Department of Health and Human Services: FY2025 Budget Request
Department of Health and Human Services:
May 23, 2024
FY2025 Budget Request
Jessica Tollestrup
This report provides information about the FY2025 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 28% of all federal outlays in FY2023. (FY2023
funding levels are generally considered final, whereas FY2024 funding levels in this report are
estimates.)
Ada S. Cornell
Senior Research Librarian
The FY2025 President’s budget request was submitted to Congress on March 11, 2024. Under
this request, HHS would spend an estimated $1.802 trillion in outlays in FY2025. This would be
$132 billion (+8%) more than estimated HHS outlays in FY2024 and $92 billion (+5%) more
than actual HHS outlays in FY2023.
Mandatory spending typically comprises the majority of the HHS budget. Two mandatory spending programs—Medicare
and Medicaid—are expected to account for 85% of all estimated HHS outlays in FY2025, 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 FY2025 HHS Outlays by Major Program or Spending Category
Source: Prepared by the Congressional Research Service (CRS) using data on page 17 of the FY2025 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 FY2025 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 7% of all discretionary budget authority across the
government in FY2023. The Department of Defense was the only federal agency to account for a larger share of all
discretionary budget authority in that year (46%).
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Contents
About the U.S. Department of Health and Human Services (HHS) ................................................ 1
Context for the FY2025 President’s Budget Request ...................................................................... 2
Overview of the FY2025 HHS Budget Request .............................................................................. 3
Budgetary Resources Versus Appropriations ............................................................................ 5
Mandatory and Discretionary Spending ............................................................................. 5
HHS in the Appropriations Process .................................................................................... 5
Proposed Law and Current Law Estimates for Mandatory Programs ................................. 6
User Fees and Other Types of Collections .......................................................................... 7
Scorekeeping and Display Conventions ............................................................................. 7
Sequestration ....................................................................................................................... 7
HHS Budget by Operating Division ................................................................................................ 8
Figures
Figure 1. Proposed FY2025 HHS Outlays by Major Program or Spending Category .................... 5
Figure 2. FY2025 President’s Request for HHS by Operating Division ......................................... 9
Tables
Table 1. FY2025 President’s Budget Request for HHS ................................................................... 3
Table 2. HHS Agencies by Appropriations Bill ............................................................................... 6
Table 3. HHS Budget by Operating and Staff Division ................................................................. 10
Appendixes
Appendix. HHS Operating Divisions: Missions and FY2025 Budget Resources ......................... 13
Contacts
Author Information ........................................................................................................................ 19
Congressional Research Service
Department of Health and Human Services: FY2025 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).2
HHS operating divisions are responsible for administering a wide variety of health and human
services programs, and conducting related research. In addition, HHS has a number of staff
divisions within the Office of the Secretary (OS). These staff divisions fulfill a broad array of
management, research, 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).
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.
1 Introduction to the HHS Strategic Plan FY2022-FY2026, https://www.hhs.gov/about/strategic-plan/2022-2026/
introduction/index.html.
2 See “HHS Organizational Charts Office of Secretary and Divisions,” last reviewed March 11, 2024,
https://www.hhs.gov/about/agencies/orgchart/index.html.
3 The FY2025 HHS budget materials include a legislative proposal to rename the Substance Abuse and Mental Health
Services Administration (SAMHSA) as the Substance use And Mental Health Services Administration. Throughout
those budget materials, SAMHSA is generally referred to using its proposed name. This report continues to use its
statutory name.
4 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
(continued...)
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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
FY2025 budget request, see the Appendix.)
Context for the FY2025 President’s Budget Request
The Budget and Accounting Act of 1921 (P.L. 67-13), as amended and later codified at 31 U.S.C.
§1105, 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 requested
funding, 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.5
The President’s budget request for FY2025 was submitted on March 11, 2024, about five weeks
after it was due.6 At the time the FY2025 budget request was being developed, discretionary
funding for FY2024 was being provided by a series of temporary continuing resolutions (CRs),
instead of full-year appropriations acts. Consequently, both the OMB and HHS budget materials
use estimates for FY2024 that are derived from two sources:
• For discretionary spending programs, the materials display annualized estimates
of funding provided under FY2024 CRs (P.L. 118-15, P.L. 118-22, P.L. 118-35,
P.L. 118-40). With limited exceptions, these CRs included a formulaic extension
of FY2023 funding levels for discretionary HHS programs and activities.
• For mandatory spending programs, the materials generally display estimates of
the amounts expected to be needed for FY2024 based on criteria outlined in
authorizing law. (For a related discussion, see the “Budgetary Resources versus
Appropriations” section.)
While the estimates of annualized spending under FY2024 CRs may have informed the
development of the FY2025 budget request, these estimates should not be treated as FY2024 final
or enacted levels. For this reason, many prior-year comparisons in this report use FY2023 final
levels rather than FY2024 estimates.
as an operating division. This reorganization was approved by the HHS Secretary on January 27, 2023, and became
effective on February 11, 2023. 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 For more information, see CRS Report R47019, The Executive Budget Process: An Overview.
6 On May 22, 2024, a package of amendments to the FY2025 budget request was submitted by the President to
Congress (available at https://www.whitehouse.gov/wp-content/uploads/2024/05/FY-2025-Budget-Amendment-
Package.pdf). One amendment made changes to the FDA Salaries and Expenses budget account, without affecting the
overall budgetary total for the FDA or HHS as a whole.
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FY2024 full-year appropriations were enacted in two omnibus appropriations acts almost six
months into the fiscal year:
• The Consolidated Appropriations Act, 2024 (P.L. 118-42) was enacted on March
9, 2024. This act provided full-year funding for several HHS entities, including
the FDA, IHS, and ATSDR.7
• The Further Consolidated Appropriations Act, 2024 (P.L. 118-47), was
subsequently enacted on March 23, 2024. This act contained full-year funding for
all remaining portions of HHS subject to the annual appropriations process.
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.8 For the reasons discussed above, this
CRS report generally refers to FY2024 funding levels as estimates. Amounts for earlier years are
called actual or final. The most recent fiscal year for which actual or final funding is available is
FY2023.
Overview of the FY2025 HHS Budget Request
Under the President’s budget request, HHS would spend an estimated $1.802 trillion in outlays9
in FY2025 (see Table 1).10 This is $132 billion (+8%) more than estimated HHS outlays in
FY2024 and $92 billion (+5%) more than actual HHS outlays in FY2023.
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 FY1995.11 Most recently, HHS
accounted for 28% of all federal outlays in FY2023, and would account for a projected 25% of
outlays if all proposals in the President’s FY2025 budget request were enacted.12
Table 1. FY2025 President’s Budget Request for HHS
(dollars in millions)
FY2024
FY2025
Estimate
Request
FY2021
FY2022
FY2023
(Annualized
Actual
Actual
Actual
CR)
Budget Authority
1,676,029
1,635,534
1,800,628
1,701,408
1,843,677
7 This bill also provided some funding for the National Institute of Environmental Health Sciences within the HHS
National Institutes of Health.
8 Other sources were consulted, including other chapters of the FY2025 HHS BIB, various volumes of the FY2025
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 FY2025 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2025-
budget-in-brief.pdf.
9 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.
10 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 2025, March
11, 2024, https://www.whitehouse.gov/wp-content/uploads/2024/03/
BBEDCA_251A_Sequestration_Report_FY2025.pdf.
11 OMB Historical Tables of the FY2025 President’s Budget, Table 4.2, “Percentage Distribution of Outlays by
Agency: 1962–2029,” https://www.whitehouse.gov/omb/historical-tables/.
12 Ibid.
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FY2024
FY2025
Estimate
Request
FY2021
FY2022
FY2023
(Annualized
Actual
Actual
Actual
CR)
Outlays
1,466,894
1,643,127
1,709,408
1,669,782
1,801,536
Sources: 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, see FY2024 HHS BIB, pp. 11-12, https://www.hhs.gov/sites/default/files/fy-
2024-budget-in-brief.pdf. For FY2023 actual, FY2024 estimate, and FY2025 request, see FY2025 HHS BIB, pp. 13-
14, https://www.hhs.gov/sites/default/files/fy-2025-budget-in-brief.pdf.
Notes: CR = continuing resolution. Budget authority is the amount of money a federal agency is legal y authorized
to commit or spend; an outlay occurs when funds are actually expended from the Treasury. Final appropriations
levels for FY2024 were unknown during the formulation of the FY2025 budget request. Accordingly, amounts
shown for FY2024 were estimated based on the annualized CR for discretionary programs and current services
baseline estimates for mandatory spending programs. Amounts for FY2025 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 FY2021-FY2024, but do not reflect estimated effects of
sequestration for FY2025.
Figure 1 displays proposed FY2025 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.13 Two mandatory spending programs—Medicare and Medicaid—are
expected to account for 85% of all estimated HHS spending in FY2025. 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.14
This figure also shows that discretionary spending accounts for about 9% of estimated FY2025
HHS outlays in the President’s request. Although discretionary spending represents a relatively
small share of total HHS spending, the department nevertheless receives more discretionary
funding than most federal departments. According to OMB data, HHS accounted for 7% of all
discretionary budget authority across the government in FY2023.15 The Department of Defense
was the only federal agency to account for a larger share of all discretionary budget authority in
that year (46%).
13 The terms mandatory spending and discretionary spending are discussed in the “Budgetary Resources Versus
Appropriations” section of this report.
14 For more information on how these entitlement programs are financed, see CRS Report R40425, Medicare Primer;
and CRS Report R42640, Medicaid Financing and Expenditures.
15 OMB Historical Tables of the FY2025 President’s Budget, Table 5.5, “Percentage Distribution of Discretionary
Budget Authority by Agency: 1976–2029,” https://www.whitehouse.gov/omb/historical-tables/.
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Figure 1. Proposed FY2025 HHS Outlays by Major Program or Spending Category
Source: Prepared by the Congressional Research Service (CRS) based on data presented on page 17 of the
FY2025 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2025-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 FY2025 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
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
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
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Development, Food and Drug Administration, and Related Agencies Appropriations Act (AG).
Table 2 lists HHS agencies by appropriations bill. Each of these three appropriations acts
provides discretionary HHS funding. In some cases, these acts also provide the necessary funding
for appropriated mandatories at HHS. However, authorizing laws provide funding for other
mandatory spending programs.
Table 2. HHS Agencies by Appropriations Bill
Appropriations Bill
HHS Agencies Funded in the Bill
Agriculture, Rural Development, Food and Drug
•
Food and Drug Administration
Administration, and Related Agencies (AG)
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: CRS. For more information, 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 FY2025 HHS budget request. Such proposals
would generally need to be enacted into law to affect the budgetary resources ultimately available
to the mandatory spending program.16 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.
16 For a list of some HHS legislative proposals for mandatory spending programs in the FY2025 President’s budget, see
Summary Table S–6 in OMB, Budget of the United States Government, Fiscal Year 2025,
https://www.whitehouse.gov/wp-content/uploads/2024/03/budget_fy2025.pdf. This table lists mandatory proposals (but
not discretionary proposals) by federal department and shows the estimated dollar change from current law levels
should the proposal be enacted. (The table does not show the actual proposed funding level.) For additional
information, see the applicable operating division chapters of the HHS Budget in Brief or congressional justifications.
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User Fees and Other Types of Collections
In some cases, agencies within HHS have the authority to expend user fees and other types of
collections that effectively supplement their appropriations. In addition, agencies may receive
transfers of budgetary resources from other sources, such as from the Public Health Service
Evaluation Set-Aside (also referred to as the PHS Tap) or one of the mandatory funds established
by the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).17 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).18
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 FY2032.19 On March 11, 2024, concurrent with the release of the
President’s budget submission, President Biden issued the required FY2025 sequestration order,
calling for nonexempt mandatory spending to be reduced on October 1, 2024.20 FY2025
sequestration will equal 2% of nonexempt spending from Medicare and certain other health
programs and 5.7% of other nonexempt nondefense mandatory spending. OMB calculated that
this will equal a total government-wide reduction in this category of spending of $29.3 billion in
budget authority in FY2025.21 OMB attributed the majority of this amount, $21.8 billion, to HHS
reductions to Medicare. (OMB also estimated a reduction of $2.1 billion (-8.3%), in nonexempt
defense mandatory spending, which does not affect HHS funds.)
17 For further information, see CRS Report R47936, Labor, Health and Human Services, and Education: FY2024
Appropriations.
18 The program level for each agency is listed in the table entitled “Composition of the HHS Budget Discretionary
Programs” in the FY2025 HHS BIB.
19 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 R47936, Labor, Health and Human Services, and Education: FY2024 Appropriations. For further information
about sequestration, see CRS Report R42972, Sequestration as a Budget Enforcement Process: Frequently Asked
Questions.
20 Sequestration Order for Fiscal Year 2025 Pursuant to Section 251A of the Balanced Budget and Emergency Deficit
Control Act, as Amended, 89 Federal Register 18531, March 14, 2024, p. 18531, https://www.govinfo.gov/content/
pkg/FR-2024-03-14/pdf/2024-05600.pdf.
21 OMB, OMB Report to the Congress on the BBEDCA 251A Sequestration for Fiscal Year 2025, March 11, 2024,
https://www.whitehouse.gov/wp-content/uploads/2024/03/BBEDCA_251A_Sequestration_Report_FY2025.pdf. See
the report’s appendix for an itemized list of budget accounts that include mandatory spending subject to sequestration
in FY2025, 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.
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By convention, HHS budget materials for FY2025 generally reflect sequestration for mandatory
spending programs in prior years (FY2023-FY2024), but do not reflect estimated effects of
mandatory sequestration for the budget year (FY2025). The numbers in this report reflect this
convention.
HHS Budget by Operating Division
Figure 2 provides a breakdown of the FY2025 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 at $1.6 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 and Medicaid is expected to increase relative to
FY2024 levels in terms of current law estimates, and to a slightly greater degree under proposed
law estimates. However, when looking exclusively at discretionary budget authority, funding for
CMS is comparatively smaller, accounting for $4.3 billion of the HHS discretionary request.
Discretionary CMS funds primarily support program operations and federal administrative
activities, though some funds also go toward efforts to reduce health care fraud and abuse.
The largest share of the HHS discretionary request would go to the PHS operating divisions:
$86.6 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.22
ACF would receive the second-largest discretionary funding level among the HHS operating
divisions: $31.4 billion. The majority of the discretionary ACF request (56%) would go to early
childhood care and education programs, such as Head Start and the Child Care and Development
Block Grant.23
22 FY2025 HHS BIB, p. 54.
23 Calculated by CRS based on data presented on pages 129-130 of the FY2025 HHS BIB.
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Figure 2. FY2025 President’s Request for HHS by Operating Division
Source: Prepared by the Congressional Research Service (CRS) based on data presented on pages 13-16 of the
FY2025 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2025-budget-in-brief.pdf. The amounts displayed as
total budget authority include mandatory and discretionary funds. The bar representing the combined mandatory
and discretionary total for CMS has been abbreviated due to space constraints. (When taking into account both
mandatory and discretionary funding, CMS receives over 17 times the funding proposed for ACF.) 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 FY2025 request for each HHS operating division and the Office of the Secretary
(OS) into context, displaying it along with estimates of funding provided over the four prior fiscal
years (FY2021-FY2024). 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
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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 $16.6 billion in FY2025 BA for HRSA, but
an estimated $18.8 billion in FY2025 HRSA outlays, reflecting the expected expenditure of funds
previously provided to the agency in addition to some funds that are expected to be newly enacted
in FY2025.
Amounts shown for the OS were calculated using funding levels in HHS BIBs for several staff
divisions, accounts, and activities under the OS.24 They also include estimates for several
mandatory spending proposals that were listed separately from the operating divisions in the front
tables of the HHS BIB, such as the Defense Production Act Medical Supplies Enhancement, PrEP
Delivery Program to End the HIV Epidemic, Mental Health Transformation Fund, Public Health
Resilience, National Hepatitis C Elimination Program, Antimicrobial Subscriptions, and
Customer Experience.
Table 3. HHS Budget by Operating and Staff Division
(mandatory and discretionary spending combined, dollars in millions)
FY2024
Estimate
FY2021
FY2022
FY2023
(Annualized
FY2025
Operating Division
Actual
Actual
Actual
CR)a
Request
FDA
Budget Authority (BA)
3,765
4,379
2,706
3,644
3,806
Outlays
3,303
4,588
2,882
4,573
3,973
HRSA
BA
21,733
13,566
14,584
16,465
16,640
Outlays
14,232
16,128
15,883
15,953
18,790
IHS
BA
13,794
7,442
7,881
13,287
8,931
Outlays
9,866
6,507
7,292
8,415
9,424
CDCb
BA
28,511
9,156
9,672
10,588
11,507
Outlays
11,269
16,526
12,278
14,697
15,658
24 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), the No Surprises Implementation Fund, and certain collections
credited to that office or the department.
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FY2024
Estimate
FY2021
FY2022
FY2023
(Annualized
FY2025
Operating Division
Actual
Actual
Actual
CR)a
Request
NIH
BA
42,186
45,415
48,927
47,669
49,790
Outlays
38,868
40,623
46,507
46,419
46,638
SAMHSA
BA
13,674
6,724
7,567
7,545
8,158
Outlays
5,910
7,384
8,261
9,235
9,813
AHRQ
BA
337
350
374
374
387
Outlays
329
339
349
381
375
CMSc
BA
1,296,727
1,471,167
1,634,038
1,518,687
1,603,501
Outlays
1,240,623
1,370,675
1,490,112
1,458,603
1,580,706
ACF
BA
122,521
73,556
78,371
71,172
91,755
Outlays
70,079
85,702
88,739
82,979
89,979
ACL
BA
4,221
2,293
2,524
2,509
2,579
Outlays
2,662
2,720
3,013
3,489
3,104
ASPRd
BA
-
-
-
-
3,768
Outlays
-
-
-
-
926
Office of the Secretarye
BA
128,560
1,486
-6,016
9,468
42,855
Outlays
69,753
91,935
34,092
25,038
22,150
Total, HHS
BA
1,676,029
1,635,534
1,800,628
1,701,408
1,843,677
Outlays
1,466,894
1,643,127
1,709,408
1,669,782
1,801,536
Sources: 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, see FY2024 HHS BIB, pp. 11-12, https://www.hhs.gov/sites/default/files/fy-
2024-budget-in-brief.pdf. For FY2023 actual, FY2024 estimate, and FY2025 request, see FY2025 HHS BIB, pp. 13-16,
https://www.hhs.gov/sites/default/files/fy-2025-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 FY2025 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 FY2021-FY2024, but do not reflect estimated effects of mandatory sequestration for
FY2025.
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a. FY2024 funding levels in the FY2025 BIB are annualized estimates of funding provided by FY2024 continuing
resolutions 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 had 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 FY2021-FY2024.
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 Defense Production Act Medical
Supplies Enhancement, PrEP Delivery Program to End the HIV Epidemic, Mental Health Transformation
Fund, National Hepatitis C Elimination Program, Antimicrobial Subscriptions, and Customer Experience.
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Department of Health and Human Services: FY2025 Budget Request
Appendix. HHS Operating Divisions: Missions and
FY2025 Budget Resources
This appendix provides for each operating division a brief summary of its mission,25 the
applicable appropriations bill, the FY2025 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.26
Appropriations Bill:
• Agriculture, Rural Development, Food and Drug Administration, and Related
Agencies (AG)
FY2025 Request:
• BA: $3.806 billion
• Outlays: $3.973 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 15), https://www.fda.gov/
media/176925/download
• BIB chapter (p. 18), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=24
Health Resources and Services Administration (HRSA)
The HRSA mission is focused on providing “equitable health care to people who are
geographically isolated and economically or medically vulnerable.”27 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
FY2025 Request:
• BA: $16.640 billion
25 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.
26 FDA, What Does FDA Do, https://www.fda.gov/about-fda/what-we-do.
27 HRSA, About HRSA, https://www.hrsa.gov/about/index.html.
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• Outlays: $18.790 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 19), https://www.hrsa.gov/
sites/default/files/hrsa/about/budget/budget-justification-fy2025.pdf
• BIB chapter (p. 25), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=31
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.”28 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.29
Appropriations Bill:
• Department of the Interior, Environment, and Related Agencies (INT)
FY2025 Request:
• BA: $8.931 billion
• Outlays: $9.424 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 11), https://www.ihs.gov/
sites/budgetformulation/themes/responsive2017/display_objects/documents/FY-
2025-IHS-CJ030824.pdf
• BIB chapter (p. 34), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=40
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.”30 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 FY2025 HHS BIB, ATSDR’s budget
request is included in the CDC totals shown in this report. ATSDR’s work is focused on
28 IHS, Agency Overview, https://www.ihs.gov/aboutihs/overview/.
29 IHS, About IHS, https://www.ihs.gov/aboutihs/.
30 CDC, Official Mission/Function Statement, updated 1/24/2023, https://www.cdc.gov/about/pdf/organization/iod-
mission-statement.pdf.
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preventing or mitigating adverse effects resulting from exposure to hazardous substances in the
environment.31
Appropriations Bills:
• LHHS (CDC)
• INT (ATSDR)
FY2025 Request (CDC and ATSDR combined):
• BA: $11.507 billion
• Outlays: $15.658 billion
Additional Resources:
• CDC Congressional Justification (all-purpose table on p. 30),
https://www.cdc.gov/budget/documents/fy2025/FY-2025-CDC-congressional-
justification.pdf
• ATSDR Congressional Justification, https://www.cdc.gov/budget/documents/
fy2025/FY-2025-ATSDR-congressional-justification.pdf
• BIB chapter (p. 44), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=50
National Institutes of Health (NIH)
The NIH mission is focused on conducting and supporting research “in the causes, diagnosis,
prevention, and cure of human diseases” and “in directing programs for the collection,
dissemination, and exchange of information in medicine and health.”32 NIH is organized into 27
research institutes and centers, headed by the NIH Director.33 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
FY2025 Request:
• BA: $49.790 billion
• Outlays: $46.638 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 39),
https://officeofbudget.od.nih.gov/pdfs/FY25/br/
Overview%20of%20FY%202025%20Presidents%20Budget.pdf34
31 ASTDR, Official Mission/Function Statement, effective 1/9/2020, https://www.cdc.gov/about/pdf/organization/atsdr-
mission-statement.pdf.
32 NIH, Mission and Goals, https://www.nih.gov/about-nih/what-we-do/mission-goals.
33 NIH, Organization, https://www.nih.gov/about-nih/who-we-are/organization.
34 NIH’s individual institutes/centers also submit justifications, available at https://officeofbudget.od.nih.gov/
insti_center_subs.html.
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• BIB chapter (p. 52), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=58
Substance Abuse and Mental Health Services Administration
(SAMHSA)35
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 use disorder and mental illness.36 SAMHSA supports
activities that include education and training, prevention programs, early intervention activities,
treatment services, and technical assistance.
Appropriations Bill:
• LHHS
FY2025 Request:
• BA: $8.158 billion
• Outlays: $9.813 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 10), https://www.samhsa.gov/
sites/default/files/samhsa-fy-2025-cj.pdf
• BIB chapter (p. 59), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=65
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.”37 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
FY2025 Request:
• BA: $0.387 billion
• Outlays: $0.375 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 15), https://www.ahrq.gov/
sites/default/files/wysiwyg/cpi/about/mission/budget/2025/fy2025-cj.pdf
35 The FY2025 HHS BIB and SAMHSA congressional justification refer to SAMHSA as the Substance use And
Mental Health Services Administration, while other sources, including the SAMHSA website and appropriations bills,
continue to use Substance Abuse and Mental Health Services Administration.
36 SAMHSA, About Us, https://www.samhsa.gov/about-us.
37 AHRQ, About AHRQ, https://www.ahrq.gov/cpi/about/index.html.
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• BIB chapter (p. 65), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=71
Centers for Medicare & Medicaid Services (CMS)
The CMS mission is focused on “advancing health equity, expanding coverage, and improving
health outcomes.”38 The President’s budget estimates that in FY2025, “over 160 million, or
roughly 1 in 2 Americans, will rely on the programs CMS administers or oversees including
Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Marketplaces.”39
Appropriations Bill:
• LHHS
FY2025 Request:
• BA: $1,603.501 billion
• Outlays: $1,580.706 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 7), https://www.cms.gov/
files/document/fy2025-cms-congressional-justification-estimates-appropriations-
committees.pdf
• BIB chapter (p. 71), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=77
Administration for Children and Families (ACF)
The ACF mission is focused on promoting the “economic and social well-being of families,
children, individuals and communities.”40 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
FY2025 Request:
• BA: $91.755 billion
• Outlays: $89.979 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 5), https://www.acf.hhs.gov/
sites/default/files/documents/olab/fy-2025-congressional-justification.pdf
• BIB chapter (p. 129), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=135
38 CMS, Fiscal Year 2025 Justification of Estimates for Appropriations Committees, March 2024,
https://www.cms.gov/files/document/fy2025-cms-congressional-justification-estimates-appropriations-committees.pdf.
39 CMS, Fiscal Year 2025 Justification of Estimates for Appropriations Committees, March 2024,
https://www.cms.gov/files/document/fy2025-cms-congressional-justification-estimates-appropriations-committees.pdf.
40 ACF, What We Do, https://www.acf.hhs.gov/about/what-we-do.
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Department of Health and Human Services: FY2025 Budget Request
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.”41 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
FY2025 Request:
• BA: $2.579 billion
• Outlays: $3.104 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 16), https://acl.gov/sites/
default/files/about-acl/2024-03/FY2025ACL-CJ-508.docx
• BIB chapter (p. 146), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=152
Administration for Strategic Preparedness and Response (ASPR)42
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.”43 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.”44
Appropriations Bill:
• LHHS
FY2025 Request:
• BA: $3.768 billion
• Outlays: $0.926 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 16), https://aspr.hhs.gov/
AboutASPR/BudgetandFunding/Documents/FY2025/ASPR-cj.pdf
41 ACL, About ACL, https://acl.gov/about-acl.
42 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.
43 ASPR, ASPR Program Offices, https://aspr.hhs.gov/AboutASPR/ProgramOffices/Pages/ProgramOffice.aspx.
44 ASPR, ASPR Budget and Funding, https://aspr.hhs.gov/AboutASPR/BudgetandFunding/Pages/default.aspx.
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• BIB chapter (p. 155), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=161
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
R48060 · VERSION 4 · UPDATED
19
May 23, 2024
FY2025 Budget Request
Jessica Tollestrup
This report provides information about the FY2025 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 28% of all federal outlays in FY2023. (FY2023
funding levels are generally considered final, whereas FY2024 funding levels in this report are
estimates.)
Ada S. Cornell
Senior Research Librarian
The FY2025 President’s budget request was submitted to Congress on March 11, 2024. Under
this request, HHS would spend an estimated $1.802 trillion in outlays in FY2025. This would be
$132 billion (+8%) more than estimated HHS outlays in FY2024 and $92 billion (+5%) more
than actual HHS outlays in FY2023.
Mandatory spending typically comprises the majority of the HHS budget. Two mandatory spending programs—Medicare
and Medicaid—are expected to account for 85% of all estimated HHS outlays in FY2025, 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 FY2025 HHS Outlays by Major Program or Spending Category
Source: Prepared by the Congressional Research Service (CRS) using data on page 17 of the FY2025 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 FY2025 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 7% of all discretionary budget authority across the
government in FY2023. The Department of Defense was the only federal agency to account for a larger share of all
discretionary budget authority in that year (46%).
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Contents
About the U.S. Department of Health and Human Services (HHS) ................................................ 1
Context for the FY2025 President’s Budget Request ...................................................................... 2
Overview of the FY2025 HHS Budget Request .............................................................................. 3
Budgetary Resources Versus Appropriations ............................................................................ 5
Mandatory and Discretionary Spending ............................................................................. 5
HHS in the Appropriations Process .................................................................................... 5
Proposed Law and Current Law Estimates for Mandatory Programs ................................. 6
User Fees and Other Types of Collections .......................................................................... 7
Scorekeeping and Display Conventions ............................................................................. 7
Sequestration ....................................................................................................................... 7
HHS Budget by Operating Division ................................................................................................ 8
Figures
Figure 1. Proposed FY2025 HHS Outlays by Major Program or Spending Category .................... 5
Figure 2. FY2025 President’s Request for HHS by Operating Division ......................................... 9
Tables
Table 1. FY2025 President’s Budget Request for HHS ................................................................... 3
Table 2. HHS Agencies by Appropriations Bill ............................................................................... 6
Table 3. HHS Budget by Operating and Staff Division ................................................................. 10
Appendixes
Appendix. HHS Operating Divisions: Missions and FY2025 Budget Resources ......................... 13
Contacts
Author Information ........................................................................................................................ 19
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Department of Health and Human Services: FY2025 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).2
HHS operating divisions are responsible for administering a wide variety of health and human
services programs, and conducting related research. In addition, HHS has a number of staff
divisions within the Office of the Secretary (OS). These staff divisions fulfill a broad array of
management, research, 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).
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.
1 Introduction to the HHS Strategic Plan FY2022-FY2026, https://www.hhs.gov/about/strategic-plan/2022-2026/
introduction/index.html.
2 See “HHS Organizational Charts Office of Secretary and Divisions,” last reviewed March 11, 2024,
https://www.hhs.gov/about/agencies/orgchart/index.html.
3 The FY2025 HHS budget materials include a legislative proposal to rename the Substance Abuse and Mental Health
Services Administration (SAMHSA) as the Substance use And Mental Health Services Administration. Throughout
those budget materials, SAMHSA is generally referred to using its proposed name. This report continues to use its
statutory name.
4 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
(continued...)
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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
FY2025 budget request, see the Appendix.)
Context for the FY2025 President’s Budget Request
The Budget and Accounting Act of 1921 (P.L. 67-13), as amended and later codified at 31 U.S.C.
§1105, 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 requested
funding, 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.5
The President’s budget request for FY2025 was submitted on March 11, 2024, about five weeks
after it was due.6 At the time the FY2025 budget request was being developed, discretionary
funding for FY2024 was being provided by a series of temporary continuing resolutions (CRs),
instead of full-year appropriations acts. Consequently, both the OMB and HHS budget materials
use estimates for FY2024 that are derived from two sources:
• For discretionary spending programs, the materials display annualized estimates
of funding provided under FY2024 CRs (P.L. 118-15, P.L. 118-22, P.L. 118-35,
P.L. 118-40). With limited exceptions, these CRs included a formulaic extension
of FY2023 funding levels for discretionary HHS programs and activities.
• For mandatory spending programs, the materials generally display estimates of
the amounts expected to be needed for FY2024 based on criteria outlined in
authorizing law. (For a related discussion, see the “Budgetary Resources versus
Appropriations” section.)
While the estimates of annualized spending under FY2024 CRs may have informed the
development of the FY2025 budget request, these estimates should not be treated as FY2024 final
or enacted levels. For this reason, many prior-year comparisons in this report use FY2023 final
levels rather than FY2024 estimates.
as an operating division. This reorganization was approved by the HHS Secretary on January 27, 2023, and became
effective on February 11, 2023. 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 For more information, see CRS Report R47019, The Executive Budget Process: An Overview.
6 On May 22, 2024, a package of amendments to the FY2025 budget request was submitted by the President to
Congress (available at https://www.whitehouse.gov/wp-content/uploads/2024/05/FY-2025-Budget-Amendment-
Package.pdf). One amendment made changes to the FDA Salaries and Expenses budget account, without affecting the
overall budgetary total for the FDA or HHS as a whole.
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FY2024 full-year appropriations were enacted in two omnibus appropriations acts almost six
months into the fiscal year:
• The Consolidated Appropriations Act, 2024 (P.L. 118-42) was enacted on March
9, 2024. This act provided full-year funding for several HHS entities, including
the FDA, IHS, and ATSDR.7
• The Further Consolidated Appropriations Act, 2024 (P.L. 118-47), was
subsequently enacted on March 23, 2024. This act contained full-year funding for
all remaining portions of HHS subject to the annual appropriations process.
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.8 For the reasons discussed above, this
CRS report generally refers to FY2024 funding levels as estimates. Amounts for earlier years are
called actual or final. The most recent fiscal year for which actual or final funding is available is
FY2023.
Overview of the FY2025 HHS Budget Request
Under the President’s budget request, HHS would spend an estimated $1.802 trillion in outlays9
in FY2025 (see Table 1).10 This is $132 billion (+8%) more than estimated HHS outlays in
FY2024 and $92 billion (+5%) more than actual HHS outlays in FY2023.
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 FY1995.11 Most recently, HHS
accounted for 28% of all federal outlays in FY2023, and would account for a projected 25% of
outlays if all proposals in the President’s FY2025 budget request were enacted.12
Table 1. FY2025 President’s Budget Request for HHS
(dollars in millions)
FY2024
FY2025
Estimate
Request
FY2021
FY2022
FY2023
(Annualized
Actual
Actual
Actual
CR)
Budget Authority
1,676,029
1,635,534
1,800,628
1,701,408
1,843,677
7 This bill also provided some funding for the National Institute of Environmental Health Sciences within the HHS
National Institutes of Health.
8 Other sources were consulted, including other chapters of the FY2025 HHS BIB, various volumes of the FY2025
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 FY2025 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2025-
budget-in-brief.pdf.
9 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.
10 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 2025, March
11, 2024, https://www.whitehouse.gov/wp-content/uploads/2024/03/
BBEDCA_251A_Sequestration_Report_FY2025.pdf.
11 OMB Historical Tables of the FY2025 President’s Budget, Table 4.2, “Percentage Distribution of Outlays by
Agency: 1962–2029,” https://www.whitehouse.gov/omb/historical-tables/.
12 Ibid.
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FY2024
FY2025
Estimate
Request
FY2021
FY2022
FY2023
(Annualized
Actual
Actual
Actual
CR)
Outlays
1,466,894
1,643,127
1,709,408
1,669,782
1,801,536
Sources: 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, see FY2024 HHS BIB, pp. 11-12, https://www.hhs.gov/sites/default/files/fy-
2024-budget-in-brief.pdf. For FY2023 actual, FY2024 estimate, and FY2025 request, see FY2025 HHS BIB, pp. 13-
14, https://www.hhs.gov/sites/default/files/fy-2025-budget-in-brief.pdf.
Notes: CR = continuing resolution. Budget authority is the amount of money a federal agency is legal y authorized
to commit or spend; an outlay occurs when funds are actually expended from the Treasury. Final appropriations
levels for FY2024 were unknown during the formulation of the FY2025 budget request. Accordingly, amounts
shown for FY2024 were estimated based on the annualized CR for discretionary programs and current services
baseline estimates for mandatory spending programs. Amounts for FY2025 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 FY2021-FY2024, but do not reflect estimated effects of
sequestration for FY2025.
Figure 1 displays proposed FY2025 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.13 Two mandatory spending programs—Medicare and Medicaid—are
expected to account for 85% of all estimated HHS spending in FY2025. 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.14
This figure also shows that discretionary spending accounts for about 9% of estimated FY2025
HHS outlays in the President’s request. Although discretionary spending represents a relatively
small share of total HHS spending, the department nevertheless receives more discretionary
funding than most federal departments. According to OMB data, HHS accounted for 7% of all
discretionary budget authority across the government in FY2023.15 The Department of Defense
was the only federal agency to account for a larger share of all discretionary budget authority in
that year (46%).
13 The terms mandatory spending and discretionary spending are discussed in the “Budgetary Resources Versus
Appropriations” section of this report.
14 For more information on how these entitlement programs are financed, see CRS Report R40425, Medicare Primer;
and CRS Report R42640, Medicaid Financing and Expenditures.
15 OMB Historical Tables of the FY2025 President’s Budget, Table 5.5, “Percentage Distribution of Discretionary
Budget Authority by Agency: 1976–2029,” https://www.whitehouse.gov/omb/historical-tables/.
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Department of Health and Human Services: FY2025 Budget Request
Figure 1. Proposed FY2025 HHS Outlays by Major Program or Spending Category
Source: Prepared by the Congressional Research Service (CRS) based on data presented on page 17 of the
FY2025 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2025-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 FY2025 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
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
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
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Development, Food and Drug Administration, and Related Agencies Appropriations Act (AG).
Table 2 lists HHS agencies by appropriations bill. Each of these three appropriations acts
provides discretionary HHS funding. In some cases, these acts also provide the necessary funding
for appropriated mandatories at HHS. However, authorizing laws provide funding for other
mandatory spending programs.
Table 2. HHS Agencies by Appropriations Bill
Appropriations Bill
HHS Agencies Funded in the Bill
Agriculture, Rural Development, Food and Drug
•
Food and Drug Administration
Administration, and Related Agencies (AG)
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: CRS. For more information, 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 FY2025 HHS budget request. Such proposals
would generally need to be enacted into law to affect the budgetary resources ultimately available
to the mandatory spending program.16 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.
16 For a list of some HHS legislative proposals for mandatory spending programs in the FY2025 President’s budget, see
Summary Table S–6 in OMB, Budget of the United States Government, Fiscal Year 2025,
https://www.whitehouse.gov/wp-content/uploads/2024/03/budget_fy2025.pdf. This table lists mandatory proposals (but
not discretionary proposals) by federal department and shows the estimated dollar change from current law levels
should the proposal be enacted. (The table does not show the actual proposed funding level.) For additional
information, see the applicable operating division chapters of the HHS Budget in Brief or congressional justifications.
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User Fees and Other Types of Collections
In some cases, agencies within HHS have the authority to expend user fees and other types of
collections that effectively supplement their appropriations. In addition, agencies may receive
transfers of budgetary resources from other sources, such as from the Public Health Service
Evaluation Set-Aside (also referred to as the PHS Tap) or one of the mandatory funds established
by the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).17 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).18
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 FY2032.19 On March 11, 2024, concurrent with the release of the
President’s budget submission, President Biden issued the required FY2025 sequestration order,
calling for nonexempt mandatory spending to be reduced on October 1, 2024.20 FY2025
sequestration will equal 2% of nonexempt spending from Medicare and certain other health
programs and 5.7% of other nonexempt nondefense mandatory spending. OMB calculated that
this will equal a total government-wide reduction in this category of spending of $29.3 billion in
budget authority in FY2025.21 OMB attributed the majority of this amount, $21.8 billion, to HHS
reductions to Medicare. (OMB also estimated a reduction of $2.1 billion (-8.3%), in nonexempt
defense mandatory spending, which does not affect HHS funds.)
17 For further information, see CRS Report R47936, Labor, Health and Human Services, and Education: FY2024
Appropriations.
18 The program level for each agency is listed in the table entitled “Composition of the HHS Budget Discretionary
Programs” in the FY2025 HHS BIB.
19 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 R47936, Labor, Health and Human Services, and Education: FY2024 Appropriations. For further information
about sequestration, see CRS Report R42972, Sequestration as a Budget Enforcement Process: Frequently Asked
Questions.
20 Sequestration Order for Fiscal Year 2025 Pursuant to Section 251A of the Balanced Budget and Emergency Deficit
Control Act, as Amended, 89 Federal Register 18531, March 14, 2024, p. 18531, https://www.govinfo.gov/content/
pkg/FR-2024-03-14/pdf/2024-05600.pdf.
21 OMB, OMB Report to the Congress on the BBEDCA 251A Sequestration for Fiscal Year 2025, March 11, 2024,
https://www.whitehouse.gov/wp-content/uploads/2024/03/BBEDCA_251A_Sequestration_Report_FY2025.pdf. See
the report’s appendix for an itemized list of budget accounts that include mandatory spending subject to sequestration
in FY2025, 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.
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By convention, HHS budget materials for FY2025 generally reflect sequestration for mandatory
spending programs in prior years (FY2023-FY2024), but do not reflect estimated effects of
mandatory sequestration for the budget year (FY2025). The numbers in this report reflect this
convention.
HHS Budget by Operating Division
Figure 2 provides a breakdown of the FY2025 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 at $1.6 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 and Medicaid is expected to increase relative to
FY2024 levels in terms of current law estimates, and to a slightly greater degree under proposed
law estimates. However, when looking exclusively at discretionary budget authority, funding for
CMS is comparatively smaller, accounting for $4.3 billion of the HHS discretionary request.
Discretionary CMS funds primarily support program operations and federal administrative
activities, though some funds also go toward efforts to reduce health care fraud and abuse.
The largest share of the HHS discretionary request would go to the PHS operating divisions:
$86.6 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.22
ACF would receive the second-largest discretionary funding level among the HHS operating
divisions: $31.4 billion. The majority of the discretionary ACF request (56%) would go to early
childhood care and education programs, such as Head Start and the Child Care and Development
Block Grant.23
22 FY2025 HHS BIB, p. 54.
23 Calculated by CRS based on data presented on pages 129-130 of the FY2025 HHS BIB.
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Figure 2. FY2025 President’s Request for HHS by Operating Division
Source: Prepared by the Congressional Research Service (CRS) based on data presented on pages 13-16 of the
FY2025 HHS BIB, https://www.hhs.gov/sites/default/files/fy-2025-budget-in-brief.pdf. The amounts displayed as
total budget authority include mandatory and discretionary funds. The bar representing the combined mandatory
and discretionary total for CMS has been abbreviated due to space constraints. (When taking into account both
mandatory and discretionary funding, CMS receives over 17 times the funding proposed for ACF.) 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 FY2025 request for each HHS operating division and the Office of the Secretary
(OS) into context, displaying it along with estimates of funding provided over the four prior fiscal
years (FY2021-FY2024). 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
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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 $16.6 billion in FY2025 BA for HRSA, but
an estimated $18.8 billion in FY2025 HRSA outlays, reflecting the expected expenditure of funds
previously provided to the agency in addition to some funds that are expected to be newly enacted
in FY2025.
Amounts shown for the OS were calculated using funding levels in HHS BIBs for several staff
divisions, accounts, and activities under the OS.24 They also include estimates for several
mandatory spending proposals that were listed separately from the operating divisions in the front
tables of the HHS BIB, such as the Defense Production Act Medical Supplies Enhancement, PrEP
Delivery Program to End the HIV Epidemic, Mental Health Transformation Fund, Public Health
Resilience, National Hepatitis C Elimination Program, Antimicrobial Subscriptions, and
Customer Experience.
Table 3. HHS Budget by Operating and Staff Division
(mandatory and discretionary spending combined, dollars in millions)
FY2024
Estimate
FY2021
FY2022
FY2023
(Annualized
FY2025
Operating Division
Actual
Actual
Actual
CR)a
Request
FDA
Budget Authority (BA)
3,765
4,379
2,706
3,644
3,806
Outlays
3,303
4,588
2,882
4,573
3,973
HRSA
BA
21,733
13,566
14,584
16,465
16,640
Outlays
14,232
16,128
15,883
15,953
18,790
IHS
BA
13,794
7,442
7,881
13,287
8,931
Outlays
9,866
6,507
7,292
8,415
9,424
CDCb
BA
28,511
9,156
9,672
10,588
11,507
Outlays
11,269
16,526
12,278
14,697
15,658
24 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), the No Surprises Implementation Fund, and certain collections
credited to that office or the department.
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FY2024
Estimate
FY2021
FY2022
FY2023
(Annualized
FY2025
Operating Division
Actual
Actual
Actual
CR)a
Request
NIH
BA
42,186
45,415
48,927
47,669
49,790
Outlays
38,868
40,623
46,507
46,419
46,638
SAMHSA
BA
13,674
6,724
7,567
7,545
8,158
Outlays
5,910
7,384
8,261
9,235
9,813
AHRQ
BA
337
350
374
374
387
Outlays
329
339
349
381
375
CMSc
BA
1,296,727
1,471,167
1,634,038
1,518,687
1,603,501
Outlays
1,240,623
1,370,675
1,490,112
1,458,603
1,580,706
ACF
BA
122,521
73,556
78,371
71,172
91,755
Outlays
70,079
85,702
88,739
82,979
89,979
ACL
BA
4,221
2,293
2,524
2,509
2,579
Outlays
2,662
2,720
3,013
3,489
3,104
ASPRd
BA
-
-
-
-
3,768
Outlays
-
-
-
-
926
Office of the Secretarye
BA
128,560
1,486
-6,016
9,468
42,855
Outlays
69,753
91,935
34,092
25,038
22,150
Total, HHS
BA
1,676,029
1,635,534
1,800,628
1,701,408
1,843,677
Outlays
1,466,894
1,643,127
1,709,408
1,669,782
1,801,536
Sources: 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, see FY2024 HHS BIB, pp. 11-12, https://www.hhs.gov/sites/default/files/fy-
2024-budget-in-brief.pdf. For FY2023 actual, FY2024 estimate, and FY2025 request, see FY2025 HHS BIB, pp. 13-16,
https://www.hhs.gov/sites/default/files/fy-2025-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 FY2025 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 FY2021-FY2024, but do not reflect estimated effects of mandatory sequestration for
FY2025.
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a. FY2024 funding levels in the FY2025 BIB are annualized estimates of funding provided by FY2024 continuing
resolutions 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 had 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 FY2021-FY2024.
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 Defense Production Act Medical
Supplies Enhancement, PrEP Delivery Program to End the HIV Epidemic, Mental Health Transformation
Fund, National Hepatitis C Elimination Program, Antimicrobial Subscriptions, and Customer Experience.
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Appendix. HHS Operating Divisions: Missions and
FY2025 Budget Resources
This appendix provides for each operating division a brief summary of its mission,25 the
applicable appropriations bill, the FY2025 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.26
Appropriations Bill:
• Agriculture, Rural Development, Food and Drug Administration, and Related
Agencies (AG)
FY2025 Request:
• BA: $3.806 billion
• Outlays: $3.973 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 15), https://www.fda.gov/
media/176925/download
• BIB chapter (p. 18), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=24
Health Resources and Services Administration (HRSA)
The HRSA mission is focused on providing “equitable health care to people who are
geographically isolated and economically or medically vulnerable.”27 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
FY2025 Request:
• BA: $16.640 billion
25 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.
26 FDA, What Does FDA Do, https://www.fda.gov/about-fda/what-we-do.
27 HRSA, About HRSA, https://www.hrsa.gov/about/index.html.
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• Outlays: $18.790 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 19), https://www.hrsa.gov/
sites/default/files/hrsa/about/budget/budget-justification-fy2025.pdf
• BIB chapter (p. 25), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=31
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.”28 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.29
Appropriations Bill:
• Department of the Interior, Environment, and Related Agencies (INT)
FY2025 Request:
• BA: $8.931 billion
• Outlays: $9.424 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 11), https://www.ihs.gov/
sites/budgetformulation/themes/responsive2017/display_objects/documents/FY-
2025-IHS-CJ030824.pdf
• BIB chapter (p. 34), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=40
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.”30 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 FY2025 HHS BIB, ATSDR’s budget
request is included in the CDC totals shown in this report. ATSDR’s work is focused on
28 IHS, Agency Overview, https://www.ihs.gov/aboutihs/overview/.
29 IHS, About IHS, https://www.ihs.gov/aboutihs/.
30 CDC, Official Mission/Function Statement, updated 1/24/2023, https://www.cdc.gov/about/pdf/organization/iod-
mission-statement.pdf.
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preventing or mitigating adverse effects resulting from exposure to hazardous substances in the
environment.31
Appropriations Bills:
• LHHS (CDC)
• INT (ATSDR)
FY2025 Request (CDC and ATSDR combined):
• BA: $11.507 billion
• Outlays: $15.658 billion
Additional Resources:
• CDC Congressional Justification (all-purpose table on p. 30),
https://www.cdc.gov/budget/documents/fy2025/FY-2025-CDC-congressional-
justification.pdf
• ATSDR Congressional Justification, https://www.cdc.gov/budget/documents/
fy2025/FY-2025-ATSDR-congressional-justification.pdf
• BIB chapter (p. 44), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=50
National Institutes of Health (NIH)
The NIH mission is focused on conducting and supporting research “in the causes, diagnosis,
prevention, and cure of human diseases” and “in directing programs for the collection,
dissemination, and exchange of information in medicine and health.”32 NIH is organized into 27
research institutes and centers, headed by the NIH Director.33 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
FY2025 Request:
• BA: $49.790 billion
• Outlays: $46.638 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 39),
https://officeofbudget.od.nih.gov/pdfs/FY25/br/
Overview%20of%20FY%202025%20Presidents%20Budget.pdf34
31 ASTDR, Official Mission/Function Statement, effective 1/9/2020, https://www.cdc.gov/about/pdf/organization/atsdr-
mission-statement.pdf.
32 NIH, Mission and Goals, https://www.nih.gov/about-nih/what-we-do/mission-goals.
33 NIH, Organization, https://www.nih.gov/about-nih/who-we-are/organization.
34 NIH’s individual institutes/centers also submit justifications, available at https://officeofbudget.od.nih.gov/
insti_center_subs.html.
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• BIB chapter (p. 52), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=58
Substance Abuse and Mental Health Services Administration
(SAMHSA)35
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 use disorder and mental illness.36 SAMHSA supports
activities that include education and training, prevention programs, early intervention activities,
treatment services, and technical assistance.
Appropriations Bill:
• LHHS
FY2025 Request:
• BA: $8.158 billion
• Outlays: $9.813 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 10), https://www.samhsa.gov/
sites/default/files/samhsa-fy-2025-cj.pdf
• BIB chapter (p. 59), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=65
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.”37 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
FY2025 Request:
• BA: $0.387 billion
• Outlays: $0.375 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 15), https://www.ahrq.gov/
sites/default/files/wysiwyg/cpi/about/mission/budget/2025/fy2025-cj.pdf
35 The FY2025 HHS BIB and SAMHSA congressional justification refer to SAMHSA as the Substance use And
Mental Health Services Administration, while other sources, including the SAMHSA website and appropriations bills,
continue to use Substance Abuse and Mental Health Services Administration.
36 SAMHSA, About Us, https://www.samhsa.gov/about-us.
37 AHRQ, About AHRQ, https://www.ahrq.gov/cpi/about/index.html.
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• BIB chapter (p. 65), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=71
Centers for Medicare & Medicaid Services (CMS)
The CMS mission is focused on “advancing health equity, expanding coverage, and improving
health outcomes.”38 The President’s budget estimates that in FY2025, “over 160 million, or
roughly 1 in 2 Americans, will rely on the programs CMS administers or oversees including
Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Marketplaces.”39
Appropriations Bill:
• LHHS
FY2025 Request:
• BA: $1,603.501 billion
• Outlays: $1,580.706 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 7), https://www.cms.gov/
files/document/fy2025-cms-congressional-justification-estimates-appropriations-
committees.pdf
• BIB chapter (p. 71), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=77
Administration for Children and Families (ACF)
The ACF mission is focused on promoting the “economic and social well-being of families,
children, individuals and communities.”40 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
FY2025 Request:
• BA: $91.755 billion
• Outlays: $89.979 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 5), https://www.acf.hhs.gov/
sites/default/files/documents/olab/fy-2025-congressional-justification.pdf
• BIB chapter (p. 129), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=135
38 CMS, Fiscal Year 2025 Justification of Estimates for Appropriations Committees, March 2024,
https://www.cms.gov/files/document/fy2025-cms-congressional-justification-estimates-appropriations-committees.pdf.
39 CMS, Fiscal Year 2025 Justification of Estimates for Appropriations Committees, March 2024,
https://www.cms.gov/files/document/fy2025-cms-congressional-justification-estimates-appropriations-committees.pdf.
40 ACF, What We Do, https://www.acf.hhs.gov/about/what-we-do.
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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.”41 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
FY2025 Request:
• BA: $2.579 billion
• Outlays: $3.104 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 16), https://acl.gov/sites/
default/files/about-acl/2024-03/FY2025ACL-CJ-508.docx
• BIB chapter (p. 146), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=152
Administration for Strategic Preparedness and Response (ASPR)42
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.”43 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.”44
Appropriations Bill:
• LHHS
FY2025 Request:
• BA: $3.768 billion
• Outlays: $0.926 billion
Additional Resources:
• Congressional Justification (all-purpose table on p. 16), https://aspr.hhs.gov/
AboutASPR/BudgetandFunding/Documents/FY2025/ASPR-cj.pdf
41 ACL, About ACL, https://acl.gov/about-acl.
42 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.
43 ASPR, ASPR Program Offices, https://aspr.hhs.gov/AboutASPR/ProgramOffices/Pages/ProgramOffice.aspx.
44 ASPR, ASPR Budget and Funding, https://aspr.hhs.gov/AboutASPR/BudgetandFunding/Pages/default.aspx.
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• BIB chapter (p. 155), https://www.hhs.gov/sites/default/files/fy-2025-budget-in-
brief.pdf#page=161
Author Information
Jessica Tollestrup
Ada S. Cornell
Specialist in Social Policy
Senior Research Librarian
Karen E. Lynch
Specialist in Social Policy
Disclaimer
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Congressional Research Service
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