Department of Health and Human Services: FY2024 Budget Request
Department of Health and Human Services:
June 29, 2023
FY2024 Budget Request
Jessica Tollestrup
This report provides information about the FY2024 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 about 26% of all federal outlays in FY2022.
(FY2022 funding levels are generally considered final, whereas some FY2023 funding levels
remain estimates.)
Ada S. Cornell
Senior Research Librarian
The FY2024 President’s budget request was submitted to Congress on March 9, 2023. Under this
request, HHS would spend an estimated $1.691 trillion in outlays in FY2024. This would be $10
billion (-1%) less than estimated HHS outlays in FY2023 and $48 billion (+3%) more than actual
HHS outlays in FY2022.
Mandatory spending typically comprises the majority of the HHS budget. Two mandatory spending programs—Medicare
and Medicaid—are expected to account for 83% of all estimated HHS outlays in FY2024, 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 FY2024 HHS Outlays by Major Program or Spending Category
Source: Prepared by the Congressional Research Service (CRS) using data on page 15 of the FY2024 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.
The amount of mandatory spending is controlled (but not always provided) by authorizing laws. By contrast, for all
discretionary spending the amount is controlled and provided through the annual appropriations process. Discretionary
spending accounts for about 9% of HHS FY2024 outlays in the 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 about 7% of all discretionary budget authority across
the government in FY2022. The Department of Defense was the only federal agency to account for a larger share of all
discretionary budget authority in that year (43%).
Congressional Research Service
link to page 4 link to page 5 link to page 6 link to page 7 link to page 7 link to page 8 link to page 8 link to page 9 link to page 9 link to page 9 link to page 10 link to page 7 link to page 11 link to page 6 link to page 8 link to page 12 link to page 14 link to page 20 Department of Health and Human Services: FY2024 Budget Request
Contents
About the U.S. Department of Health and Human Services (HHS) ................................................ 1
Context for the FY2024 President’s Budget Request ...................................................................... 2
Overview of the FY2024 HHS Budget Request ....................................................................... 3
Budgetary Resources Versus Appropriations ............................................................................ 4
Mandatory and Discretionary Spending ............................................................................. 4
HHS in the Appropriations Process .................................................................................... 5
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 FY2024 HHS Outlays by Major Program or Spending Category .................... 4
Figure 2. FY2024 President’s Request for HHS by Operating Division ......................................... 8
Tables
Table 1. FY2024 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 FY2024 Budget Resources .......................... 11
Contacts
Author Information ........................................................................................................................ 17
Congressional Research Service
Department of Health and Human Services: FY2024 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 12 main agencies, called operating divisions (listed below). HHS
operating divisions are responsible for administering a wide variety of health and human services
programs, and conducting related research.2 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, and oversight functions in support of the entire department.
Acronym
HHS Operating Division
ACF
Administration for Children and Families
ACL
Administration for Community Living
AHRQ
Agency for Healthcare Research and Quality
ASPR
Administration for Strategic Preparedness and Response
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 Administration3
Nine 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); the preparation for and response to disasters
and public health emergencies (e.g., ASPR); and the regulation of food and drugs (e.g., FDA).
1 Introduction to the HHS Strategic Plan FY2022-FY2026, https://www.hhs.gov/about/strategic-plan/2022-2026/
introduction/index.html.
2 On July 22, 2022, HHS announced that the Office of the Assistant Secretary for Preparedness and Response would be
renamed the Administration for Strategic Preparedness and Response (retaining the ASPR acronym) and be established
as an operating division. This reorganization was approved by the HHS Secretary on January 27, 2023, and became
effective on February 11, 2023 (Statement of Organization, Functions and Delegations of Authority in Federal Record
vol. 88, no. 32, pp. 10125-10127, February 16, 2023).
3 In some places, FY2024 HHS budget materials refer to SAMHSA as the “Substance use And Mental Health Services
Administration,” while in others those materials use the statutory name, “Substance Abuse and Mental Health Services
Administration.”
Congressional Research Service
1
link to page 14 link to page 8 Department of Health and Human Services: FY2024 Budget Request
ASPR is the newest operating division at HHS, established effective February 2023.4 Before this
transition, ASPR was a staff division within the HHS Office of the Secretary.
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.
(For a summary of each operating division’s mission and links to agency resources related to the
FY2024 budget request, see the Appendix.)
Context for the FY2024 President’s Budget Request
The overview chapter (“Building a Healthy America”) of the HHS Budget in Brief (BIB) is the
main source used for the budget numbers in this report.5 Because FY2023 has not yet concluded,
this report generally refers to FY2023 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.6
The President’s budget request for FY2024 was submitted on March 9, 2023, about five weeks
after it was due. It was preceded by the enactment of FY2023 full-year annual appropriations
(P.L. 117-328) on December 29, 2022, almost three months into the fiscal year. The delay of the
budget submission allowed the FY2023 funding amounts in the BIB and the HHS congressional
justifications generally to reflect the annual appropriations that were enacted in December.
4 For more information on this reorganization, see HHS, ASPR, “Statement of Organization, Functions, and
Delegations of Authority,” 88 Federal Register 10125-10127, February 16, 2023, https://www.govinfo.gov/content/
pkg/FR-2023-02-16/pdf/2023-03277.pdf.
5 Other sources were consulted, including other chapters of the FY2024 HHS Budget in Brief (BIB), various volumes
of the FY2024 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 “Building a Healthy America” chapter of the FY2024 HHS BIB, available at https://www.hhs.gov/
sites/default/files/fy-2024-budget-in-brief.pdf.
6 For more information, see CRS Report R47019, The Executive Budget Process: An Overview.
Congressional Research Service
2
link to page 6 link to page 7 link to page 10 link to page 10 link to page 7 link to page 7 Department of Health and Human Services: FY2024 Budget Request
Overview of the FY2024 HHS Budget Request
Under the President’s budget request, HHS would spend an estimated $1.691 trillion in outlays7
in FY2024 (see Table 1).8 This is $10 billion (-1%) less than estimated HHS outlays in FY2023
and about $48 billion (+3%) more than actual HHS outlays in FY2022.
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 FY1995.9 Most recently, OMB
estimated that HHS accounted for about 26% of all federal outlays in FY2022, and projects that it
would account for nearly 25% of outlays if all proposals in the President’s FY2024 budget
request were enacted.10
Table 1. FY2024 President’s Budget Request for HHS
(dollars in billions)
FY2020
FY2021
FY2022
FY2023
FY2024
Actual
Actual
Actual
Estimate
Request
Budget Authority
1,721,681
1,676,029
1,635,534
1,772,315
1,737,965
Outlays
1,504,270
1,466,894
1,643,127
1,701,433
1,691,374
Sources: 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, see FY2023 HHS BIB, pp. 13-14, https://www.hhs.gov/sites/default/files/fy-
2023-budget-in-brief.pdf. For FY2022 actual, FY2023 estimate, and FY2024 request, see FY2024 HHS BIB, pp. 11-
12, https://www.hhs.gov/sites/default/files/fy-2024-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 FY2024 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 FY2020-FY2023, but do not reflect estimated
effects of sequestration for FY2024.
Figure 1 displays proposed FY2024 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.11 Two mandatory spending programs—Medicare and Medicaid—are
expected to account for 83% of all estimated HHS spending in FY2024. 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.12
This figure also shows that discretionary spending accounts for about 9% of estimated FY2024
HHS outlays in the President’s request. Although discretionary spending represents a relatively
7 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.
8 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 2024, March
13, 2023, https://www.whitehouse.gov/wp-content/uploads/2023/03/BBEDCA_Sequestration_Report_and_Letter_3-
13-2024.pdf.
9 OMB Historical Tables of the FY2024 President’s Budget, Table 4.2, “Percentage Distribution of Outlays by Agency:
1962–2028,” https://www.whitehouse.gov/omb/historical-tables/.
10 Ibid.
11 The terms mandatory spending and discretionary spending are discussed in the “Budgetary Resources Versus
Appropriations” section of this report.
12 For more information on how these entitlement programs are financed, see CRS Report R40425, Medicare Primer;
and CRS Report R42640, Medicaid Financing and Expenditures.
Congressional Research Service
3
Department of Health and Human Services: FY2024 Budget Request
small share of total HHS spending, the department nevertheless receives more discretionary
funding than most federal departments. According to OMB data, HHS accounted for 7% of all
discretionary budget authority across the government in FY2022.13 The Department of Defense
was the only federal agency to account for a larger share of all discretionary budget authority in
that year (43%).
Figure 1. Proposed FY2024 HHS Outlays by Major Program or Spending Category
Source: Prepared by the Congressional Research Service (CRS) based on data presented on page 15 of the
FY2024 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2024-budget-in-brief.pdf.
Notes: Percentages may not sum to 100 due to rounding. For mandatory spending, outlays reflect proposed law
spending levels, not the current services baseline.
Budgetary Resources Versus Appropriations
The HHS budget reflects funding from a broad set of budgetary resources. These include, but are
not limited to, amounts provided to HHS through the annual appropriations process. In some
cases, amounts shown in FY2024 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
Certain budget documents may show only discretionary spending, while others may also show
some or all types of mandatory 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
13 OMB Historical Tables of the FY2024 President’s Budget, Table 5.5, “Percentage Distribution of Discretionary
Budget Authority by Agency: 1976–2028,” https://www.whitehouse.gov/omb/historical-tables/.
Congressional Research Service
4
link to page 8 link to page 8 link to page 8 Department of Health and Human Services: FY2024 Budget Request
be provided through the annual appropriations process; such programs are commonly referred to
as appropriated entitlements or appropriated mandatories.
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 Department of the
Interior, Environment, and Related Agencies Appropriations Act (INT) and the Agriculture, Rural
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)
Department 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
•
Administration for Strategic Preparedness and
Response
•
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 FY2024 HHS budget request. Such proposals
would generally need to be enacted into law to affect the budgetary resources ultimately available
Congressional Research Service
5
Department of Health and Human Services: FY2024 Budget Request
to the mandatory spending program.14 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.
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).15 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).16
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
The Balanced Budget and Emergency Deficit Control Act of 1985 (BBEDCA) provides a
mechanism (sequestration) to reduce mandatory spending in each fiscal year beginning with
FY2013 and continuing through FY2031 (or for Medicare only, through the first six months of
FY2032).17 On March 13, 2023, concurrent with the release of the President’s budget submission,
President Biden issued the required FY2024 sequestration order, calling for nonexempt
mandatory spending to be reduced on October 1, 2023.18 Using its current law baseline, OMB
14 For a list of some HHS legislative proposals for mandatory spending programs in the FY2024 President’s budget, see
Summary Table S–6 in OMB, Budget of the United States Government, Fiscal Year 2024,
https://www.whitehouse.gov/wp-content/uploads/2023/03/budget_fy2024.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.
15 For further information, see CRS Report R47345, Labor, Health and Human Services, and Education: FY2023
Appropriations.
16 The program level for each agency is listed in the table entitled “Composition of the HHS Budget Discretionary
Programs” in the FY2022 HHS BIB.
17 As originally enacted, mandatory sequestration was scheduled to run through FY2021, but this period has
subsequently been incrementally extended. For further information about these extensions, see the Appendix of CRS
Report R47345, Labor, Health and Human Services, and Education: FY2023 Appropriations. For further information
about sequestration, see CRS Report R42972, Sequestration as a Budget Enforcement Process: Frequently Asked
Questions.
18 Sequestration Order for Fiscal Year 2024 Pursuant to Section 251A of the Balanced Budget and Emergency Deficit
(continued...)
Congressional Research Service
6
link to page 11 Department of Health and Human Services: FY2024 Budget Request
estimated that the FY2024 sequestration percentages would equal 2% of nonexempt spending
from Medicare and certain other health programs and 5.7% of other nonexempt nondefense
mandatory spending, for a total government-wide reduction in this category of spending of $26
billion in budget authority in FY2024.19 OMB attributed the majority of this amount, roughly $20
billion, to HHS (mostly for reductions to Medicare). (OMB also estimated an 8.3% reduction,
totaling $1 billion, in nonexempt defense mandatory spending, which does not affect HHS funds.)
By convention, HHS budget materials for FY2024 generally reflect sequestration for mandatory
spending programs in prior years (FY2022-FY2023), but do not reflect estimated effects of
mandatory sequestration for the budget year (FY2024). The numbers in this report reflect this
convention.
HHS Budget by Operating Division
Figure 2 provides a breakdown of the FY2024 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.
Under the President’s budget, spending on Medicare is expected to increase relative to FY2023
levels in terms of current law estimates, but would slightly decrease under proposed law
estimates. Spending on Medicaid is estimated to decrease relative to FY2023 based on both
current law and proposed law estimates. However, when looking exclusively at discretionary
budget authority, funding for CMS is comparatively smaller, accounting for $4.6 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 $92.9 billion in combined public health funding for FDA, HRSA, IHS, CDC, ATSDR,
NIH, SAMHSA, AHRQ, and ASPR. NIH would receive the largest amount of discretionary
budget authority of any single HHS operating division: $46.4 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.20
ACF would receive the second-largest discretionary funding level among the HHS operating
divisions: $39.4 billion. The majority of the discretionary ACF request (about 57%) would go to
early childhood care and education programs, such as Head Start and the Child Care and
Development Block Grant.21
Control Act, as Amended, Federal Register, Vol. 88, No. 51, March 16, 2023, p. 16171, https://www.govinfo.gov/
content/pkg/FR-2023-03-16/pdf/2023-05511.pdf.
19 OMB, OMB Report to the Congress on the BBEDCA 251A Sequestration for Fiscal Year 2024, March 13, 2023,
https://www.whitehouse.gov/wp-content/uploads/2023/03/BBEDCA_Sequestration_Report_and_Letter_3-13-
2024.pdf. See the report’s appendix for an itemized list of budget accounts that include mandatory spending subject to
sequestration in FY2024, 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.
20 FY2024 HHS BIB, p. 47.
21 Calculated by CRS based on data presented on pages 119-120 of the FY2024 HHS BIB.
Congressional Research Service
7
link to page 12 link to page 12
Department of Health and Human Services: FY2024 Budget Request
Figure 2. FY2024 President’s Request for HHS by Operating Division
Source: Prepared by the Congressional Research Service (CRS) based on data presented on pages 11-14 of the
FY2024 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2024-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 of this report. 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 cancel ations of budget
authority. 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 FY2024 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 (FY2020-FY2023). 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,
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 $16.2 billion in FY2024 BA for HRSA, but
an estimated $17.2 billion in FY2024 HRSA outlays, reflecting the expected expenditure of funds
Congressional Research Service
8
link to page 13 link to page 13 link to page 13 Department of Health and Human Services: FY2024 Budget Request
previously provided to the agency in addition to some funds that are expected to be newly enacted
in FY2024.
Amounts shown for the OS were calculated using funding levels in HHS BIBs for several staff
divisions, accounts, and activities under the OS.22 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, Mental Health Transformation
Fund, National Hepatitis C Elimination Program, and Antimicrobial Subscriptions.
Table 3. HHS Budget by Operating and Staff Division
(mandatory and discretionary spending combined, dollars in millions)
FY2020
FY2021
FY2022
FY2023
FY2024
Operating Division
Actual
Actual
Actual
Estimatea
Request
FDA
Budget Authority (BA)
3,365
3,765
4,379
3,644
4,015
Outlays
2,963
3,303
4,588
5,037
3,876
HRSA
BA
14,399
21,733
13,566
14,705
16,183
Outlays
12,113
14,232
16,128
17,051
17,196
IHS
BA
7,393
13,794
7,442
7,994
10,355
Outlays
6,184
9,866
6,507
7,369
10,487
CDC (incl. ATSDR)b
BA
15,855
28,511
9,156
10,979
13,158
Outlays
8,721
11,269
16,526
13,247
13,446
NIH
BA
44,590
42,186
45,415
48,952
49,630
Outlays
36,387
38,868
40,623
44,759
46,281
SAMHSA
BA
6,174
13,674
6,724
7,567
10,863
Outlays
5,206
5,910
7,384
8,334
11,729
AHRQ
BA
338
337
350
374
403
Outlays
333
329
339
304
402
CMSc
BA
1,328,620
1,296,727
1,471,167
1,593,907
1,487,835
Outlays
1,258,071
1,240,623
1,370,675
1,475,653
1,448,709
22 These include Departmental Management, 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.
Congressional Research Service
9
link to page 13 link to page 13 link to page 13 Department of Health and Human Services: FY2024 Budget Request
FY2020
FY2021
FY2022
FY2023
FY2024
Operating Division
Actual
Actual
Actual
Estimatea
Request
ACF
BA
67,349
122,521
73,556
78,977
94,474
Outlays
60,819
70,079
85,702
92,397
102,436
ACL
BA
3,403
4,221
2,293
2,526
3,035
Outlays
2,418
2,662
2,720
4,110
3,429
ASPRd
BA
4,272
Outlays
1,063
Office of the Secretarye
BA
230,195
128,560
1,486
2,690
43,742
Outlays
111,055
69,753
91,935
33,172
32,320
Total, HHS
BA
1,721,681
1,676,029
1,635,534
1,772,315
1,737,965
Outlays
1,504,270
1,466,894
1,643,127
1,701,433
1,691,374
Sources: 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, see FY2023 HHS BIB, pp. 13-14, https://www.hhs.gov/sites/default/files/fy-
2023-budget-in-brief.pdf. For FY2022 actual, FY2023 estimate, and FY2024 request, see FY2024 HHS BIB, pp. 11-12,
https://www.hhs.gov/sites/default/files/fy-2024-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 FY2020-FY2023, but do not reflect estimated effects of mandatory sequestration for
FY2024.
a. FY2023 funding levels in the FY2024 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. On February 11, 2023, HHS established ASPR as an operating division named the Administration for
Strategic Preparedness and Response. Funding for the prior entity within the HHS Office of the Secretary,
the Office of the Assistant Secretary for Preparedness and Response, is included in the Office of the
Secretary funding listed in this table for FY2020-FY2023.
e. 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,
Mental Health Transformation Fund, National Hepatitis C Elimination Program, and Antimicrobial
Subscriptions.
Congressional Research Service
10
Department of Health and Human Services: FY2024 Budget Request
Appendix. HHS Operating Divisions: Missions and
FY2024 Budget Resources
This appendix provides for each operating division a brief summary of its mission,23 the
applicable appropriations bill, the FY2024 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 and labeling 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 tobacco products.24
Appropriations Bill:
• Agriculture, Rural Development, Food and Drug Administration, and Related
Agencies (AG)
FY2024 Request:
• BA: $4.015 billion
• Outlays: $3.876 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 15), https://www.fda.gov/
media/166182/download
• BIB chapter (p. 22), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=22
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.”25 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.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $16.183 billion
23 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.
24 FDA, What Does FDA Do, https://www.fda.gov/about-fda/fda-basics/what-does-fda-do.
25 HRSA, About HRSA, https://www.hrsa.gov/about/index.html.
Congressional Research Service
11
Department of Health and Human Services: FY2024 Budget Request
• Outlays: $17.196 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 20), https://www.hrsa.gov/
sites/default/files/hrsa/about/budget/budget-justification-fy2024.pdf
• BIB chapter (p. 24), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=30
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.”26 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.27
Appropriations Bill:
• Department of the Interior, Environment, and Related Agencies (INT)
FY2024 Request:
• BA: $10.355 billion
• Outlays: $10.487 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 10), https://www.ihs.gov/
sites/budgetformulation/themes/responsive2017/display_objects/documents/
FY2024-IHS-CJ32223.pdf
• BIB chapter (p. 32), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=38
Centers for Disease Control and Prevention (CDC) and Agency for
Toxic Substances and Disease Registry (ATSDR)
The CDC mission is focused on “developing and applying disease prevention and control,
environmental health, and health promotion and health education activities designed to improve
the health of the people of the United States.”28 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 FY2024 HHS BIB, ATSDR’s budget
request is included in the CDC totals shown in this report. ATSDR’s work is focused on
26 IHS, Agency Overview, https://www.ihs.gov/aboutihs/overview/.
27 IHS, About IHS, https://www.ihs.gov/aboutihs/
28 CDC, Official Mission/Function Statement, updated 2/10/2023, https://www.cdc.gov/about/pdf/organization/iod-
mission-statement.pdf.
Congressional Research Service
12
Department of Health and Human Services: FY2024 Budget Request
preventing or mitigating adverse effects resulting from exposure to hazardous substances in the
environment.29
Appropriations Bills:
• LHHS (CDC)
• INT (ATSDR)
FY2024 Request (CDC and ATSDR combined):
• BA: $13.158 billion
• Outlays: $13.446 billion
Additional Resources:
• CDC Congressional Justification (all-purpose table on p. 35),
https://www.cdc.gov/budget/documents/fy2024/FY-2024-CDC-congressional-
justification.pdf
• ATSDR Congressional Justification, https://www.cdc.gov/budget/documents/
fy2024/FY-2024-ATSDR-congressional-justification.pdf
• BIB chapter (p. 39), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=45
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.”30 NIH is organized into 27
research institutes and centers, headed by the NIH Director.31 In addition, FY2022 appropriations
called for HHS to establish a new entity: the Advanced Research Projects Agency for Health
(ARPA-H). HHS subsequently placed this entity within NIH.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $49.630 billion
• Outlays: $ 46.281 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 33),
https://officeofbudget.od.nih.gov/pdfs/FY24/br/
Overview%20of%20FY%202024%20Presidents%20Budget.pdf32
29 ASTDR, Official Mission/Function Statement, updated 1/10/2023, https://www.cdc.gov/about/pdf/organization/
atsdr-mission-statement.pdf.
30 NIH, Mission and Goals, https://www.nih.gov/about-nih/what-we-do/mission-goals.
31 NIH, Organization, https://www.nih.gov/about-nih/who-we-are/organization.
32 NIH’s individual institutes/centers also submit justifications, available at https://officeofbudget.od.nih.gov/
insti_center_subs.html.
Congressional Research Service
13
Department of Health and Human Services: FY2024 Budget Request
• BIB chapter (p. 46), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=52
Substance Abuse and Mental Health Services Administration
(SAMHSA)33
SAMHSA is the federal agency primarily responsible for supporting community-based mental
health and substance abuse treatment and prevention services. The SAMHSA mission is focused
on reducing the impacts of substance abuse and mental illness.34 SAMHSA supports activities
that include education and training, prevention programs, early intervention activities, treatment
services, and technical assistance.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $10.863 billion
• Outlays: $11.729 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 12), https://www.samhsa.gov/
sites/default/files/samhsa-fy-2024-cj.pdf
• BIB chapter (p. 53), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=59
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.”35 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.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $0.403 billion
• Outlays: $0.402 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 14), https://www.ahrq.gov/
sites/default/files/wysiwyg/cpi/about/mission/budget/2024/fy2024-cj.pdf
33 In some places, the FY2024 HHS BIB refers to SAMHSA as the “Substance use And Mental Health Services
Administration,” while in others the BIB uses the statutory name, “Substance Abuse and Mental Health Services
Administration.”
34 SAMHSA, About Us, https://www.samhsa.gov/about-us.
35 AHRQ, About AHRQ, https://www.ahrq.gov/cpi/about/index.html.
Congressional Research Service
14
Department of Health and Human Services: FY2024 Budget Request
• BIB chapter (p. 59), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=65
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.”36 CMS administers the Medicare program, work[s] in partnership with
state governments to administer Medicaid and CHIP, and manage[s] health insurance standards.37
The President’s budget estimates that in FY2024, “over 160 million Americans will rely on the
programs CMS administers or oversees including Medicare, Medicaid, the Children’s Health
Insurance Program (CHIP), and the [Health Insurance] Marketplaces.”38
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $1,487.835 billion
• Outlays: $1,448.709 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 7), https://www.cms.gov/
files/document/cms-fy-2024-congressional-justification-estimates-
appropriations-committees.pdf
• BIB chapter (p. 64), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=70
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.”39 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.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $94.474 billion
• Outlays: $102.436 billion
36 CMS, Fiscal Year 2024 Justification of Estimates for Appropriations Committees, March 2024,
https://www.cms.gov/files/document/cms-fy-2024-congressional-justification-estimates-appropriations-
committees.pdf.
37 CMS, Press Kit, https://www.cms.gov/newsroom/press-kit.
38 CMS, Fiscal Year 2024 Justification of Estimates for Appropriations Committees, March 2024,
https://www.cms.gov/files/document/cms-fy-2024-congressional-justification-estimates-appropriations-
committees.pdf.
39 ACF, What We Do, https://www.acf.hhs.gov/about/what-we-do.
Congressional Research Service
15
Department of Health and Human Services: FY2024 Budget Request
Additional Resources:
• Congressional Justification (all-purpose table on p. 6), https://www.acf.hhs.gov/
sites/default/files/documents/olab/fy-2024-congressional-justification.pdf
• BIB chapter (p. 118), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=124
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.”40 ACL
administers a number of programs targeted at older Americans and people with disabilities,
including Home and Community-Based Supportive Services and State Councils on
Developmental Disabilities.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $3.035 billion
• Outlays: $3.429 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 25), https://acl.gov/sites/
default/files/2023-03/FY2024ACL-CJ-508.docx
• BIB chapter (p. 141), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=141
Administration for Strategic Preparedness and Response (ASPR)41
The ASPR mission is to lead “the nation’s medical and public health preparedness for, response
to, and recovery from disasters and other public health emergencies.”42 ASPR “serves as the
principal advisor to the HHS Secretary on issues related to public health and medical emergency
preparedness and response. ASPR has operational responsibilities for the advanced research,
development and stockpiling of medical countermeasures as well as the coordination of the
federal public health and medical response to emergencies and disasters.”43
Appropriations Bill:
• LHHS
40 ACL, About ACL, https://acl.gov/about-acl.
41 The Administration for Strategic Preparedness and Response (ASPR) was established as an HHS operating division,
effective February 11, 2023. It was formerly the “Office of the Assistant Secretary for Preparedness and Response,”
within the HHS Office of the Secretary. For more information on this reorganization, see HHS, ASPR, “Statement of
Organization, Functions, and Delegations of Authority,” 88 Federal Register 10125-10127, February 16, 2023,
https://www.govinfo.gov/content/pkg/FR-2023-02-16/pdf/2023-03277.pdf.
42 ASPR, ASPR Organization, https://aspr.hhs.gov/AboutASPR/ProgramOffices/Pages/ProgramOffice.aspx.
43 ASPR, ASPR Budget and Funding, https://aspr.hhs.gov/AboutASPR/BudgetandFunding/Pages/default.aspx.
Congressional Research Service
16
Department of Health and Human Services: FY2024 Budget Request
FY2024 Request:
• BA: $4.272 billion
• Outlays: $1.063 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 16), https://aspr.hhs.gov/
AboutASPR/BudgetandFunding/Documents/FY2024/ASPR-cj.pdf
• BIB chapter (p. 142), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=148
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
R47616 · VERSION 1 · NEW
17
June 29, 2023
FY2024 Budget Request
Jessica Tollestrup
This report provides information about the FY2024 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 about 26% of all federal outlays in FY2022.
(FY2022 funding levels are generally considered final, whereas some FY2023 funding levels
remain estimates.)
Ada S. Cornell
Senior Research Librarian
The FY2024 President’s budget request was submitted to Congress on March 9, 2023. Under this
request, HHS would spend an estimated $1.691 trillion in outlays in FY2024. This would be $10
billion (-1%) less than estimated HHS outlays in FY2023 and $48 billion (+3%) more than actual
HHS outlays in FY2022.
Mandatory spending typically comprises the majority of the HHS budget. Two mandatory spending programs—Medicare
and Medicaid—are expected to account for 83% of all estimated HHS outlays in FY2024, 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 FY2024 HHS Outlays by Major Program or Spending Category
Source: Prepared by the Congressional Research Service (CRS) using data on page 15 of the FY2024 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.
The amount of mandatory spending is controlled (but not always provided) by authorizing laws. By contrast, for all
discretionary spending the amount is controlled and provided through the annual appropriations process. Discretionary
spending accounts for about 9% of HHS FY2024 outlays in the 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 about 7% of all discretionary budget authority across
the government in FY2022. The Department of Defense was the only federal agency to account for a larger share of all
discretionary budget authority in that year (43%).
Congressional Research Service
link to page 4 link to page 5 link to page 6 link to page 7 link to page 7 link to page 8 link to page 8 link to page 9 link to page 9 link to page 9 link to page 10 link to page 7 link to page 11 link to page 6 link to page 8 link to page 12 link to page 14 link to page 20 Department of Health and Human Services: FY2024 Budget Request
Contents
About the U.S. Department of Health and Human Services (HHS) ................................................ 1
Context for the FY2024 President’s Budget Request ...................................................................... 2
Overview of the FY2024 HHS Budget Request ....................................................................... 3
Budgetary Resources Versus Appropriations ............................................................................ 4
Mandatory and Discretionary Spending ............................................................................. 4
HHS in the Appropriations Process .................................................................................... 5
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 FY2024 HHS Outlays by Major Program or Spending Category .................... 4
Figure 2. FY2024 President’s Request for HHS by Operating Division ......................................... 8
Tables
Table 1. FY2024 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 FY2024 Budget Resources .......................... 11
Contacts
Author Information ........................................................................................................................ 17
Congressional Research Service
Department of Health and Human Services: FY2024 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 12 main agencies, called operating divisions (listed below). HHS
operating divisions are responsible for administering a wide variety of health and human services
programs, and conducting related research.2 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, and oversight functions in support of the entire department.
Acronym
HHS Operating Division
ACF
Administration for Children and Families
ACL
Administration for Community Living
AHRQ
Agency for Healthcare Research and Quality
ASPR
Administration for Strategic Preparedness and Response
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 Administration3
Nine 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); the preparation for and response to disasters
and public health emergencies (e.g., ASPR); and the regulation of food and drugs (e.g., FDA).
1 Introduction to the HHS Strategic Plan FY2022-FY2026, https://www.hhs.gov/about/strategic-plan/2022-2026/
introduction/index.html.
2 On July 22, 2022, HHS announced that the Office of the Assistant Secretary for Preparedness and Response would be
renamed the Administration for Strategic Preparedness and Response (retaining the ASPR acronym) and be established
as an operating division. This reorganization was approved by the HHS Secretary on January 27, 2023, and became
effective on February 11, 2023 (Statement of Organization, Functions and Delegations of Authority in Federal Record
vol. 88, no. 32, pp. 10125-10127, February 16, 2023).
3 In some places, FY2024 HHS budget materials refer to SAMHSA as the “Substance use And Mental Health Services
Administration,” while in others those materials use the statutory name, “Substance Abuse and Mental Health Services
Administration.”
Congressional Research Service
1
link to page 14 link to page 8 Department of Health and Human Services: FY2024 Budget Request
ASPR is the newest operating division at HHS, established effective February 2023.4 Before this
transition, ASPR was a staff division within the HHS Office of the Secretary.
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.
(For a summary of each operating division’s mission and links to agency resources related to the
FY2024 budget request, see the Appendix.)
Context for the FY2024 President’s Budget Request
The overview chapter (“Building a Healthy America”) of the HHS Budget in Brief (BIB) is the
main source used for the budget numbers in this report.5 Because FY2023 has not yet concluded,
this report generally refers to FY2023 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.6
The President’s budget request for FY2024 was submitted on March 9, 2023, about five weeks
after it was due. It was preceded by the enactment of FY2023 full-year annual appropriations
(P.L. 117-328) on December 29, 2022, almost three months into the fiscal year. The delay of the
budget submission allowed the FY2023 funding amounts in the BIB and the HHS congressional
justifications generally to reflect the annual appropriations that were enacted in December.
4 For more information on this reorganization, see HHS, ASPR, “Statement of Organization, Functions, and
Delegations of Authority,” 88 Federal Register 10125-10127, February 16, 2023, https://www.govinfo.gov/content/
pkg/FR-2023-02-16/pdf/2023-03277.pdf.
5 Other sources were consulted, including other chapters of the FY2024 HHS Budget in Brief (BIB), various volumes
of the FY2024 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 “Building a Healthy America” chapter of the FY2024 HHS BIB, available at https://www.hhs.gov/
sites/default/files/fy-2024-budget-in-brief.pdf.
6 For more information, see CRS Report R47019, The Executive Budget Process: An Overview.
Congressional Research Service
2
link to page 6 link to page 7 link to page 10 link to page 10 link to page 7 link to page 7 Department of Health and Human Services: FY2024 Budget Request
Overview of the FY2024 HHS Budget Request
Under the President’s budget request, HHS would spend an estimated $1.691 trillion in outlays7
in FY2024 (see Table 1).8 This is $10 billion (-1%) less than estimated HHS outlays in FY2023
and about $48 billion (+3%) more than actual HHS outlays in FY2022.
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 FY1995.9 Most recently, OMB
estimated that HHS accounted for about 26% of all federal outlays in FY2022, and projects that it
would account for nearly 25% of outlays if all proposals in the President’s FY2024 budget
request were enacted.10
Table 1. FY2024 President’s Budget Request for HHS
(dollars in billions)
FY2020
FY2021
FY2022
FY2023
FY2024
Actual
Actual
Actual
Estimate
Request
Budget Authority
1,721,681
1,676,029
1,635,534
1,772,315
1,737,965
Outlays
1,504,270
1,466,894
1,643,127
1,701,433
1,691,374
Sources: 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, see FY2023 HHS BIB, pp. 13-14, https://www.hhs.gov/sites/default/files/fy-
2023-budget-in-brief.pdf. For FY2022 actual, FY2023 estimate, and FY2024 request, see FY2024 HHS BIB, pp. 11-
12, https://www.hhs.gov/sites/default/files/fy-2024-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 FY2024 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 FY2020-FY2023, but do not reflect estimated
effects of sequestration for FY2024.
Figure 1 displays proposed FY2024 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.11 Two mandatory spending programs—Medicare and Medicaid—are
expected to account for 83% of all estimated HHS spending in FY2024. 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.12
This figure also shows that discretionary spending accounts for about 9% of estimated FY2024
HHS outlays in the President’s request. Although discretionary spending represents a relatively
7 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.
8 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 2024, March
13, 2023, https://www.whitehouse.gov/wp-content/uploads/2023/03/BBEDCA_Sequestration_Report_and_Letter_3-
13-2024.pdf.
9 OMB Historical Tables of the FY2024 President’s Budget, Table 4.2, “Percentage Distribution of Outlays by Agency:
1962–2028,” https://www.whitehouse.gov/omb/historical-tables/.
10 Ibid.
11 The terms mandatory spending and discretionary spending are discussed in the “Budgetary Resources Versus
Appropriations” section of this report.
12 For more information on how these entitlement programs are financed, see CRS Report R40425, Medicare Primer;
and CRS Report R42640, Medicaid Financing and Expenditures.
Congressional Research Service
3
Department of Health and Human Services: FY2024 Budget Request
small share of total HHS spending, the department nevertheless receives more discretionary
funding than most federal departments. According to OMB data, HHS accounted for 7% of all
discretionary budget authority across the government in FY2022.13 The Department of Defense
was the only federal agency to account for a larger share of all discretionary budget authority in
that year (43%).
Figure 1. Proposed FY2024 HHS Outlays by Major Program or Spending Category
Source: Prepared by the Congressional Research Service (CRS) based on data presented on page 15 of the
FY2024 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2024-budget-in-brief.pdf.
Notes: Percentages may not sum to 100 due to rounding. For mandatory spending, outlays reflect proposed law
spending levels, not the current services baseline.
Budgetary Resources Versus Appropriations
The HHS budget reflects funding from a broad set of budgetary resources. These include, but are
not limited to, amounts provided to HHS through the annual appropriations process. In some
cases, amounts shown in FY2024 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
Certain budget documents may show only discretionary spending, while others may also show
some or all types of mandatory 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
13 OMB Historical Tables of the FY2024 President’s Budget, Table 5.5, “Percentage Distribution of Discretionary
Budget Authority by Agency: 1976–2028,” https://www.whitehouse.gov/omb/historical-tables/.
Congressional Research Service
4
link to page 8 link to page 8 link to page 8 Department of Health and Human Services: FY2024 Budget Request
be provided through the annual appropriations process; such programs are commonly referred to
as appropriated entitlements or appropriated mandatories.
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 Department of the
Interior, Environment, and Related Agencies Appropriations Act (INT) and the Agriculture, Rural
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)
Department 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
•
Administration for Strategic Preparedness and
Response
•
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 FY2024 HHS budget request. Such proposals
would generally need to be enacted into law to affect the budgetary resources ultimately available
Congressional Research Service
5
Department of Health and Human Services: FY2024 Budget Request
to the mandatory spending program.14 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.
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).15 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).16
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
The Balanced Budget and Emergency Deficit Control Act of 1985 (BBEDCA) provides a
mechanism (sequestration) to reduce mandatory spending in each fiscal year beginning with
FY2013 and continuing through FY2031 (or for Medicare only, through the first six months of
FY2032).17 On March 13, 2023, concurrent with the release of the President’s budget submission,
President Biden issued the required FY2024 sequestration order, calling for nonexempt
mandatory spending to be reduced on October 1, 2023.18 Using its current law baseline, OMB
14 For a list of some HHS legislative proposals for mandatory spending programs in the FY2024 President’s budget, see
Summary Table S–6 in OMB, Budget of the United States Government, Fiscal Year 2024,
https://www.whitehouse.gov/wp-content/uploads/2023/03/budget_fy2024.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.
15 For further information, see CRS Report R47345, Labor, Health and Human Services, and Education: FY2023
Appropriations.
16 The program level for each agency is listed in the table entitled “Composition of the HHS Budget Discretionary
Programs” in the FY2022 HHS BIB.
17 As originally enacted, mandatory sequestration was scheduled to run through FY2021, but this period has
subsequently been incrementally extended. For further information about these extensions, see the Appendix of CRS
Report R47345, Labor, Health and Human Services, and Education: FY2023 Appropriations. For further information
about sequestration, see CRS Report R42972, Sequestration as a Budget Enforcement Process: Frequently Asked
Questions.
18 Sequestration Order for Fiscal Year 2024 Pursuant to Section 251A of the Balanced Budget and Emergency Deficit
(continued...)
Congressional Research Service
6
link to page 11 Department of Health and Human Services: FY2024 Budget Request
estimated that the FY2024 sequestration percentages would equal 2% of nonexempt spending
from Medicare and certain other health programs and 5.7% of other nonexempt nondefense
mandatory spending, for a total government-wide reduction in this category of spending of $26
billion in budget authority in FY2024.19 OMB attributed the majority of this amount, roughly $20
billion, to HHS (mostly for reductions to Medicare). (OMB also estimated an 8.3% reduction,
totaling $1 billion, in nonexempt defense mandatory spending, which does not affect HHS funds.)
By convention, HHS budget materials for FY2024 generally reflect sequestration for mandatory
spending programs in prior years (FY2022-FY2023), but do not reflect estimated effects of
mandatory sequestration for the budget year (FY2024). The numbers in this report reflect this
convention.
HHS Budget by Operating Division
Figure 2 provides a breakdown of the FY2024 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.
Under the President’s budget, spending on Medicare is expected to increase relative to FY2023
levels in terms of current law estimates, but would slightly decrease under proposed law
estimates. Spending on Medicaid is estimated to decrease relative to FY2023 based on both
current law and proposed law estimates. However, when looking exclusively at discretionary
budget authority, funding for CMS is comparatively smaller, accounting for $4.6 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 $92.9 billion in combined public health funding for FDA, HRSA, IHS, CDC, ATSDR,
NIH, SAMHSA, AHRQ, and ASPR. NIH would receive the largest amount of discretionary
budget authority of any single HHS operating division: $46.4 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.20
ACF would receive the second-largest discretionary funding level among the HHS operating
divisions: $39.4 billion. The majority of the discretionary ACF request (about 57%) would go to
early childhood care and education programs, such as Head Start and the Child Care and
Development Block Grant.21
Control Act, as Amended, Federal Register, Vol. 88, No. 51, March 16, 2023, p. 16171, https://www.govinfo.gov/
content/pkg/FR-2023-03-16/pdf/2023-05511.pdf.
19 OMB, OMB Report to the Congress on the BBEDCA 251A Sequestration for Fiscal Year 2024, March 13, 2023,
https://www.whitehouse.gov/wp-content/uploads/2023/03/BBEDCA_Sequestration_Report_and_Letter_3-13-
2024.pdf. See the report’s appendix for an itemized list of budget accounts that include mandatory spending subject to
sequestration in FY2024, 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.
20 FY2024 HHS BIB, p. 47.
21 Calculated by CRS based on data presented on pages 119-120 of the FY2024 HHS BIB.
Congressional Research Service
7
link to page 12 link to page 12
Department of Health and Human Services: FY2024 Budget Request
Figure 2. FY2024 President’s Request for HHS by Operating Division
Source: Prepared by the Congressional Research Service (CRS) based on data presented on pages 11-14 of the
FY2024 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2024-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 of this report. 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 cancel ations of budget
authority. 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 FY2024 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 (FY2020-FY2023). 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,
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 $16.2 billion in FY2024 BA for HRSA, but
an estimated $17.2 billion in FY2024 HRSA outlays, reflecting the expected expenditure of funds
Congressional Research Service
8
link to page 13 link to page 13 link to page 13 Department of Health and Human Services: FY2024 Budget Request
previously provided to the agency in addition to some funds that are expected to be newly enacted
in FY2024.
Amounts shown for the OS were calculated using funding levels in HHS BIBs for several staff
divisions, accounts, and activities under the OS.22 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, Mental Health Transformation
Fund, National Hepatitis C Elimination Program, and Antimicrobial Subscriptions.
Table 3. HHS Budget by Operating and Staff Division
(mandatory and discretionary spending combined, dollars in millions)
FY2020
FY2021
FY2022
FY2023
FY2024
Operating Division
Actual
Actual
Actual
Estimatea
Request
FDA
Budget Authority (BA)
3,365
3,765
4,379
3,644
4,015
Outlays
2,963
3,303
4,588
5,037
3,876
HRSA
BA
14,399
21,733
13,566
14,705
16,183
Outlays
12,113
14,232
16,128
17,051
17,196
IHS
BA
7,393
13,794
7,442
7,994
10,355
Outlays
6,184
9,866
6,507
7,369
10,487
CDC (incl. ATSDR)b
BA
15,855
28,511
9,156
10,979
13,158
Outlays
8,721
11,269
16,526
13,247
13,446
NIH
BA
44,590
42,186
45,415
48,952
49,630
Outlays
36,387
38,868
40,623
44,759
46,281
SAMHSA
BA
6,174
13,674
6,724
7,567
10,863
Outlays
5,206
5,910
7,384
8,334
11,729
AHRQ
BA
338
337
350
374
403
Outlays
333
329
339
304
402
CMSc
BA
1,328,620
1,296,727
1,471,167
1,593,907
1,487,835
Outlays
1,258,071
1,240,623
1,370,675
1,475,653
1,448,709
22 These include Departmental Management, 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.
Congressional Research Service
9
link to page 13 link to page 13 link to page 13 Department of Health and Human Services: FY2024 Budget Request
FY2020
FY2021
FY2022
FY2023
FY2024
Operating Division
Actual
Actual
Actual
Estimatea
Request
ACF
BA
67,349
122,521
73,556
78,977
94,474
Outlays
60,819
70,079
85,702
92,397
102,436
ACL
BA
3,403
4,221
2,293
2,526
3,035
Outlays
2,418
2,662
2,720
4,110
3,429
ASPRd
BA
4,272
Outlays
1,063
Office of the Secretarye
BA
230,195
128,560
1,486
2,690
43,742
Outlays
111,055
69,753
91,935
33,172
32,320
Total, HHS
BA
1,721,681
1,676,029
1,635,534
1,772,315
1,737,965
Outlays
1,504,270
1,466,894
1,643,127
1,701,433
1,691,374
Sources: 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, see FY2023 HHS BIB, pp. 13-14, https://www.hhs.gov/sites/default/files/fy-
2023-budget-in-brief.pdf. For FY2022 actual, FY2023 estimate, and FY2024 request, see FY2024 HHS BIB, pp. 11-12,
https://www.hhs.gov/sites/default/files/fy-2024-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 FY2020-FY2023, but do not reflect estimated effects of mandatory sequestration for
FY2024.
a. FY2023 funding levels in the FY2024 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. On February 11, 2023, HHS established ASPR as an operating division named the Administration for
Strategic Preparedness and Response. Funding for the prior entity within the HHS Office of the Secretary,
the Office of the Assistant Secretary for Preparedness and Response, is included in the Office of the
Secretary funding listed in this table for FY2020-FY2023.
e. 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,
Mental Health Transformation Fund, National Hepatitis C Elimination Program, and Antimicrobial
Subscriptions.
Congressional Research Service
10
Department of Health and Human Services: FY2024 Budget Request
Appendix. HHS Operating Divisions: Missions and
FY2024 Budget Resources
This appendix provides for each operating division a brief summary of its mission,23 the
applicable appropriations bill, the FY2024 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 and labeling 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 tobacco products.24
Appropriations Bill:
• Agriculture, Rural Development, Food and Drug Administration, and Related
Agencies (AG)
FY2024 Request:
• BA: $4.015 billion
• Outlays: $3.876 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 15), https://www.fda.gov/
media/166182/download
• BIB chapter (p. 22), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=22
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.”25 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.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $16.183 billion
23 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.
24 FDA, What Does FDA Do, https://www.fda.gov/about-fda/fda-basics/what-does-fda-do.
25 HRSA, About HRSA, https://www.hrsa.gov/about/index.html.
Congressional Research Service
11
Department of Health and Human Services: FY2024 Budget Request
• Outlays: $17.196 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 20), https://www.hrsa.gov/
sites/default/files/hrsa/about/budget/budget-justification-fy2024.pdf
• BIB chapter (p. 24), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=30
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.”26 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.27
Appropriations Bill:
• Department of the Interior, Environment, and Related Agencies (INT)
FY2024 Request:
• BA: $10.355 billion
• Outlays: $10.487 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 10), https://www.ihs.gov/
sites/budgetformulation/themes/responsive2017/display_objects/documents/
FY2024-IHS-CJ32223.pdf
• BIB chapter (p. 32), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=38
Centers for Disease Control and Prevention (CDC) and Agency for
Toxic Substances and Disease Registry (ATSDR)
The CDC mission is focused on “developing and applying disease prevention and control,
environmental health, and health promotion and health education activities designed to improve
the health of the people of the United States.”28 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 FY2024 HHS BIB, ATSDR’s budget
request is included in the CDC totals shown in this report. ATSDR’s work is focused on
26 IHS, Agency Overview, https://www.ihs.gov/aboutihs/overview/.
27 IHS, About IHS, https://www.ihs.gov/aboutihs/
28 CDC, Official Mission/Function Statement, updated 2/10/2023, https://www.cdc.gov/about/pdf/organization/iod-
mission-statement.pdf.
Congressional Research Service
12
Department of Health and Human Services: FY2024 Budget Request
preventing or mitigating adverse effects resulting from exposure to hazardous substances in the
environment.29
Appropriations Bills:
• LHHS (CDC)
• INT (ATSDR)
FY2024 Request (CDC and ATSDR combined):
• BA: $13.158 billion
• Outlays: $13.446 billion
Additional Resources:
• CDC Congressional Justification (all-purpose table on p. 35),
https://www.cdc.gov/budget/documents/fy2024/FY-2024-CDC-congressional-
justification.pdf
• ATSDR Congressional Justification, https://www.cdc.gov/budget/documents/
fy2024/FY-2024-ATSDR-congressional-justification.pdf
• BIB chapter (p. 39), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=45
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.”30 NIH is organized into 27
research institutes and centers, headed by the NIH Director.31 In addition, FY2022 appropriations
called for HHS to establish a new entity: the Advanced Research Projects Agency for Health
(ARPA-H). HHS subsequently placed this entity within NIH.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $49.630 billion
• Outlays: $ 46.281 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 33),
https://officeofbudget.od.nih.gov/pdfs/FY24/br/
Overview%20of%20FY%202024%20Presidents%20Budget.pdf32
29 ASTDR, Official Mission/Function Statement, updated 1/10/2023, https://www.cdc.gov/about/pdf/organization/
atsdr-mission-statement.pdf.
30 NIH, Mission and Goals, https://www.nih.gov/about-nih/what-we-do/mission-goals.
31 NIH, Organization, https://www.nih.gov/about-nih/who-we-are/organization.
32 NIH’s individual institutes/centers also submit justifications, available at https://officeofbudget.od.nih.gov/
insti_center_subs.html.
Congressional Research Service
13
Department of Health and Human Services: FY2024 Budget Request
• BIB chapter (p. 46), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=52
Substance Abuse and Mental Health Services Administration
(SAMHSA)33
SAMHSA is the federal agency primarily responsible for supporting community-based mental
health and substance abuse treatment and prevention services. The SAMHSA mission is focused
on reducing the impacts of substance abuse and mental illness.34 SAMHSA supports activities
that include education and training, prevention programs, early intervention activities, treatment
services, and technical assistance.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $10.863 billion
• Outlays: $11.729 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 12), https://www.samhsa.gov/
sites/default/files/samhsa-fy-2024-cj.pdf
• BIB chapter (p. 53), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=59
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.”35 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.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $0.403 billion
• Outlays: $0.402 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 14), https://www.ahrq.gov/
sites/default/files/wysiwyg/cpi/about/mission/budget/2024/fy2024-cj.pdf
33 In some places, the FY2024 HHS BIB refers to SAMHSA as the “Substance use And Mental Health Services
Administration,” while in others the BIB uses the statutory name, “Substance Abuse and Mental Health Services
Administration.”
34 SAMHSA, About Us, https://www.samhsa.gov/about-us.
35 AHRQ, About AHRQ, https://www.ahrq.gov/cpi/about/index.html.
Congressional Research Service
14
Department of Health and Human Services: FY2024 Budget Request
• BIB chapter (p. 59), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=65
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.”36 CMS administers the Medicare program, work[s] in partnership with
state governments to administer Medicaid and CHIP, and manage[s] health insurance standards.37
The President’s budget estimates that in FY2024, “over 160 million Americans will rely on the
programs CMS administers or oversees including Medicare, Medicaid, the Children’s Health
Insurance Program (CHIP), and the [Health Insurance] Marketplaces.”38
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $1,487.835 billion
• Outlays: $1,448.709 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 7), https://www.cms.gov/
files/document/cms-fy-2024-congressional-justification-estimates-
appropriations-committees.pdf
• BIB chapter (p. 64), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=70
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.”39 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.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $94.474 billion
• Outlays: $102.436 billion
36 CMS, Fiscal Year 2024 Justification of Estimates for Appropriations Committees, March 2024,
https://www.cms.gov/files/document/cms-fy-2024-congressional-justification-estimates-appropriations-
committees.pdf.
37 CMS, Press Kit, https://www.cms.gov/newsroom/press-kit.
38 CMS, Fiscal Year 2024 Justification of Estimates for Appropriations Committees, March 2024,
https://www.cms.gov/files/document/cms-fy-2024-congressional-justification-estimates-appropriations-
committees.pdf.
39 ACF, What We Do, https://www.acf.hhs.gov/about/what-we-do.
Congressional Research Service
15
Department of Health and Human Services: FY2024 Budget Request
Additional Resources:
• Congressional Justification (all-purpose table on p. 6), https://www.acf.hhs.gov/
sites/default/files/documents/olab/fy-2024-congressional-justification.pdf
• BIB chapter (p. 118), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=124
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.”40 ACL
administers a number of programs targeted at older Americans and people with disabilities,
including Home and Community-Based Supportive Services and State Councils on
Developmental Disabilities.
Appropriations Bill:
• LHHS
FY2024 Request:
• BA: $3.035 billion
• Outlays: $3.429 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 25), https://acl.gov/sites/
default/files/2023-03/FY2024ACL-CJ-508.docx
• BIB chapter (p. 141), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=141
Administration for Strategic Preparedness and Response (ASPR)41
The ASPR mission is to lead “the nation’s medical and public health preparedness for, response
to, and recovery from disasters and other public health emergencies.”42 ASPR “serves as the
principal advisor to the HHS Secretary on issues related to public health and medical emergency
preparedness and response. ASPR has operational responsibilities for the advanced research,
development and stockpiling of medical countermeasures as well as the coordination of the
federal public health and medical response to emergencies and disasters.”43
Appropriations Bill:
• LHHS
40 ACL, About ACL, https://acl.gov/about-acl.
41 The Administration for Strategic Preparedness and Response (ASPR) was established as an HHS operating division,
effective February 11, 2023. It was formerly the “Office of the Assistant Secretary for Preparedness and Response,”
within the HHS Office of the Secretary. For more information on this reorganization, see HHS, ASPR, “Statement of
Organization, Functions, and Delegations of Authority,” 88 Federal Register 10125-10127, February 16, 2023,
https://www.govinfo.gov/content/pkg/FR-2023-02-16/pdf/2023-03277.pdf.
42 ASPR, ASPR Organization, https://aspr.hhs.gov/AboutASPR/ProgramOffices/Pages/ProgramOffice.aspx.
43 ASPR, ASPR Budget and Funding, https://aspr.hhs.gov/AboutASPR/BudgetandFunding/Pages/default.aspx.
Congressional Research Service
16
Department of Health and Human Services: FY2024 Budget Request
FY2024 Request:
• BA: $4.272 billion
• Outlays: $1.063 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 16), https://aspr.hhs.gov/
AboutASPR/BudgetandFunding/Documents/FY2024/ASPR-cj.pdf
• BIB chapter (p. 142), https://www.hhs.gov/sites/default/files/fy-2024-budget-in-
brief.pdf#page=148
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
R47616 · VERSION 1 · NEW
17