HHS FY2016 Budget in Brief
Health 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)
|Discretionary Budget Authority (non-add)||1,397||1,392||1,392||--|
|Current Law Mandatory Funding [non-add]||2,145||3,509||--||-3,509|
|New Mandatory Proposal [non-add]||--||--||2,700||+2,700|
|Health Centers Tort Claims||95||100||100||--|
|Free Clinics Medical Malpractice||0.040||0.100||0.100||--|
|Subtotal, Primary Care||3,636||5,001||4,191||-809|
|National Health Service Corps||283||287||810||+523|
|Discretionary Budget Authority (non-add)||--||--||287||+287|
|Current Law Mandatory (non-add)||283||287||--||-287|
|New Mandatory Proposal (non-add)||--||--||523||+523|
|Training for Diversity||81||82||85||+3|
|New Diversity Program [non-add]||--||--||14||+14|
|Oral Health Training||37||39||39||--|
|Interdisciplinary Community-Based Linkages||32||34||34||--|
|Area Health Education Centers [non-add]||71||73||53||-20|
|Clinical Training in Interprofessional Practice [non-add]||30||30||--||-30|
|Rural Physician Training Grants||--||--||10||+10|
|Workforce Information and Analysis||--||--||4||+4|
|Public Health and Preventive Medicine Programs||5||5||5||--|
|Nursing Workforce Development||18||21||17||-4|
|Children's Hospital Graduate Medical Education||223||232||232||--|
|Targeted Support for Graduate Medical Education||264||265||100||-165|
|National Practitioner Data Bank User Fees||--||--||400||+400|
|Subtotal, Health Workforce||27||19||20||+1|
|Maternal and Child Health||2014||2015||2016||2016
|Maternal and Child Health Block Grant||632||637||637||--|
|Sickle Cell Service Demonstrations||4||4||4||--|
|Traumatic Brain Injury||9||9||9||--|
|Autism and Other Developmental Disorders||47||47||47||--|
|Universal Newborn Hearing Screening||18||18||18||--|
|Emergency Medical Services for Children||20||20||20||--|
|Family to Family Health Information Centers (Mandatory)||5||2.5||--||-2.5|
|Current Law Mandatory Funding (non-add)||371||400||--||-400|
|New Mandatory Proposal (non-add)||--||--||500||+500|
|Subtotal, Maternal and Child Health||1,220||1,254||1,352||+97.5|
|Ryan White HIV/AIDS||2014||2015||2016||2016
|Emergency Relief - Part A||649||656||656||--|
|Comprehensive Care - Part B||1,314||1,315||1,315||--|
|AIDS Drug Assistance Program (non-add)||900||900||900||--|
|Early Intervention - Part C||206||201||280||+79|
|Children, Youth, Women, and Families - Part D||72||75||--||-75|
|Education and Training Centers - Part F||33||34||34||--|
|Dental Services - Part F||13||13||13||--|
|Special Projects of National Significance||25||25||25||--|
|Health Care Systems||2014||2015||2016||2016
|Cord Blood Stem Cell Bank||11||11||11||--|
|C.W. Bill Young Cell Transplantation Program||22||22||22||--|
|Poison Control Centers||19||19||19||--|
|340B Drug Pricing Program||10||10||25||+14.5|
|User Fee (non-add)||--||--||7.5||+7.5|
|Hansen's Disease Programs||17||17||17||--|
|Subtotal, Health Care Systems||103||103||118||+14.5|
|Rural and Community Access to Emergency Devices||3||4.5||--||-4.5|
|Rural Hospital Flexibility Grants||41||42||26||-15|
|Other Rural Health||92||101||101||--|
|Subtotal, Rural Health||142||147||128||-20|
|Vaccine Injury Compensation Program Direct Operations||6||7.5||7.5||--|
|Subtotal, Other Activities||445||448||465||+17|
|HRSA Budget Totals – Less Funds From Other Sources||2014||2015||2016||2016
|Total, Program Level||8,902||10,330||10,375||+45|
|PHS Evaluation Fund Appropriation||-25||--||--||--|
|Current Law Mandatory Funding||-2,804||-4,199||--||+4,199|
|New Mandatory Proposals||--||--||-4,123||-4,123|
|Total, Discretionary Budget Authority||6,046||6,112||6,225||+113|
Full Time Equivalents
2014 : 1,856
2015 : 1,985
2016 : 2,072
2016 +/- 2015 : +216
As the principal federal agency charged with increasing access to basic health care for those who are medically underserved, uninsured, or underinsured, the Health Resources and Services Administration (HRSA) is a vital component of the nation’s safety net. The FY 2016 Budget provides $10.4 billion total, including $4.1 billion in mandatory funding, to invest in and expand programs that will ensure that the nation’s most vulnerable populations, as well as the millions of newly insured individuals, have access to services and providers that meet their healthcare needs.
Ensuring Affordable and Available Health Care
Health Centers: Health centers provide quality, affordable health care and the peace of mind that comes with it to millions of individuals, regardless of their ability to pay, who they are, where they live, or their native language. The Budget provides $4.2 billion for the Health Centers Program in FY 2016, and requests $2.7 billion in mandatory resources in each of FYs 2016, 2017, and 2018, for a total of $8.1 billion in new mandatory funding. These resources, combined with FY 2015 funding reserved for use in FYs 2016-2018, will help sustain health center funding in future years and ensure that current health centers can continue to provide essential health care services to their patient populations.
In FY 2016, health centers will grow to serve a total of 28.6 million patients, an increase of 1.1 million, at 1,300 health centers that operate in over 9,000 locations across the country. This funding will maintain ongoing services for current grantees, including those funded in FY 2015, invest $50 million to establish 75 new health center locations across the country, and provide $40 million to recognize the highest clinically performing health centers nationwide as well as those that have made significant quality improvement gains.
Helping Americans Access Health Care
In small towns and big cities, health centers serve as a trusted network, connecting patients with community resources. The Affordable Care Act made substantial investments in health centers so they can open their doors to record numbers of patients. Since the beginning of the Administration, health centers have added 5 million patients; they now serve nearly 22 million patients each year, and that number is expected to grow to 28.6 million in FY 2016. Further, over 7 million people received enrollment assistance at their local health center to help them access coverage through the Affordable Care Act.
Americans continue to gain access to health insurance through Health Insurance Marketplaces or through expanded access to Medicaid in many states. Health centers are well positioned to meet this demand for services as they can provide an accessible and dependable source of primary care in underserved communities. In Massachusetts, after the passage of health insurance reform, health centers saw a significant increase in newly-insured patients. From 2005 to 2013, the number of health center patients in the state increased by more than 50 percent, even while the percentage of uninsured patients decreased by nearly 20 percent. 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 not covered by insurance.
340B Drug Pricing Program: The Budget provides $17 million in budget authority for the 340B Drug Pricing Program, an increase of $7 million above FY 2015. In addition, it proposes a new user fee totaling $7.5 million as a long‑term financing strategy to support the program’s activities.
The 340B Program requires drug manufacturers to provide outpatient prescription drugs to eligible health care organizations at significantly reduced prices. By offering organizations access to low‑cost medications, the 340B Program enables participating entities to stretch federal resources to treat more patients and provide more services to the most vulnerable patient populations. Eligible organizations include safety-net clinics and hospitals such as Federally Qualified Health Centers, children’s hospitals, critical access hospitals, Ryan White HIV/AIDS clinics and State AIDS Drug Assistance programs, Indian Health Service tribal clinics, and certain other community-based providers.
In recent years, HRSA has significantly increased its commitment to program integrity and compliance. As additional covered entities and associated sites join the 340B Program, HRSA has nearly doubled its program audits, instituted annual recertification for all entities, and increased its proactive education and technical assistance. Nearly 13,000 organizations and over 15,000 associated sites across the country currently participate in the 340B Program. In FY 2013, organizations participating in the 340B Program saved an estimated $3.8 billion on covered outpatient drugs.
Investing in a 21st Century Health Workforce
A well-trained and high-performing health workforce is vital to our nation’s future. The Budget provides a total of $1.8 billion for HRSA workforce programs—including $923 million in mandatory funding—in order to ensure that all Americans have access to high‑quality clinicians, particularly in areas across the country where shortages of health professionals exist. This effort includes strategic investments in graduate medical education, the National Health Service Corps, and workforce diversity. Additionally, the Budget invests in health workforce programs that target a number of specific disciplines and competencies, including oral health, mental and behavioral health, and geriatric medicine. By addressing the inadequate supply and distribution of certain health professionals, the diversity of the health workforce, and the need for training in interdisciplinary practices focused on more efficient models of care, the Budget works toward ensuring that all Americans have access to quality clinicians.
Targeted Support for Graduate Medical Education: The Budget requests $400 million in mandatory funding for the Targeted Support for Graduate Medical Education program. This competitive grant program would continue the work of the Teaching Health Center Graduate Medical Education program and offer a variety of eligible entities—including teaching hospitals, children’s hospitals, and community-based consortia of teaching hospitals and/or other health care entities— the opportunity to expand residency training, with a focus on primary and preventive care, which advances the goals of higher value health care that reduces long‑term costs.
The Budget proposes to continue mandatory funding for the Targeted Support for Graduate Medical Education program annually in FYs 2016-2025, for a total investment of $5.3 billion over these 10 years. During this period, the program is expected to support more than 13,000 residents by providing them with a range of training experiences while addressing key health care workforce development goals, including the training of more physicians in primary care and other specialties where there are shortages, better aligning training with efficient and effective care delivery, and encouraging physicians to practice in rural and underserved areas.
Children’s Hospital Graduate Medical Education: The Budget includes $100 million for the Children’s Hospital Graduate Medical Education program, which supports graduate training for physicians in freestanding children’s teaching hospitals across the country. This level would cover the full direct costs associated with training all the residents currently in the program.
National Health Service Corps: The National Health Service Corps is one of the most efficient and effective means to assist communities facing shortages of key health care professionals, including primary medical, oral, and mental and behavioral health clinicians. To achieve the goal of supporting communities with limited access to care, the Budget includes $810 million for the National Health Service Corps, including $523 million in mandatory funding. This funding will support scholarships and loan repayment for clinicians who commit to providing care in underserved communities across the country. In 2014, over 9,200 National Health Service Corps clinicians were practicing in underserved communities, approximately half of which were health centers and close to half of which were in rural America. The Budget would allow for significant growth in the National Health Service Corps, bringing it to a historic high of over 15,000 Corps members who serve nearly 16 million patients.
Supporting Diversity within the Health Workforce: A number of HRSA programs seek to foster a more diverse health workforce by providing support for individuals from disadvantaged backgrounds, including underrepresented racial and ethnic minorities. The Budget provides $14 million to establish a new program to increase the diversity of the health professions workforce. Greater diversity among health professionals is associated with improve access to care to health care, as minority clinicians are more likely to go on to practice in underserved communities.
This new program is expected to leverage or establish partnerships, including public-private partnerships, in academic training and workforce development. Building on both the experience gained from the Health Careers Opportunity Program and evidence-based strategies, grantees will provide academic enrichment and other supports to disadvantaged students to help them complete their education and enter the workforce. The Budget also includes $45 million for the Scholarships for Disadvantaged Students program, $25 million for the Centers of Excellence program, and $15 million for the Nursing Workforce Diversity program. These programs seek to increase the number of disadvantaged and/or underrepresented minorities within the health workforce. The goal of increasing diversity is to meet the growing need for culturally‑competent, quality health care for the nation’s diverse population and to reduce health disparities and inequities.
AIDS Drug Assistance Program Wait Lists
The most recent data demonstrates that those who remain in medical care through the Ryan White HIV/AIDS Program increased their viral suppression rates from 69.5 percent in 2010 to 75.1 percent in 2012, due in part to increased investments in the AIDS Drug Assistance Program. In FY 2012, the AIDS Drug Assistance Program, which provides grants to states to pay for HIV/AIDS medications for uninsured and low-income clients, served more than 244,000 individuals.
As a result of the economic downturn, a national HIV testing initiative that brought more people infected with HIV into care, changing federal guidelines for the treatment of HIV, and continued improvements in HIV care to prolong survival, led a number of states to implement waiting lists, beginning in 2008, to contain program costs at the expense of limiting patients’ access to drugs. Due to funding increases and the Department’s work to leverage funding flexibilities, waiting lists for HIV-related medications from the AIDS Drug Assistance Program decreased from a peak of 9,310 individuals in September 2011 to 0 in July 2014.
Continuing the Progress Needed to Achieve an AIDS-Free Generation
The FY 2016 Budget provides $2.3 billion for the Ryan White HIV/AIDS Program to support cities, states, and local community-based organizations that provide 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.
Funding in FY 2016 will continue to address gaps in the HIV Care Continuum, a model that shows the sequential stages of care from being diagnosed to receiving optimal treatment. Today, more than 1.2 million Americans are living with HIV infection; however, only 30 percent of these individuals are virally suppressed. The Ryan White HIV/AIDS Program supports many of the services that are essential for people to access and remain in care but are not covered by Medicaid or private insurance. By helping people stay in care and adhere to their 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. Within the requested funding level, $900 million, the same level as FY 2015, is allocated for the AIDS Drug Assistance Program, which provides grants to states to pay for HIV/AIDS medications for uninsured and low‑income clients who cannot afford the drugs due to inadequate insurance coverage. Since the beginning of this Administration, the number of clients served annually by state AIDS Drug Assistance Programs has increased by nearly 20 percent.
The Budget continues to propose consolidating funds in Ryan White Part C and Part D programs. The consolidated 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 among an increased number of grantees, while reducing duplication of effort and administrative burden.
Keeping Families and Communities Healthy
Maternal and Child Health: The FY 2016 Budget requests $1.4 billion, an increase of $98 million, to improve the physical and mental health, safety, and well‑being of the nation’s mothers, children, and their families. Of this amount, $500 million in mandatory funding is requested in FY 2016 and $15 billion through FY 2025 to extend and expand the Maternal, Infant, and Early Childhood Home Visiting program, which allows states to implement voluntary, evidence-based home visiting services to women during pregnancy and to parents with young children. These services enable nurses, social workers, and other professionals to meet with at-risk families and connect them to assistance to support children’s health, development, and learning ability. Home visiting programs have been shown to prevent child abuse and neglect, promote child health and development, including school readiness, and improve parenting skills. The request also provides $637 million, the same as FY 2015, for the Maternal and Child Health Block Grant, to improve the health of mothers, adolescents and children through a broad array of public health and community-based programs.
Rural Health: Over 46 million Americans live in rural areas. These individuals experience higher rates of chronic disease, disability, and mortality as well as inequities in access to health services, including preventive care, than their urban counterparts. The Budget provides $128 million for the Federal Office of Rural Health Policy within HRSA to work with rural hospitals and other rural health providers to ensure that Americans living in rural communities have access to high‑quality care.
The Budget also provides $4 million to fund new Rural Health Physician grants to help rural‑focused training programs recruit and graduate students most likely to practice medicine in underserved areas. In addition, the proposed expansion of the National Health Service Corps will also allow more providers to serve in high‑need rural communities across the country.
Family Planning: The Budget includes $300 million, an increase of $14 million above FY 2015, to expand family planning services to low-income individuals by improving access to family planning centers and preventive services. This funding will provide services to nearly 4.7 million low-income women and men at more than 4,150 clinics. Historically, 90 percent of family planning clients have family incomes at or below 200 percent of the federal poverty level.
In FY 2016, approximately 90 percent of family planning funding will be used for clinical services, such as screening for Chlamydia, other sexually transmitted diseases, and cervical cancer; providing a broad range of contraceptive methods; and administering community-based education and outreach. These services assist individuals and families with both preventing unintended pregnancy and assisting with achieving pregnancy leading to healthy birth outcomes.
Supporting HRSA Programs
Program Management: The Budget requests $157 million, an increase of $3 million, to support the infrastructure necessary to operate HRSA programs. Funding in FY 2016 will allow HRSA to enhance oversight of grant and contract recipients, improve program integrity and reduce improper payments, develop and maintain its information technology infrastructure, train and hire skilled staff, improve return on investment, and eliminate duplication.