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FY 2005 Budget in BriefHealth Resources and Services AdministrationOn this page:
The FY 2005 budget requests $6.6 billion for HRSA, a net decrease of $610 million from the FY 2004 level. FY 2005 represents the fourth year of support for the President's multi-year initiative to increase access to health care for the uninsured and underserved by enhancing and strengthening the Health Center program. In order to alleviate the national nursing shortage, HRSA will direct more resources towards basic nurse education, loan repayments, and scholarships. The Agency will increase resources available to respond to national emergencies through the National Health Service Corps. HRSA will also maintain a significant investment in preparing our nation's hospitals and health professions workforce for a bioterrorism event. The Agency will expand support for medications for people living with HIV/AIDS. The budget also supports rural health policy development and State-level infrastructure, to help meet the unique challenges facing rural America, maternal and child health programs, and important transplantation programs. Expanding Access to Health Care For Medically Underserved Americans In 2002, the President launched an initiative to expand access to health care by creating 1,200 new or expanded health center sites and serving an additional 6.1 million people by 2006. Since FY 2001, the Health Center program has significantly impacted over 600 communities, serving over 13 million patients – 3 million more than in FY 2001 – 40 percent of whom have no insurance coverage, and many others who have inadequate coverage. In FY 2005, the budget includes $1.8 billion, an increase of $219 million from FY 2004, resulting in services for an additional 1.6 million individuals in approximately 330 new and expanded sites. At this level, a total of 15 million uninsured and underserved individuals will receive comprehensive preventive and primary care services at over 3,800 health center sites across the country – nearly 7 million in rural areas. Health centers employ approximately 5,400 physicians and dentists, and 17,000 other health care clinicians – 13 percent more physicians and dentists than in FY 2001, and 20 percent more clinicians. The budget request includes $45 million in no year funding for the Health Centers Federal Tort Claims Program, which provides medical malpractice coverage for the increasing number of health center employees. The budget also provides $5 million in no year funding to maintain support for medical malpractice coverage for volunteer providers in free clinics. In addition, the FY 2005 budget proposes to reshape the Healthy Communities Access Program (HCAP) to support efficient Health Center networks and successful chronic disease management activities. The reshaped HCAP program, funded at $10 million, will support networks of health centers that increase centers' ability to maximize efficiency, resources, and quality while minimizing costs and duplication of effort. By placing the focus on health centers, resources will better serve patients living with chronic diseases through interdisciplinary teams implementing patient-centered practice models. Developing A Health Professions Workforce for the 21st Century Expanding access to health care requires ensuring an adequate supply of nurses. The Nation currently faces a nursing shortage of approximately 168,000 nurses. As the population continues to grow and age, and medical services advance, the need for nurses will continue to increase. The budget requests $147 million for nursing education programs, an overall increase of $5 million. Since FY 2001, funding for nursing education programs has increased by 75 percent. In FY 2005, the budget increases support for basic nurse education and retention by $10 million, for a total of $42 million. An additional $32 million, a $5 million increase, is requested to support over 1,000 loan repayments and scholarships that will reduce the financial barrier to nursing education for all levels of professional nursing students. The budget also includes $21 million for diversity, $44 million for advanced nursing education, and maintains an $8 million investment in loans for nurse faculty and support for comprehensive geriatric education. These programs will support the recruitment, education, and retention of 24,000 nurses and nursing students. Geographic maldistribution of health professionals also remains a major problem for many inner city and isolated rural communities. Over the National Health Service Corps' (NHSC) 30 year history, more than 24,500 health professionals have committed to service in underserved areas across the country. Through a targeted management reform initiative, which began in FY 2002, the NHSC is now better able to assist the neediest communities. The ratio of loan repayments compared to scholarships has increased by over 30 percent, enabling the NHSC to immediately place more health professionals into service in needy communities – increasing the current field strength to more than 4,200 clinicians. The NHSC will continue to work with the Health Center program to help meet its provider needs. Currently, half of NHSC clinicians serve in health centers. The FY 2005 budget continues the expansion of the NHSC with an increase of $35 million, for a total of $205 million. Within this increased funding, $25 million will be directed to a specific new effort to recruit nurses and physicians to serve in health professional shortage areas. As a condition of receiving this assistance, these individuals will incur a service obligation in underserved areas similar to other NHSC scholarship and loan repayment recipients, and will be employees of community facilities. These health care providers will also have a long term reserve commitment to the Public Health Service Commissioned Corps. To ensure a continuing source of scholarships focused on increasing diversity in the health professions workforce, the FY 2005 budget proposes a $10 million investment in the Scholarships for Disadvantaged Students program. The budget continues the policy of not funding more general training efforts – primary care, interdisciplinary community projects, training for diversity, and public health. The budget maintains a $303 million investment in health professions training in free-standing children's hospitals, the same as FY 2004. The Program Assessment Rating Tool (PART) assessment found the Children's Hospitals Graduate Medical Education program has a clear purpose and since the program was initiated the percentage of children's hospitals with negative margins has declined. Preparing America's Health Care System and Providers for Bioterrorism The mission of the Hospital Preparedness program is to ready hospitals and supporting health care systems – primary care facilities, EMS systems, poison control centers – to deliver coordinated and effective care to victims of terrorism and other public health emergencies. A recent PART review found that this program has a clear and important purpose and that it is well coordinated with other Federal preparedness efforts. Between FY 2002 and FY 2004, a total of $1.2 billion has been made available for these efforts in States, Territories, and certain municipalities. By the end of FY 2003, every awardee had staffed a hospital preparedness office and advisory committee, completed a needs assessment, and developed a plan of action in response to the identified needs. Approximately 60 percent of awardees had developed regional hospital plans to address surge capacity and manage a potential epidemic involving at least 500 patients. Awardees are also using funds to conduct disaster drills; enhance communication systems; make infrastructure improvements and expansions so that hospitals have adequate laboratory capacity and improve capabilities to control infection. The FY 2005 budget requests $476 million to continue progress towards the goal of 100 percent of States having surge capacity plans. Specific areas of emphasis will include surge bed capacity, clinical personnel augmentation, isolation capacity, and hospital-based pharmaceutical caches. HHS is developing a plan to review the funding allocation and will consider whether the current formula could be improved by including indicators such as level of risk, level of preparedness, or measures related to performance. Our health professions workforce must be prepared to recognize indications of a terrorist event in their patients. The Bioterrorism Training and Curriculum Development program, first initiated in FY 2003, supports 19 cooperative agreements to deliver continuing education to a diverse health care workforce and 12 cooperative agreements to facilitate the training and preparation of current medical, nursing, allied health, and other health professions students. The FY 2005 budget includes $28 million for this activity. Ensuring Access to Services for People Living with HIV/AIDS The FY 2005 budget requests $2.1 billion for the Ryan White HIV/AIDS program, a net increase of $35 million over FY 2004. The Ryan White Care Act program provides services to approximately 530,000 individuals each year with little or no insurance. These services include medical care, access to lifesaving pharmaceuticals, dental care, outpatient mental health services, outpatient substance abuse treatment, and home health care. Within the total FY 2005 request, the budget provides $784 million, an increase of $35 million, for the AIDS Drug Assistance Program to support the purchase of medications for persons living with HIV/AIDS. At this level, monthly utilization of ADAP will increase from approximately 93,800 clients in FY 2004 to approximately 100,000 clients in FY 2005. HHS continues its commitment to enhance and improve the delivery of
health care by Ryan White CARE Act programs to persons living with
HIV/AIDS. HRSA is working closely with grantees to fully implement
management and improvement programs to enhance the quality of care
and services provided to persons living with HIV/AIDS. Providing Health Care in Rural Communities Rural residents tend to have more difficulty accessing health care and poorer health outcomes than their urban counterparts. The rural provisions of the recently enacted Medicare Prescription Drug and Modernization bill will substantially increase the resources available to rural communities – $9 billion over the next 5 years. In addition, nearly 7 of the 15 million patients served by health centers in FY 2005 will be from rural communities. The FY 2005 budget also requests $52 million for targeted rural health programs, including $22 million for the Denali Commission. As noted in the PART review, independent evaluations indicate that these rural health programs are effective and achieve results. However, PART also found that a less fragmented and more seamless Federal effort could help maximize access, generate effectiveness, yield cost efficiencies, and reduce the number of specific and geographically targeted projects funded each year. In FY 2005, the budget targets select activities. A total of $17 million is requested for State Offices of Rural Health that monitor and direct State-level strategy for rural health care, and for Federal policy research studies and rural health information dissemination. An additional $13 million is requested for Rural Health Outreach and Network Development grants, which enable community partnerships to implement creative strategies to meet their unique health needs, and for grants to purchase life-saving emergency devices. Improving Maternal and Child Health The Department continues to work towards improved health outcomes
for all American women and children. The budget requests $730
million for the Maternal and Child Health (MCH) Block Grant, the
same as FY 2004. The Block Grant supports Federal and State
partnerships that provide critical services to 27 million women and
children. These services include direct health care services for
children with special health care needs, the promotion of health
and safety in child care settings, and enabling services such as
home visiting and nutrition counseling. The MCH Block Grant also
provides support for newborn screening, lead poisoning, and injury
prevention. The budget also includes $98 million for the Healthy
Start program, which supports community-driven programs in targeted
high risk communities to reduce the incidence of risk factors that
contribute to infant mortality.
The budget also includes $53 million to maintain three important emergency services programs: Emergency Medical Services for Children, $20 million; Poison Control Centers, $24 million; and Traumatic Brain Injury, $9 million. The EMS for Children program will award 51 grants to States and Territories to improve care for the 31 million children and adolescents who are seen in emergency departments each year, and 37 additional grants to medical schools to develop and evaluate improved procedures and protocols for treating children. The Poison Control Center program will award 80 stabilization and enhancement grants to Centers, which provide expert advice to the public 24 hours a day regarding exposure to poisons, and will maintain a national toll-free number. The Traumatic Brain Injury program facilitates State-wide needs assessments and implement action plans, thereby ensuring comprehensive and coordinated services. Supporting Transplantation Each day approximately 68 people in the United States receive a life-saving organ transplant, but another 17 people die because the demand for transplantable organs far exceeds the available supply. The FY 2005 budget includes $25 million to maintain support for the Organ Transplantation program, which funds the network that manages the distribution of organs throughout the United States and the national registry of transplant recipients that assists in organ allocation. The program will also award 25 grants to evaluate strategies for increasing the consent to donate and to refine methods for identifying those patients with the greatest medical need for transplantation. Each year approximately 38,000 Americans under 55 years old are diagnosed with leukemia and other blood and genetic diseases, and about 16,000 of them cannot be successfully treated with therapy other than a blood stem cell transplant. Blood stem cells can be obtained from the bone marrow or circulating blood of volunteer adult donors or collected from the newest source – umbilical cord and placenta after a normal birth. The FY 2005 budget requests $23 million to maintain the National Bone Marrow Donor Registry, which enables patients to search for a suitable, unrelated bone marrow donor. The budget also includes $10 million to maintain the newly funded Cord Blood Stem Cell Bank. This level of funding, along with the FY 2004 funds, would increase the national inventory of cord blood stem cells by approximately 25 percent. Other HRSA Programs The budget proposes $30 million for the remaining HRSA programs including Telehealth, Hansen's Disease, Black Lung, and Radiation Exposure Compensation, maintaining FY 2004 levels. Program Management The budget requests $158 million for HRSA's program management, an increase of $3 million over the FY 2004 level. Resources requested will enable HRSA to manage and operate a wide array of Federal programs as well as to fund Federal pay cost increases. |
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Last revised: March 1, 2004
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