HHS FY 2017 Budget in Brief - HRSA
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)
|Primary Health Care||2015||2016||2017||2017
|Discretionary Budget Authority [non-add]||1,392||1,392||1,242||-150|
|Current Law Mandatory Funding [non-add]||3,509||3,600||3,600||--|
|New Mandatory Proposal [non-add]||--||--||150||+150|
|Health Centers Tort Claims||100||100||100||--|
|Free Clinics Medical Malpractice||0.1||0.1||1||+0.9|
|Subtotal, Primary Care||5,001||5,092||5,092||--|
|National Health Service Corps||287||310||380||+70|
|Discretionary Budget Authority [non-add]||--||--||20||+20|
|Current Law Mandatory Funding [non-add]||287||310||310||--|
|New Mandatory Proposal [non-add]||--||--||50||+50|
|Training for Diversity||83||83||86||+3|
|Training in Primary Care Medicine||39||39||39||--|
|Oral Health Training||34||36||36||--|
|Teaching Health Centers Graduate Medical Education [Mandatory]||--||60||60||--|
|Interdisciplinary Community-Based Linkages /1||108||129||105||-24|
|Area Health Education Centers [non-add]||30||30||--||-30|
Behavioral Health Workforce Education and Training [non-add]
|Health Care Workforce Assessment||5||5||5||--|
|Public Health and Preventive Medicine Programs||21||21||17||-4|
|Nursing Workforce Development||232||229||229||--|
|Children's Hospital Graduate Medical Education||265||295||295||--|
|Discretionary Budget Authority [non-add]||265||295||--||-295|
|Proposed Mandatory Funding [non-add]||--||--||295||+295|
|National Practitioner Data Bank User Fees||19||21||21||--|
|Subtotal, Health Workforce||1,093||1,228||1,273||+45|
|Maternal and Child Health /2||2015||2016||2017||2017
|Maternal and Child Health Block Grant||637||638||638||--|
|Sickle Cell Demonstration Program||4||4||4||--|
|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||5||5||--|
|Subtotal, Maternal and Child Health||1,247||1,250||1,250||--|
|Ryan White HIV/AIDS Program||2015||2016||2017||2017
|Emergency Relief - Part A||655||656||656||--|
|Comprehensive Care - Part B||1,315||1,315||1,315||--|
|AIDS Drug Assistance Program [non-add]||900||900||900||--|
|Early Intervention - Part C||204||205||280||+75|
|Children, Youth, Women, and Families - Part D||73||75||--||-75|
|Education and Training Centers - Part F||33||34||34||--|
|Dental Services - Part F||13||13||13||--|
|Special Projects of National Significance (SPNS)||25||25||--||-25|
|SPNS PHS Evaluation Funds||--||--||34||+34|
Hepatitis C Treatment in People Living with HIV [non-add]
|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||26||+16|
|User Fees [non-add]||--||--||9||+9|
|Hansen's Disease Programs||17||17||17||--|
|Subtotal, Healthcare Systems||103||103||119||+16|
|Rural and Community Access to Emergency Devices||5||--||--||--|
|Rural Hospital Flexibility Grants||42||42||26||-16|
|Rural Opioid Overdose Reversal Grant Program||--||--||10||+10|
|Other Rural Health||86||91||91||--|
|Subtotal, Rural Health||147||150||144||-6|
|Vaccine Injury Compensation Program Direct Operations||7.5||7.5||9.2||+1.7|
|Subtotal, Other Activities||448||448||466||+18|
|HRSA Budget Totals – Less Funds from Other Sources||2015||2016||2017||2017
|Total, Program Level||10,358||10,593||10,677||+84|
|PHS Evaluation Funds||--||--||34||34|
|Current Law Mandatory Funding||4,201||4,375||4,375||--|
|New Mandatory Proposals||--||--||495||495|
|Total, Discretionary Budget Authority||6,138||6,197||5,743||-454|
1/ FY 2015 and FY 2016 final funding levels reflect funding for the Behavioral Health Workforce Education and Training program, which were appropriated to SAMHSA. This program is proposed to be transferred to HRSA beginning in FY 2017.
2/ Comparably adjusted to reflect the transfer of the Traumatic Brain Injury Program from HRSA to the Administration for Community Living beginning in FY 2016.
The Health Resources and Services Administration (HRSA) is the primary federal agency improving health and achieving health equity through access to quality services, a skilled health workforce, and innovative programs. HRSA’s programs provide health care to people who are geographically isolated, economically or medically vulnerable. The FY 2017 Budget provides $10.7 billion total, including $4.9 billion in mandatory funding to promote improvements in access, quality, and equity that are essential for a healthy nation.
Making Health Care Affordable and Accessible
Ensuring All Americans Have Access to Health Care
1 in 14 people nationwide receive care at a health center. For nearly 23 million Americans, health centers are essential medical institutions where they receive affordable care and diagnoses, treatment for disease and disability, and other important health care services. About 65 percent of health centers have been designated patient-centered medical homes, which means they provide high‑quality care and improve patient outcomes, while reducing disparities, despite serving a population that is often sicker and more at risk than the general population. Nearly 90 percent of health centers have electronic health records that support comprehensive care coordination and key quality improvement practices to manage patients with multiple health care needs. Health centers are a vital source of local employment and economic growth for the nation’s medically underserved communities and populations.
For 50 years, health centers have provided high‑quality preventive and primary health care to vulnerable populations across the country, regardless of ability to pay. Today, more than 1,300 health centers operate over 9,000 service delivery sites and provide valuable health care services to patients in every state, the District of Columbia, Puerto Rico, U.S. Virgin Islands, and the Pacific Basin. In 2014, 1 in every 14 people received care at a health center.
The FY 2017 Budget provides $5.1 billion for Health Centers. At this funding level, Health Centers will serve approximately 27 million patients nationwide. In addition, the funding level will support key primary care services, as well as oral health and behavioral health services, including substance abuse treatment. The FY 2017 Budget also proposes $3.6 billion in new mandatory resources in FY 2018 and FY 2019, to extend the current mandatory funding for 2 additional years.
340B Drug Pricing Program
The 340B Program requires drug manufacturers to provide outpatient prescription drugs to eligible health care organizations at significantly reduced prices. This program helps covered entities to stretch scarce resources as far as possible, reaching more eligible patients and providing more comprehensive services. Below is an example of some organizations that participate in the 340B Program:
- Safety‑net clinics, hospitals, and programs (e.g., Federally Qualified Health Centers, Ryan White HIV/AIDS clinics and State AIDS Drug Assistance programs, etc.)
- Indian Health Service tribal clinic funding
- Children’s hospitals
- Other community-based providers (e.g., Black Lung Clinics, Title X Family Planning Clinics, Tuberculosis Clinics, etc.)
To support these efforts, the Budget provides $17 million in budget authority for the 340B Drug Pricing Program, an increase of $7 million above FY 2016. In addition, it proposes a new user fee totaling $9 million to support the overall successful operation of the program in the long term.
The Administration is committed to program integrity in the 340B Program, and the FY 2017 Budget seeks new rulemaking authority to ensure adherence to the program’s principles, compliance with the law, and the most effective use of this critical safety‑net program.
Strengthening the Nation’s Health Workforce
HRSA health workforce programs improve the health of underserved and vulnerable populations by strengthening the health workforce and connecting skilled professionals to communities in need. These programs address supply and distribution challenges by training and placing health care providers in underserved areas across the nation; training a diverse, qualified, and culturally competent health care workforce to meet the unique needs of patients; and transforming training for health care delivery to meet the current and future needs of people across the country.
The Budget provides a total of $1.3 billion for HRSA workforce programs, including $715 million in mandatory funding to provide access to high‑quality health care professionals, particularly those living in areas across the country with shortages of health professionals. This funding includes investments in graduate medical education, the National Health Service Corps, and workforce diversity efforts. By addressing the shortage of primary care professionals that exists in certain parts of the country, HRSA health workforce programs play a critical role in making sure all Americans have access to high‑quality health care.
Children’s Hospital Graduate Medical Education
The Budget includes $295 million in mandatory funding in each of FYs 2017 through 2021 for the Children’s Hospital Graduate Medical Education Program, which helps eligible hospitals provide graduate training for pediatricians and pediatric subspecialists, and enhances their ability to care for low-income pediatric patients. Mandatory funding will provide a predictable funding stream for this program, as is the case for other residency programs supported by HHS.
Teaching Health Center Graduate Medical Education
The Budget proposes to strengthen and extend the Teaching Health Center Graduate Medical Education Program with a request for $527 million in new mandatory funding in FY 2018 through FY 2020. This program increases access in underserved communities by supporting primary care resident training in community-based, patient care settings. Since the program’s inception, nearly all residents received training in a medically underserved community, and just over 1 out of every 5 received training in a rural area.
National Health Service Corps
The National Health Service Corps is committed to serving medically underserved populations and is one of the nation’s most effective programs in placing health care professionals in communities with the highest need. The Budget includes $380 million for the National Health Service Corps, including $20 million in new discretionary and $50 million in new mandatory funding. The new mandatory funding will support two key Administration Initiatives to expand access to treatment for prescription drug abuse and heroin use, and to expand access to mental health services. The funding supports additional new loan repayment awards for behavioral health clinicians, including enhanced loan repayment for providers certified in medication-assisted treatment. The Budget also proposes to increase mandatory funding to $810 million in FYs 2018 through 2020. This funding will allow the National Health Service Corps field strength to increase to approximately 15,000.
Supporting Diversity within the Health Workforce
HRSA funding supports several workforce programs dedicated to training diverse and highly skilled health care providers across the country. The Budget provides $86 million for the Health Careers Opportunity Program, the Centers of Excellence Program, Scholarships for Disadvantaged Students Program, and the Faculty Loan Repayment Program.
Together with the National Health Service Corps, these investments are effective mechanisms for increasing diversity among health professionals and improving access to culturally competent, high‑quality care in underserved areas and for vulnerable populations.
Working Toward an AIDS‑Free Generation
First authorized in 1990, the Ryan White HIV/AIDS Program was established to provide services to individuals living with HIV/AIDS who do not have sufficient health care coverage or resources to access lifesaving care. The FY 2017 Budget provides $2.3 billion for the Ryan White HIV/AIDS Program to support cities, states, and community-based organizations to ensure that patients living with HIV have access to health services.
In line with the President’s National HIV/AIDS Strategy for the United States: Updated to 2020, the Ryan White HIV/AIDS Program plays a crucial role in the goals of reducing new HIV infections, increasing access to care, and optimizing health outcomes for people living with HIV, and achieving a more coordinated national response to the HIV epidemic.
Recent studies conclude that people living with HIV on antiretroviral medication who achieve viral load suppression are less likely to transmit HIV to others, thus reducing new infections by more than 96 percent. Funding in FY 2017 will help support the HIV Care Continuum Initiative, which is now integrated in the National HIV/AIDS Strategy. This initiative focuses on testing and antiretroviral treatment to achieve viral suppression for and improve the health outcomes of individuals with HIV. In 2013, over 78 percent of patients served by the Ryan White HIV/AIDS Program achieved viral suppression, an increase from 69 percent seen in 2010. By providing primary medical care, access to medications and supportive services, the Ryan White HIV/AIDS Program helps people gain access to consistent health care services and adhere to their individualized treatment plans.
Within the requested funding level, $900 million, the same level as FY 2016, is allocated for the AIDS Drug Assistance Program, which provides grants to states to pay for HIV/AIDS medications for uninsured, underinsured, and low-income patients who cannot afford them. Since the beginning of this Administration, the number of clients served annually by state AIDS Drug Assistance Programs has increased by nearly 37 percent.
The HIV epidemic is constantly changing, and thanks to the efforts of Ryan White HIV/AIDS Program grantees, a stand-alone, population‑specific grant program is no longer needed. The Budget continues to propose to consolidate the Part D program with the Part C program to ensure resources are better targeted to points along the care continuum, improve patient outcomes, and address the emerging needs of the epidemic across all populations. The consolidated Part C program will emphasize care for women, infants, children, and youth across all funded recipients, while reducing duplication of effort and administrative burden.
Hepatitis C Treatment in People Living with HIV
People living with HIV are disproportionally affected by viral hepatitis and are at increased risk for serious, life‑threatening complications. About one quarter of all people living with HIV are co-infected with Hepatitis C, and the rate is even higher (80 percent) amongst people living with HIV who inject drugs. Given the changes in the health care environment and advances in Hepatitis C Treatment, the FY 2017 Budget includes $9 million to expand screening and treatment of Hepatitis C in People Living with HIV.
This year, the Budget includes $9 million for an initiative to expand Hepatitis C Treatment in People Living with HIV. This program will use existing systems to develop evidence-informed models to increase testing for Hepatitis C, build capacity to expand treatment of Hepatitis C, and disseminate the models of care to patients in need.
Promoting Healthy Families and Communities
Maternal and Child Health
The FY 2017 request proposes to extend and expand the Maternal, Infant, and Early Childhood Home Visiting program by an additional $15 billion in new funds over 10 years to expand access for at-risk families to voluntary, evidence-based home visiting services where nurses, social workers, and other professionals meet with families and connect them with assistance that supports and improves their children’s health, development, and ability to learn. This proposal builds on HRSA’s update of the program in FY 2016 that sought to stabilize funding to states and allow programs to maximize the use of resources to deliver services to families. The Budget also provides $845 million to maintain other programs that improve the physical and mental health, safety, and well-being of the nation’s mothers, children, and their families, including the Maternal and Child Health Block Grant.
Rural residents experience higher rates of age-adjusted mortality, chronic disease, and disability than residents of urban communities. The Budget provides $144 million for the Federal Office of Rural Health Policy, which supports rural hospitals and other rural health providers in their provision of accessible and quality health care for Americans living in rural communities. According to the Centers for Disease Control and Prevention, Americans living in rural areas are more likely to overdose from opioid drug abuse than individuals living in cities. The FY 2017 Budget includes $10 million for the Rural Opioid Overdose Reversal Program, which aims to reverse the incidence of morbidity and mortality related to opioid overdoses in rural communities through the purchase and placement of emergency devices used to rapidly reverse the effects of opioid overdoses, as well as training of licensed health care professionals and emergency responders on their use.
The Title X Family Planning Program is the sole federal grant program dedicated to providing individuals with quality, comprehensive family planning and preventive health services. The Budget provides $300 million, an increase of $14 million above FY 2016, to expand family planning services to individuals in need by improving access to family planning centers and preventive services. This funding will provide support to approximately 4 million women, roughly 90 percent of whom have family incomes at or below 200 percent of the federal poverty level.
At this funding level, the Family Planning Program expects to help prevent approximately 1,300 cases of infertility though chlamydia screenings, as well as help prevent over 400 cases of cervical cancer through cervical cancer screenings.
Supporting HRSA Programs
The Budget provides $157 million, an increase of $3 million about FY 2016, to support HRSA’s program operations. Funding in FY 2017 will allow HRSA to enhance oversight of grant and contract recipients, improve data transparency and program integrity, develop and maintain infrastructure, train and hire quality staff, and improve overall management and program operations.