-budget-in-brief.pdf.
4 For more information, see CRS Report R47019, The Executive Budget Process: An Overview.
5 Budget authority is the amount of funding a federal agency is legally authorized to commit or spend; an outlay occurs
when funds are actually expended from the Treasury. These terms are discussed in the “HHS Budget by Operating
Division” section of this report.
6 This does not account for expected reductions to nonexempt mandatory spending due to sequestration. For further
information, see OMB, OMB Report to the Congress on the BBEDCA 251A Sequestration for Fiscal Year 2023, March
28, 2022, https://www.whitehouse.gov/wp-content/uploads/2022/03/
BBEDCA_251A_Sequestration_Report_FY2023.pdf.
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Historical estimates by the Office of Management and Budget (OMB) indicate that HHS has
accounted for at least 20% of all federal outlays in each year since FY1995.7 Most recently, OMB
estimated that HHS accounted for nearly 22% of all federal outlays in FY2021, and projects that
it would account for nearly 29% of outlays if all proposals in the President’s FY2023 budget
request were enacted.8
Table 1. FY2023 President’s Budget Request for HHS
(dollars in billions)
FY2019
FY2020
FY2021
FY2022
FY2023
Actual
Actual
Actual
Estimate
Request
Budget Authority
1,284
1,722
1,676
1,573
1,765
Outlays
1,214
1,504
1,467
1,626
1,649
Sources: For FY2019 actual, see FY2021 HHS BIB, pp. 15-16, https://www.hhs.gov/sites/default/files/fy-2021-
budget-in-brief.pdf. For FY2020 actual, see FY2022 HHS BIB, pp. 10-11, https://www.hhs.gov/sites/default/files/fy-
2022-budget-in-brief.pdf. For FY2022 estimate and FY2023 request, see FY2023 HHS BIB, pp. 13-14,
https://www.hhs.gov/sites/default/files/fy-2023-budget-in-brief.pdf.
Notes: Budget authority is the amount of money a federal agency is legally authorized to commit or spend; an
outlay occurs when funds are actually expended from the Treasury. Amounts for FY2023 reflect all proposals in
the President’s budget for both mandatory and discretionary spending programs. In keeping with source
materials, amounts in this table reflect mandatory sequestration in FY2019-FY2022, but do not reflect estimated
effects of sequestration for FY2023.
Figure 1 displays proposed FY2023 HHS outlays by major program or spending category in the
President’s request. As this figure shows, mandatory spending typically accounts for the vast
majority of the HHS budget.9 Two mandatory spending programs—Medicare and Medicaid—are
expected to account for 84% of all estimated HHS spending in FY2023. Medicare and Medicaid
are entitlement programs, meaning the federal government is required to make mandatory
payments to individuals, states, or other entities based on criteria established in authorizing law.10
This figure also shows that discretionary spending accounts for about 8% of estimated FY2023
HHS outlays in the President’s request. Although discretionary spending represents a relatively
small share of total HHS spending, the department nevertheless receives more discretionary
funding than most federal departments. According to OMB data, HHS accounted for 11% of all
discretionary budget authority across the government in FY2021.11 The Department of Defense
was the only federal agency to account for a larger share of all discretionary budget authority in
that year (44%).
7 OMB Historical Tables of the FY2023 President’s Budget, Table 4.2, “Percentage Distribution of Outlays by Agency:
1962–2027,” https://www.whitehouse.gov/omb/historical-tables/.
8 Ibid.
9 The terms mandatory spending and discretionary spending are discussed in the “Budgetary Resources Versus
Appropriations” section of this report.
10 For more information on how these entitlement programs are financed, see CRS Report R40425, Medicare Primer;
and CRS Report R42640, Medicaid Financing and Expenditures.
11 OMB Historical Tables of the FY2023 President’s Budget, Table 5.5, “Percentage Distribution of Discretionary
Budget Authority by Agency: 1976–2027,” https://www.whitehouse.gov/omb/historical-tables/.
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Department of Health and Human Services: FY2023 Budget Request
Figure 1. Proposed FY2023 HHS Outlays by Major Program and Spending Category
Source: Prepared by the Congressional Research Service (CRS) based on data presented on page 17 of the
FY2023 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2023-budget-in-brief.pdf.
Notes: Percentages may not sum due to rounding. For mandatory spending, outlays reflect proposed law
spending levels, not the current services baseline.
Budgetary Resources Versus Appropriations
As previously mentioned, the HHS budget reflects funding from a broad set of budgetary
resources that includes, but is not limited to, the amounts provided to HHS through the annual
appropriations process. As a result, certain amounts shown in FY2023 HHS budget materials
(including amounts for prior years) will not match amounts provided to HHS by annual
appropriations acts and displayed in accompanying congressional documents. There are several
reasons for this, discussed briefly below.
Mandatory and Discretionary Spending
Mandatory spending makes up a large portion of the HHS budget. Whereas all discretionary
spending is controlled and provided through the annual appropriations process, all mandatory
spending is controlled by the program’s authorizing statute. In most cases, that authorizing statute
also provides the funding for the program (e.g., State Children’s Health Insurance Program).
However, the budget authority for some mandatory programs (including Medicaid), while
controlled by criteria in the authorizing statute, must still be provided through the annual
appropriations process; such programs are commonly referred to as appropriated entitlements or
appropriated mandatories. Certain budget documents may show only discretionary spending,
while others may also show some or all types of mandatory spending.
HHS in the Appropriations Process
The HHS budget request accounts for the department as a whole, while the appropriations process
divides HHS funding across three different appropriations bills. Most of the department’s
discretionary appropriations are provided through the Departments of Labor, Health and Human
Services, and Education, and Related Agencies (LHHS) Appropriations Act. However, funding
for certain HHS agencies and activities is provided in two other bills—the Departments of the
Interior, Environment, and Related Agencies Appropriations Act (INT) and the Agriculture, Rural
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Development, Food and Drug Administration, and Related Agencies Appropriations Act (AG).
Table 2 lists HHS agencies by appropriations bill. Each of these three appropriations acts
provides discretionary HHS funding. In some cases, these acts also provide the necessary funding
for appropriated mandatories at HHS. However, authorizing laws provide funding for other
mandatory spending programs.
Table 2. HHS Agencies by Appropriations Bill
Appropriations Bill
HHS Agencies Funded in the Bill
Agriculture, Rural Development, Food and Drug
Food and Drug Administration
Administration, and Related Agencies (AG)
Departments of the Interior, Environment, and Related
Indian Health Service
Agencies (INT)a
Agency for Toxic Substances and Disease Registry
Departments of Labor, Health and Human Services, and
Health Resources and Services Administration
Education, and Related Agencies (LHHS)
Centers for Disease Control and Prevention
National Institutes of Healtha
Substance Abuse and Mental Health Services
Administration
Agency for Healthcare Research and Quality
Centers for Medicare & Medicaid Services
Administration for Children and Families
Administration for Community Living
Office of the Secretary
Source: See CRS Report R40858, Locate an Agency or Program Within Appropriations Bills.
a. Funding for NIH comes primarily from the LHHS appropriations bil , with an additional amount for
Superfund-related activities provided as part of the INT appropriations bil .
Proposed Law and Current Law Estimates for Mandatory Programs
HHS budget materials may include two different estimates for mandatory spending programs
when appropriate: proposed law and current law. The proposed law estimates take into account
changes in mandatory spending proposed in the FY2023 HHS budget request. Such proposals
would generally need to be enacted into law to affect the budgetary resources ultimately available
to the mandatory spending program.12 HHS materials may also show a current law or current
services estimate for mandatory spending programs. These estimates assume that no changes will
be made to existing policies, and instead estimate mandatory spending for programs based on
criteria established in current authorizing law. The HHS budget estimates in this report reflect the
proposed law estimates for mandatory spending programs; readers should be aware that other
HHS, OMB, or congressional estimates might reflect current law instead.
12 For a list of some HHS legislative proposals for mandatory spending programs in the FY2021 President’s budget, see
pages 124-128 and 128-129 of Summary Table S-6 in OMB, Budget of the United States Government, Fiscal Year
2023, https://www.whitehouse.gov/wp-content/uploads/2022/03/budget_fy2023.pdf. This table lists mandatory
proposals (but not discretionary proposals) by federal department and shows the estimated dollar change from current
law levels should the proposal be enacted. (The table does not show the actual proposed funding level.) For additional
information, see the applicable operating division chapters of the HHS Budget in Brief or congressional justifications.
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Department of Health and Human Services: FY2023 Budget Request
User Fees and Other Types of Collections
In some cases, agencies within HHS have the authority to expend user fees and other types of
collections that effectively supplement their appropriations. In addition, agencies may receive
transfers of budgetary resources from other sources, such as from the Public Health Service
Evaluation Set-Aside (also referred to as the PHS Tap) or one of the mandatory funds established
by the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).13 Budgetary
totals that account for these sorts of resources in the HHS estimates are often referred to as being
at the program level. HHS agencies that have historically had notable differences between the
amounts in the appropriations bills and their program level include, for instance, FDA (due to
user fees) and AHRQ (due to transfers).14
Scorekeeping and Display Conventions
The Administration may choose to follow different conventions than those of congressional
scorekeepers for its estimates of HHS programs. For example, certain transfers of funding
between HHS agencies (or from HHS to other federal agencies) that occurred in prior fiscal years,
or are expected to occur in the current fiscal year, may be accounted for in the Administration’s
estimates but not necessarily in the congressional documents.
Sequestration
For FY2023, the Budget Control Act of 2011 (BCA; P.L. 112-25) provides a mechanism
(sequestration) to reduce mandatory spending in each of fiscal years between FY2013 and
FY2031.15 On March 28, 2022, concurrent with the release of the President’s budget submission,
President Biden issued the required FY2023 sequestration order, calling for nonexempt
mandatory spending to be reduced on October 1, 2022.16 Using its current law baseline, OMB
estimated that the FY2023 sequestration percentages would equal 2% of nonexempt Medicare
spending and 5.7% of other nonexempt nondefense mandatory spending, for a total government-
wide reduction in this category of spending of $24 billion in budget authority in FY2023.17 OMB
attributed the majority of this amount, roughly $20 billion, to HHS (mostly for reductions to
Medicare). Notably, however, the OMB estimate does not account for provisions in P.L. 117-71,
which effectively suspended Medicare sequestration through March 31, 2022.18 (OMB also
13 For further information, see CRS Report R44916, Public Health Service Agencies: Overview and Funding (FY2016-
FY2018).
14 The program level for each agency is listed in the table entitled “Composition of the HHS Budget Discretionary
Programs” in the FY2022 HHS BIB.
15 As originally enacted, mandatory sequestration was scheduled to run through FY2021, but this period has
subsequently been incrementally extended. For further information about sequestration, see CRS Report R42972,
Sequestration as a Budget Enforcement Process: Frequently Asked Questions.
16 Sequestration Order for Fiscal Year 2023 Pursuant to Section 251A of the Balanced Budget and Emergency Deficit
Control Act, as Amended, Federal Register, Vol. 87, No. 62, March 31, 2022, p. 18603, https://www.govinfo.gov/
content/pkg/FR-2022-03-31/pdf/2022-06939.pdf.
17 OMB, OMB Report to the Congress on the BBEDCA 251A Sequestration for Fiscal Year 2023, March 28, 2022,
https://www.whitehouse.gov/wp-content/uploads/2022/03/BBEDCA_251A_Sequestration_Report_FY2023.pdf. See
the report’s appendix for an itemized list of budget accounts that include mandatory spending subject to sequestration
in FY2023, the dollar amounts subject to sequestration (based on OMB’s current law baseline), the percentage by
which they would be reduced, and the dollar amount of the reduction. While the report displays reductions at the
account level, the sequester itself is implemented at the program, project, or activity level.
18 Ibid, p. 3. Since FY2020, the Medicare sequestration has been temporarily suspended through a series of laws,
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estimated an 8.3% reduction, totaling $1 billion, in nonexempt defense mandatory spending,
which does not affect HHS funds.)
By long-standing convention, HHS budget materials for FY2023 generally reflect sequestration
for mandatory spending programs in prior years (FY2019-FY2022), but do not reflect estimated
effects of mandatory sequestration for the budget year (FY2023). The numbers in this report
reflect this convention.
HHS Budget by Operating Division
Figure 2 provides a breakdown of the FY2023 HHS budget request by operating division. When
taking into account mandatory and discretionary budget authority (i.e., total budget authority),
CMS accounts for the largest share of the request: nearly $1.5 trillion. The majority of the CMS
budget request would go toward mandatory spending programs, such as Medicare and Medicaid.
Spending on Medicare and Medicaid is expected to increase relative to FY2022 levels under the
President’s request, both in terms of proposed law and current law estimates. However, when
looking exclusively at discretionary budget authority, funding for CMS is comparatively smaller,
accounting for $4.3 billion of the HHS discretionary request. Discretionary CMS funds primarily
support program operations and federal administrative activities, though some funds also go
toward efforts to reduce health care fraud and abuse.
The largest share of the HHS discretionary request would go to the PHS operating divisions:
roughly $81.5 billion in combined public health funding for FDA, HRSA, IHS, CDC, ATSDR,
NIH, SAMHSA, and AHRQ. Note that the estimates for IHS in Figure 2 reflect the President’s
budget proposal to fund the agency entirely with mandatory funds. Typically, IHS is funded
primarily with discretionary funds. In addition, the HHS request includes an $81.7 billion
proposal for new mandatory budget authority spread across four agencies—FDA, CDC, NIH, and
the Assistant Secretary for Preparedness and Response (an entity with significant public health
responsibilities located within the Office of the Secretary). The amount of this proposal is
comparable to the total discretionary BA proposed for all of the PHS operating divisions
combined.
NIH would receive the largest amount of discretionary budget authority of any single HHS
operating division: $49.0 billion. The majority of the proposed NIH budget would support
biomedical research performed by hospitals, medical schools, universities, and other research
institutions around the country.19
ACF would receive the second-largest discretionary funding level among the HHS operating
divisions: $33.3 billion. The majority of the discretionary ACF request (about 61%) would go to
early childhood care and education programs, such as Head Start and the Child Care and
Development Block Grant.20
starting with the enactment of the CARES Act on May 1, 2020 (P.L. 116-136). The act suspended the Medicare
sequestration from May 1, 2020, through December 31, 2020. Subsequent laws (P.L. 116-260, P.L. 117-7, and P.L.
117-71) extended this suspension through March 31, 2022.
19 FY2023 HHS BIB, p. 54.
20 Calculated by CRS based on data presented on pages 121-122 of the FY2023 HHS BIB.
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link to page 12
Department of Health and Human Services: FY2023 Budget Request
Figure 2. FY2023 President’s Request for HHS by Operating Division
Source: Prepared by the Congressional Research Service (CRS) based on data presented on pages 13-16 of the
FY2023 HHS Budget in Brief, https://www.hhs.gov/sites/default/files/fy-2023-budget-in-brief.pdf. The amounts
displayed as total budget authority include mandatory and discretionary funds. The HHS BIB sources the OMB
Budget Appendix for the total budget authority amounts shown above and cautions that these amounts
“potentially differ from the levels displayed” elsewhere in the BIB. HHS does not use the same disclaimer for the
discretionary budget authority levels shown in the BIB and above, meaning that the methodology used to
calculate and present these numbers may differ from that used by HHS in calculating total budget authority. For
this reason, the figure should be viewed as il ustrative.
Notes: Acronyms listed on page 1. Amounts for mandatory spending programs are based on the President’s
proposed law baseline, not the current services baseline. Amounts for discretionary spending programs have not
been adjusted to reflect the effects of proposed rescissions or other cancelations of budget authority. The
estimate for IHS reflects a proposal in the FY2023 President’s budget to transition that agency to being entirely
funded via mandatory spending. Amounts in this figure exclude funding for the HHS staff divisions within the
Office of the Secretary and estimates for several mandatory spending proposals that were listed separately from
the operating divisions in the HHS BIB.
Table 3 puts the FY2023 request for each HHS operating division and the Office of the Secretary
into context, displaying it along with estimates of funding provided over the four prior fiscal
years (FY2019-FY2022). These totals are inclusive of both mandatory and discretionary funding.
The amounts in this table are shown in terms of budget authority (BA) and outlays. BA is the
authority provided by federal law to enter into contracts or other financial obligations that will
result in immediate or future expenditures involving federal government funds. Outlays occur
when funds are actually expended from the Treasury; they could be the result of either new
budget authority enacted in the current fiscal year or unexpended budget authority that was
enacted in previous fiscal years. The rate at which outlays occur often is dependent on the
purpose of the funding and the timeline for which expenditures are to occur. (For example,
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outlays for salaries and expenses tend to happen at a more rapid rate than those for multiyear
projects.) In addition, as outlays over the course of a fiscal year may occur from funds enacted
over a series of fiscal years, they may be more or less than the amount of budget authority newly
enacted for that fiscal year. As a consequence, the BA and outlays in this table represent two
different ways of accounting for the funding that is provided to each HHS agency through the
federal budget process. For example, Table 3 shows $13.6 billion in FY2023 BA for HRSA, but
an estimated $15.8 billion in FY2023 HRSA outlays, reflecting the expected expenditure of funds
previously provided to the agency in addition to some that are expected to be newly enacted in
FY2023.
Amounts shown for the Office of the Secretary were calculated using funding levels in HHS BIBs
for the following staff divisions, accounts, or activities: Departmental Management (including
funding for the Pregnancy Assistance Fund, the Health Insurance Reform Implementation Fund,
transfers from the Patient-Centered Outcomes Research Trust Fund, and payments to the State
Response to the Opioid Abuse Crisis Account), Nonrecurring Expenses Fund, Office of Medicare
Hearings and Appeals, Office of the National Coordinator for Health Information Technology,
Office for Civil Rights, Office of Inspector General, Public Health and Social Services
Emergency Fund, Program Support Center (including retirement pay, medical benefits, and
miscellaneous trust funds), and certain collections credited to that office or the department. They
also include estimates for several mandatory spending proposals that were listed separately from
the operating divisions in the HHS BIB, such as the No Surprises Implementation Fund, Defense
Production Act Medical Supplies Enhancement, PrEP Delivery Program to End the HIV
Epidemic, and Mental Health Transformation Fund.
Table 3. HHS Budget by Operating and Staff Division
(mandatory and discretionary spending combined, dollars in millions)
FY2019
FY2020
FY2021
FY2022
FY2023
Operating Division
Actual
Actual
Actual
Estimatea
Request
FDA
Budget Authority (BA)
3,147
3,365
3,765
3,315
5,403
Outlays
2,831
2,963
3,303
4,729
4,102
HRSA
BA
12,000
14,399
21,733
12,196
13,614
Outlays
11,575
12,113
14,232
18,127
15,845
IHS
BA
5,939
7,393
13,794
7,413
9,973
Outlays
5,455
6,184
9,866
10,011
9,249
CDC (incl. ATSDR)b
BA
7,878
15,855
28,511
8,556
41,343
Outlays
7,736
8,721
11,269
15,826
21,197
NIH
BA
38,090
44,590
42,186
42,225
62,398
Outlays
34,914
36,387
38,868
41,610
43,825
SAMHSA
BA
5,700
6,174
13,674
5,960
10,562
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FY2019
FY2020
FY2021
FY2022
FY2023
Operating Division
Actual
Actual
Actual
Estimatea
Request
Outlays
4,328
5,206
5,910
8,250
10,456
AHRQ
BA
337
338
337
338
376
Outlays
322
333
329
335
358
CMSc
BA
1,144,763
1,328,620
1,296,727
1,418,723
1,493,654
Outlays
1,085,909
1,258,071
1,240,623
1,359,740
1,421,716
ACF
BA
61,735
67,349
122,521
69,741
73,931
Outlays
55,969
60,819
70,079
90,041
89,841
ACL
BA
2,139
3,403
4,221
2,234
2,958
Outlays
2,023
2,418
2,662
3,769
3,666
Office of the Secretaryd
BA
2,621
230,195
128,560
2,702
50,909
Outlays
3,110
111,055
69,753
73,918
28,878
Total, HHS
BA
1,284,349
1,721,681
1,676,029
1,573,403
1,765,121
Outlays
1,214,172
1,504,270
1,466,894
1,626,356
1,649,133
Sources: For FY2019 actual, see FY2021 HHS BIB, pp. 15-16, https://www.hhs.gov/sites/default/files/fy-2021-
budget-in-brief.pdf. For FY2020 actual, see FY2022 HHS BIB, pp. 10-11, https://www.hhs.gov/sites/default/files/fy-
2022-budget-in-brief.pdf. For FY2021 actual, FY2022 estimate, and FY2023 request, see FY2023 HHS BIB, pp. 13-
14, https://www.hhs.gov/sites/default/files/fy-2023-budget-in-brief.pdf.
Notes: Totals are as reported in HHS BIBs. The HHS BIBs source the Budget Appendix prepared by the Office
of Management and Budget for the BA amounts shown in these particular BIB tables. HHS cautions that these
amounts “potentially differ from the levels displayed in the individual Operating or Staff Division Chapters.”
Totals may not sum due to rounding and, in prior years, may reflect some adjustments for comparability.
Amounts for FY2023 reflect all proposals in the President’s budget for both mandatory and discretionary
spending programs. In keeping with source materials, amounts in this table reflect sequestration for mandatory
spending programs in FY2019-FY2022, but do not reflect estimated effects of mandatory sequestration for
FY2023.
a. FY2022 funding levels in the FY2023 BIB reflect amounts enacted in law (P.L. 117-103) for programs and
activities funded by the annual appropriations process. For mandatory spending provided outside the annual
appropriations process, funding levels generally reflect amounts provided by authorizing law. In cases where
ful -year funding has not yet been provided in authorizing law, these levels are based on annualized amounts
provided in the most recent short-term funding extension in effect at the time that the budget formulation
process was completed.
b. By HHS convention, the amounts shown for CDC include funding for ATSDR.
c. Per source materials, the budget authority for CMS includes non-CMS budget authority for Hospital
Insurance and Supplementary Medical Insurance for the Social Security Administration and the Medicare
Payment Advisory Commission (MedPAC).
d. Amounts shown for the OS include estimates for several mandatory spending proposals that were listed
separately from the operating divisions in the HHS BIB, such as the No Surprises Implementation Fund,
Defense Production Act Medical Supplies Enhancement, PrEP Delivery Program to End the HIV Epidemic,
and Mental Health Transformation Fund.
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Department of Health and Human Services: FY2023 Budget Request
Appendix. HHS Operating Divisions: Missions and
FY2022 Budget Resources
This appendix provides for each operating division a brief summary of its mission,21 the
applicable appropriations bill, the FY2023 budget request level, and links to additional resources
related to that request.
Food and Drug Administration (FDA)
The FDA mission is focused on regulating the safety, efficacy, and security of human foods,
dietary supplements, cosmetics, and animal foods; and the safety and effectiveness of human
drugs, biological products (e.g., vaccines), medical devices, radiation-emitting products, and
animal drugs. It also regulates the manufacture, marketing, and sale of tobacco products.22
Relevant Appropriations Bill:
Agriculture, Rural Development, Food and Drug Administration, and Related
Agencies (AG)
FY2023 Request:
BA: $5.403 billion
Outlays: $4.102 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 30), https://www.fda.gov/
media/157192/download
BIB chapter (p. 18), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=24
Health Resources and Services Administration (HRSA)
The HRSA mission is focused on “providing health care to people who are geographically
isolated and economically or medically vulnerable.”23 Among its many programs and activities,
HRSA supports health care workforce training; the National Health Service Corps; and the
federal health centers program, which provides grants to nonprofit entities that provide primary
care services to people who experience financial, geographic, cultural, or other barriers to health
care.
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $13.614 billion
21 The mission summaries below exclude the Office of the Secretary, which comprises multiple staff divisions whose
goals are to “provide leadership, direction, and policy guidance to the Department.” See HHS Strategic Plan FY2022-
2026, Introduction: About HHS, https://www.hhs.gov/about/strategic-plan/2022-2026/overview/index.html.
22 FDA, What Does FDA Do, https://www.fda.gov/about-fda/fda-basics/what-does-fda-do.
23 HRSA, About HRSA, https://www.hrsa.gov/about/index.html.
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Department of Health and Human Services: FY2023 Budget Request
Outlays: $15.845 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 19), https://www.hrsa.gov/
sites/default/files/hrsa/about/budget/budget-justification-fy2023.pdf
BIB chapter (p. 26), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=32
Indian Health Service (IHS)
The IHS mission is to provide “federal health services to American Indians and Alaska Natives”
and “raise the physical, mental, social, and spiritual health of American Indians and Alaska
Natives to the highest level.”24 IHS provides health care for approximately 2.6 million eligible
American Indians and Alaska Natives through a system of programs and facilities located on or
near Indian reservations, and through contractors in certain urban areas.
Relevant Appropriations Bill:
Departments of the Interior, Environment, and Related Agencies (INT)
FY2023 Request:
BA: $9.973 billion
Outlays: $9.249 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 19), https://www.ihs.gov/
sites/budgetformulation/themes/responsive2017/display_objects/documents/
FY2023BudgetJustificaton.pdf
BIB chapter (p. 35), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=41
Centers for Disease Control and Prevention (CDC) and Agency for
Toxic Substances and Disease Registry (ATSDR)
The CDC mission is focused on “disease prevention and control, environmental health, and health
promotion and health education.”25 CDC is organized into a number of centers, institutes, and
offices, some focused on specific public health challenges (e.g., injury prevention) and others
focused on general public health capabilities (e.g., surveillance and laboratory services).
In addition, the ATSDR is headed by the CDC director. For that reason, the ATSDR budget is
often shown within CDC. Following the conventions of the FY2023 HHS BIB, ATSDR’s budget
request is included in the CDC totals shown in this report. ATSDR’s work is focused on
preventing or mitigating adverse effects resulting from exposure to hazardous substances in the
environment.
24 IHS, Agency Overview, https://www.ihs.gov/aboutihs/overview/.
25 CDC, Official Mission Statements & Organizational Charts, https://www.cdc.gov/maso/pdf/cdcmiss.pdf.
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Department of Health and Human Services: FY2023 Budget Request
Relevant Appropriations Bills:
LHHS (CDC)
INT (ATSDR)
FY2023 Request (CDC and ATSDR combined):
BA: $41.343 billion
Outlays: $21.197 billion
Additional Resources Related to the FY2023 Request:
CDC Congressional Justification (all-purpose table on p. 32),
https://www.cdc.gov/budget/documents/fy2023/FY-2023-CDC-congressional-
justification.pdf
ATSDR Congressional Justification, https://www.cdc.gov/budget/documents/
fy2023/FY-2023-ATSDR-congressional-justification.pdf
BIB chapter (p. 42), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=48
National Institutes of Health (NIH)
The NIH mission is focused on conducting and supporting research “in causes, diagnosis,
prevention, and cure of human diseases” and “in directing programs for the collection,
dissemination, and exchange of information in medicine and health.”26 NIH is organized into 27
research institutes and centers, headed by the NIH Director.27
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $62.398 billion
Outlays: $43.825 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 25),
https://officeofbudget.od.nih.gov/pdfs/FY23/br/
Overview%20of%20FY%202023%20Presidents%20Budget.pdf
BIB chapter (p. 53), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=59
Substance Abuse and Mental Health Services Administration
(SAMHSA)
The SAMHSA mission is focused on reducing the “impact of substance abuse and mental illness
on America’s communities.”28 SAMHSA coordinates behavioral health surveillance to improve
26 NIH, Mission and Goals, https://www.nih.gov/about-nih/what-we-do/mission-goals.
27 NIH, Organization, https://www.nih.gov/about-nih/who-we-are/organization.
28 SAMHSA, About Us, https://www.samhsa.gov/about-us.
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Department of Health and Human Services: FY2023 Budget Request
understanding of the impact of substance abuse and mental illness on children, individuals, and
families, and the costs associated with treatment.
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $10.562 billion
Outlays: $10.456 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 15), https://www.samhsa.gov/
sites/default/files/samhsa-fy-2023-cj.pdf
BIB chapter (p. 61), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=67
Agency for Healthcare Research and Quality (AHRQ)
The AHRQ mission is focused on research to “make health care safer, higher quality, more
accessible, equitable, and affordable.”29 Specific AHRQ research efforts are aimed at reducing the
costs of care, promoting patient safety, measuring the quality of health care, and improving health
care services, organization, and financing.
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $0.376 billion
Outlays: $0.358 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 15), https://www.ahrq.gov/
sites/default/files/wysiwyg/cpi/about/mission/budget/2023/fy2023-cj.pdf
BIB chapter (p. 68), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=74
Centers for Medicare & Medicaid Services (CMS)
The CMS mission is focused on supporting “innovative approaches to improving quality,
accessibility, and affordability, while finding the best ways to use advanced technology to support
person-centered care.”30 CMS “administers the Medicare program and works in partnership with
state governments to administer Medicaid, the Children’s Health Insurance Program (CHIP), and
health insurance portability standards.”31 The President’s budget estimates that in FY2023, “over
29 AHRQ, About AHRQ, https://www.ahrq.gov/cpi/about/index.html.
30 CMS, Fiscal Year 2023 Justification of Estimates for Appropriations Committees, March 2023,
https://www.cms.gov/files/document/fy2023-cms-congressional-justification-estimates-appropriations-committees.pdf.
31 CMS, Press Kit, https://www.cms.gov/newsroom/press-kit.
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Department of Health and Human Services: FY2023 Budget Request
150 million Americans will rely on the programs CMS administers including Medicare,
Medicaid, the Children’s Health Insurance Program (CHIP), and the [Health Insurance]
Marketplaces.”32
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $1,493.654 billion
Outlays: $1,421.716 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 9), https://www.cms.gov/
files/document/fy2023-cms-congressional-justification-estimates-appropriations-
committees.pdf
BIB chapter (p. 74), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=80
Administration for Children and Families (ACF)
The ACF mission is focused on promoting the “economic and social well-being of children,
youth, families, and communities.”33 ACF administers a wide array of human services programs,
including Temporary Assistance for Needy Families (TANF), Head Start, child care, the Social
Services Block Grant (SSBG), and various child welfare programs.
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $73.931 billion
Outlays: $89.841 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 6), https://www.acf.hhs.gov/
sites/default/files/documents/olab/fy-2023-congressional-justification.pdf
BIB chapter (p. 129), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=125
Administration for Community Living (ACL)
The ACL mission is focused on maximizing the “independence, well-being, and health of older
adults, people with disabilities across the lifespan, and their families and caregivers.”34 ACL
32 CMS, Fiscal Year 2023 Justification of Estimates for Appropriations Committees, March 2023,
https://www.cms.gov/files/document/fy2023-cms-congressional-justification-estimates-appropriations-committees.pdf.
33 ACF, What We Do, https://www.acf.hhs.gov/about/what-we-do.
34 ACL, About ACL, https://acl.gov/about-acl.
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Department of Health and Human Services: FY2023 Budget Request
administers a number of programs targeted at older Americans and the disabled, including Home
and Community-Based Supportive Services and State Councils on Developmental Disabilities.
Relevant Appropriations Bill:
LHHS
FY2023 Request:
BA: $2.958 billion
Outlays: $3.666 billion
Additional Resources Related to the FY2023 Request:
Congressional Justification (all-purpose table on p. 18), https://acl.gov/sites/
default/files/about-acl/2022-02/FY2023_ACL-BudgetJustification.docx
BIB chapter (p. 138), https://www.hhs.gov/sites/default/files/fy-2023-budget-in-
brief.pdf#page=144
Author Information
Jessica Tollestrup
Ada S. Cornell
Specialist in Social Policy
Senior Research Librarian
Karen E. Lynch
Specialist in Social Policy
Disclaimer
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Congressional Research Service
R47122 · VERSION 1 · NEW
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