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HHS FY2015 Budget in Brief

Health Resources and Services AdministrationHealth Resources and Services Administration (HRSA)

The Health Resources and Services Administration’s mission is to improve health and achieve health equity through access to quality services, a skilled health workforce and innovative programs. 

HRSA Budget Overview

(Dollars in millions)

Primary Care

2013

2014

2015

2015
+/
2014

Health Centers

2,856

3,545

4,511

+966

ACA Mandatory (non-add)

1,465

2,145

3,600

+1,455

Health Centers Tort Claims

89

95

89

-6

ACA School Based Health Centers

47

--

--

--

Free Clinics Medical Malpractice

0.038

0.040

0.040

--

Subtotal, Primary Care

2,992

3,640

4,600

+960


 

Health Workforce, Clinician Recruitment and Service:

2013

2014

2015

2015
+/
2014

National Health Service Corps

285

283

810

+527

Discretionary Budget Authority (non-add)

--

--

100

+100

ACA Mandatory (non-add)

285

283

310

+27

New Mandatory Proposal (non-add)

--

--

400

+400

Other Clinician Recruitment and Services

79

81

81

--


 

Health Workforce, Health Professions:

2013

2014

2015

2015
+/
2014

Training for Diversity

80

81

67

-14

Health Workforce Information and Analysis

3

5

5

--

Primary Care Training and Enhancement

37

37

37

--

Oral Health Training

31

32

32

--

Interdisciplinary, Community-Based Linkages

62

72

51

-20

Prevention and Public Health Fund (non-add)

2

--

--

--

Public Health Workforce Development

8

18

18

--

Nursing Workforce Development

140

144

144

--

PHS Evaluation Funds (non-add)

--

--

62

+62

Children's Hospital Graduate Medical Education

251

265

--

-265

Rural Physician Training Grants

--

--

4

+4

Graduate Medical Education (New Mandatory Proposal)

--

--

530

+530

Children's Hospital Set-Aside (non-add)

--

--

100

+100


 

Health Workforce, User Fees:

2013

2014

2015

2015
+/
2014

National Practitioner Data Bank User Fees

27

27

19

-9


 

Health Workforce Total

2013

2014

2015

2015
+/
2014

Subtotal, Health Workforce

1,001

1,045

1,798

+753


 

Maternal and Child Health

2013

2014

2015

2015
+/
2014

Maternal and Child Health Block Grant

605

634

634

--

Autism and Other Developmental Disorders

45

47

47

--

Traumatic Brain Injury

9

9

9

--

Sickle Cell Service Demonstrations

4

4

4

--

Universal Newborn Hearing Screening

18

18

18

--

Emergency Medical Services for Children

20

20

20

--

Healthy Start

98

101

101

--

Heritable Disorders

9

12

12

--

Family to Family Health Information Centers (Mandatory)

5

3

--

-3

Home Visiting

380

371

500

+129

ACA Mandatory Funding (non-add)

380

371

--

-371

New Mandatory Proposal (non-add)

--

--

500

+500

Subtotal, Maternal and Child Health

1,193

1,220

1,346

+126


 

Ryan White HIV/AIDS

2013

2014

2015

2015
+/
2014

Emergency Relief - Part A

624

656

656

--

Comprehensive Care - Part B

1,288

1,315

1,315

--

AIDS Drug Assistance Program (non-add)

886

900

900

--

Early Intervention - Part C

194

201

280

+79

Children, Youth, Women, and Families - Part D

72

75

--

-75

Education and Training Centers - Part F

32

34

34

--

Dental Services - Part F

13

13

13

--

Special Projects of National Significance (PHS Evaluation)

25

25

25

--

Subtotal, HIV/AIDS

2,249

2,319

2,323

+4


 

Health Care Systems

2013

2014

2015

2015
+/
2014

Organ Transplantation

23

24

24

+0.5

Cord Blood Stem Cell Bank

11

11

11

--

C.W. Bill Young Cell Transplantation Program

22

22

22

--

Poison Control Centers

18

19

19

--

340B Drug Pricing Program

4

10

17

+7

User Fee (non-add)

--

--

7

+7

Hansen's Disease Programs

17

17

17

--

Subtotal, Health Care Systems

95

103

111

+7


 

Rural Health

2013

2014

2015

2015
+/
2014

Rural and Community Access to Emergency Devices

2

3

--

-3

Rural Hospital Flexibility Grants

38

41

26

-14

Other Rural Health

90

98

98

--

Subtotal, Rural Health

131

142

125

-18


 

Other Activities

2013

2014

2015

2015
+/
2014

Family Planning

278

286

286

--

Program Management

151

153

157

+4

Vaccine Injury Compensation Program Direct Operations

6

6

8

+1

Subtotal, Other Activities

436

446

451

+5


 

HRSA Budget Totals – Less Funds From Other Sources

2013

2014

2015

2015
+/
2014

Total, Program Level

8,097

8,915

10,753

+1,838

PHS Evaluation Funds

-25

-25

-87

-62

User Fees

-27

-27

-26

+2

Prevention and Public Health Fund

-2

--

--

--

Appropriated Mandatory Funding

-2,182

-2,801

-3,910

-1,109

New Mandatory Proposals--

--

-1,430

-1,430

Total, Discretionary Budget Authority

5,861

6,061

5,300

-761


 

Full Time Equivalents

2013: 1,902

2014: 1,940

2015: 1,983

2015 +/- 2014: +43

HRSA Programs

The Health Resources and Services Administration (HRSA) is the principal federal agency charged with improving access to health care services for people who are medically underserved. Millions of families still face barriers to quality health care because of their income, geographic isolation, or language barriers. HRSA programs work to minimize these barriers by promoting improvements in access, quality, and equity that are essential for a healthy nation. To support this mission, the FY 2015 Budget requests $10.8 billion, including $1.4 billion for new mandatory proposals.

Providing Access to High-Quality, Affordable Primary Care

Health Centers: Health centers are a critical component of the health care system, providing comprehensive primary care services in medically underserved communities. The Budget includes $4.6 billion for the Health Center program, including $3.6 billion in mandatory funding provided through the Affordable Care Act, a total increase of $960 million above FY 2014. Funding will serve approximately 31 million patients at over 1,300 health centers that operate more than 9,500 service delivery sites and provide care in every state, the District of Columbia, Puerto Rico, the United States Virgin Islands, and the Pacific Basin.

The Budget requests resources to meet an increase in newly-insured patients seeking care at health centers across the country. After the passage of health reform in Massachusetts, health centers saw a significant increase in the number of patients, many of whom were newly insured. In addition to continuing to serve newly insured patients in FY 2015, health centers will also remain a vital source of primary care for patients who cannot gain access to coverage, as well as insured patients seeking a quality source of care for services, including services not covered by insurance.

FY 2015 is the final year under current law for the Health Center Fund established in the Affordable Care Act. In FY 2015, $100 million is allocated to fund 150 new health center sites that will serve an additional 900,000 patients. Further, approximately $860 million is allocated for one-time quality improvement and capital development awards that will support new renovation, expansion, or construction projects, to improve health center capacity to provide quality primary and preventive health services to existing patients and expand access to new patients. The Budget includes a proposal to continue mandatory funding for health centers in FYs 2016, 2017, and 2018 at $2.7 billion per year, for a total investment of $8.1 billion.

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Strengthening the Nation’s Health Workforce Capacity

As health insurance coverage expansions that began in 2014 continue nationwide, it is vital to make targeted investments that promote a high-performing health workforce. In order to ensure that all Americans have access to high quality care, HRSA's health workforce programs seek to provide targeted support for health professions and for parts of the country where shortages of health professionals exist. To this end, the Budget provides a total of $1.8 billion for HRSA workforce programs, a total that includes $1.2 billion in mandatory funding, to expand the nation’s health workforce capacity and to target health workforce resources to where they are needed most.

Insurance Expansion -- Outreach and Enrollment

Community health centers are on the front line of helping uninsured residents enroll in new health insurance options available in the Health Insurance Marketplaces under the Affordable Care Act, through expanded access to Medicaid in many states, and new private health insurance options and tax credits. Since FY 2013, HRSA has awarded more than $200 million in grants to over 1,100 health centers to provide expanded assistance for people in communities nationwide looking for help in understanding their insurance options and enrolling in affordable coverage.

National Health Service Corps: The Budget includes $810 million for the National Health Service Corps, of which $710 million is mandatory funding. Since its inception in 1972, the Corps has worked to build healthy communities by supporting qualified health care providers dedicated to working in rural and other areas of the country where access to care is limited and where shortages of health care professionals persist. Nearly half of all current Corps providers work in rural communities. Approximately 50 percent of National Health Service Corps clinicians serve in health centers around the country. With this level of funding going forward, the Corps is projected to support a field strength of over 15,000 providers over FYs 2015 2020 and serve primary health care needs of more than 16 million patients.

Targeted Support for Graduate Medical Education: The Budget includes $530 million in mandatory funding for a new program, Targeted Support for Graduate Medical Education. This new competitive grant program will fund teaching hospitals, children’s hospitals, and community-based consortia of teaching hospitals and/or other health care entities to expand residency training, with a focus on ambulatory and preventive care, in order to advance the Affordable Care Act’s goals of higher value health care that reduces long term costs.

The new Targeted Support for Graduate Medical Education Program will incorporate two existing HRSA programs, the Children’s Hospital Graduate Medical Education program and the Teaching Health Center Graduate Medical Education program. Current awardees in those programs will be eligible to compete for funding through the Targeted Support’s competitive grant program, with a minimum of $100 million set aside specifically for children’s hospitals in FY 2015. The Budget proposes to continue mandatory funding for the new Targeted Support for Graduate Medical Education program annually in FYs 2015 2024, for a total investment of $5.2 billion.

Training and Assistance for Health Professionals: HRSA health professions programs serve as a catalyst to advance changes in health professions training responsive to the evolving needs of the health care system. Within the total provided for Health Workforce, $144 million is provided to develop the nation’s nursing workforce through programs that, among other strategies, support the enhancement of advanced nursing education and practice, increased nursing education opportunities for individuals from disadvantaged backgrounds, and an expanded nursing pipeline. In addition, $32 million is provided for Oral Health Training programs, $37 million is provided for the Primary Care Training and Enhancement program, $33 million is provided for Geriatric programs, $18 million is provided for Public Health Workforce Development, and $8 million is provided for Mental and Behavioral Health Education and Training programs.

The Budget also provides for two new workforce initiatives, including $10 million to support a new Clinical Training in Interprofessional Practice program to increase the capacity of community-based primary health care teams to deliver quality care. In addition, the Budget provides $4 million to fund new Rural Physician Training grants to help rural-focused training programs recruit and graduate students most likely to practice medicine in underserved rural communities.


Building a Health Workforce for the 21st Century

The Budget proposes over $14 billion in new investments beginning in FY 2015 to bolster the nation’s health workforce and to improve the delivery of health care across the country. HRSA is spearheading two components of the workforce initiative:
  • Between FY 2015 and FY 2020, HRSA will devote a total of $4 billion in mandatory funding to the National Health Service Corps to address health professional shortages in high-need rural and urban communities across the country.
  • Starting in FY 2015, HRSA will devote $5.2 billion to a new Targeted Support for Graduate Medical Education program, a competitive grant program aimed at supporting medical residency positions across the country that advance key workforce goals, including the training of more physicians in primary care and understaffed specialties and encouraging physicians to practice in rural and other underserved areas.
  • Concurrent with these efforts at HRSA, the Medicaid primary care payment increase will be extended through CY 2015 with modifications to expand eligibility for reimbursements to mid-level providers, including physician assistants and nurse practitioners, and exclude emergency room codes to better target primary care.  This extension is estimated to cost $5.4 billion.

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Improving Access to and Retention in HIV Care

Ryan White HIV/AIDS Program: Working with cities, states, and local community-based organizations, the Ryan White Program provides HIV-related services to more than half a million people each year who do not have sufficient health care coverage or financial resources for coping with HIV. As a payor of last resort, the Ryan White Program fills gaps in care not covered by other sources.

HIV Care Continuum

The Ryan White HIV/AIDS Program continues to be responsive to the needs of people living with HIV/AIDS and plays a critical role in supporting patients across the HIV care continuum. This continuum, also referred to as the HIV treatment cascade, includes linkage to care, engaging and retaining patients in care, prescribing and improving adherence to antiretroviral medications, and achieving viral suppression. Many of the services supported by the Ryan White HIV/AIDS Program that are essential to people accessing care and remaining in care and on their medications are not covered by Medicaid or private insurance. By helping people stay in care and adhere to their antiretroviral treatments, the Ryan White HIV/AIDS Program plays a critical role in preventing the spread of the HIV epidemic, as people living with HIV who are on drug treatment and virally suppressed are much less likely to transmit the infection.

Many Ryan White clients will continue to gain access to health insurance or see their current health insurance improve in FY 2015 as a result of the Affordable Care Act. To respond to these changes, as well as changes in the epidemic, the federal government will continue thoughtful and careful coordination with state and local governments, Ryan White Program grantees, and clients.

The Budget includes $2.3 billion for the Ryan White HIV/AIDS Program to improve and expand access to care for persons living with HIV/AIDS. Of this amount, $900 million, the same level provided in FY 2014, is included for the AIDS Drug Assistance Program to ensure that people living with HIV/AIDS have access to life-saving antiretroviral medications. The Budget also proposes to consolidate funds from Part D to Part C. The Part C program will emphasize care across all vulnerable populations, genders and ages thus assuring services for women, infants, children, and youth throughout the program. By consolidating the two programs, resources can be better targeted to points along the care continuum and populations most in need throughout the country among an increased number of grantees.

Enhancing the Health of Families and Communities

Maternal and Child Health: The FY 2015 Budget requests $1.3 billion to improve the health of mothers and children, an increase of $126 million. This level includes $500 million in FY 2015 and $15 billion through FY 2024 to extend and expand the Maternal, Infant, and Early Childhood Home Visiting program, through which states are implementing evidence based home visiting programs that enable nurses, social workers, and other professionals to meet with at-risk families and connect them to assistance to support the child’s health, development, and ability to learn. These programs have been shown to improve maternal and child health and developmental outcomes, improve parenting skills and school readiness. The request also includes $634 million, the same as FY 2014, for the Maternal and Child Health Block Grant.

Investing in Critical Public Health Activities

340B Prescription Drug Discount Program: The 340B program provides discounts on outpatient prescription drugs to programs that serve a high number of low income patients. Participants in the 340B program include safety-net clinics and hospitals such as community health centers, Indian Health Service tribal clinics, children’s hospitals, critical access hospitals, Federally Qualified Health Centers and certain other community-based providers, and programs that target sexually transmitted disease and tuberculosis prevention and treatment among others. The Budget includes $17 million for the 340B program, an increase of $7 million above FY 2014, through a new cost recovery fee, which will help improve the program’s operations, oversight and integrity.

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Organ Transplantation: The Budget includes

$24 million, a modest increase over FY 2014, to coordinate organ donation activities and provide grants to states to develop and improve donor registries. In addition, the Budget requests $33 million to support patients who need a potentially life-saving marrow or cord blood transplant and to maintain the National Cord Blood Inventory.

Rural Health: Rural Americans experience higher rates of chronic disease, disability, and mortality as well as inequities in access to health services, including preventive care. In addition to the investments in health centers and the National Health Service Corps that will improve access to health care in rural areas, the Budget provides $125 million for targeted programs to assist Americans living in rural communities.

The Budget includes $57 million for Rural Health Outreach Grants to improve access to quality care, coordination of care, and integration of services to the 50 million Americans living in rural areas. Funding will also focus on improving the health care professional workforce in rural areas. Rural Health Outreach grantees are provided with the flexibility to allocate funds in ways that best meets the needs of their community. The Budget also provides $26 million to continue funding for Rural Hospital Flexibility grants to strengthen the infrastructure of small rural hospitals and administering quality improvement activities. The Budget also provides $14 million to support HRSA’s efforts to expand health technology systems and improve access to quality health care.

Supporting HRSA Programs

Program Management: The Budget requests $157 million, an increase of $4 million, to support a new consolidated facility that will improve efficiency over time. Program management funding also supports the infrastructure necessary to operate HRSA programs including rent, information technology, utilities, security, and agency oversight.

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