Health Resources and Services Administration (HRSA)
HRSA Budget Overview
(Dollars in millions)
|Primary Health Care||2016 /1||2017 /2||2018||2018
|Discretionary Budget Authority [non-add]||1,392||1,389||1,389||--|
|Mandatory Funding [non-add]||3,600||3,511||3,600||+89|
|Health Centers Tort Claims||100||100||100||--|
|Free Clinics Medical Malpractice||0.1||0.1||0.1||--|
|Subtotal, Primary Care||5,092||5,000||5,089||+89|
|Health Workforce||2016 /1||2017 /2||2018||2018
|National Health Service Corps [Mandatory]||310||289||310||+21|
|Training for Diversity||83||83||--||-83|
|Training in Primary Care Medicine||39||39||--||-39|
|Oral Health Training||36||36||--||-36|
|Teaching Health Centers Graduate Medical Education [Mandatory]||60||56||60||+4|
|Area Health Education Centers||30||30||--||-30|
|Health Care Workforce Assessment||5||5||5||--|
|Public Health and Preventive Medicine Programs||21||21||--||-21|
|Nursing Workforce Development||229||229||83||-146|
|Children's Hospital Graduate Medical Education||295||294||295||+1|
|National Practitioner Data Bank User Fees||21||18||18||--|
|Other Workforce Programs||49||48||--||-48|
|Subtotal, Health Workforce||1,178||1,148||771||-377|
|Maternal and Child Health||2016 /1||2017 /2||2018||2018
|Maternal and Child Health|
|Maternal and Child Health Block Grant||638||637||667||+30|
|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||--|
|Home Visiting [Mandatory]||400||372||400||+28|
|Subtotal, Maternal and Child Health||1,250||1,236||1,200||-35|
|Ryan White HIV/AIDS Program||2016 /1||2017 /2||2018||2018
|Emergency Relief - Part A||656||655||655||--|
|Comprehensive Care - Part B||1,315||1,313||1,313||--|
|AIDS Drug Assistance Program [non-add]||900||899||899||--|
|Early Intervention - Part C||205||205||205||--|
|Children, Youth, Women, and Families - Part D||75||75||75||--|
|AIDS Education and Training Centers - Part F||34||34||--||-34|
|Dental Services - Part F||13||13||13||--|
|Special Projects of National Significance (SPNS)||25||25||--||-25|
|Subtotal, Ryan White HIV/AIDS||2,323||2,318||2,260||-59|
|Healthcare Systems||2016 /1||2017 /2||2018||2018
|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||10||--|
|Hansen's Disease Programs||17||17||13||-4|
|Subtotal, Healthcare Systems||103||103||99||-4|
|Rural Health||2016 /1||2017 /2||2018||2018
|Rural Outreach Grants||64||63||51||-13|
|Rural Hospital Flexibility Grants||42||42||--||-42|
|Rural Health Policy Development||9||9||5||-4|
|State Offices of Rural Health||10||9||--||-9|
|Radiation Exposure Screening and Education||2||2||2||--|
|Black Lung Clinics||7||7||7||--|
|Subtotal, Rural Health||150||149||74||-75|
dollars in millions
|2016 /1||2017 /2||2018||2018
|Vaccine Injury Compensation Program Direct Operations||8||7||9||+2|
|Subtotal, Other Activities||448||448||448||--|
|HRSA Budget Totals – Less Funds from Other Sources||2016 /1||2017 /2||2018||2018
|Total, Program Level||10,543||10,401||9,940||-460|
|Current Law Mandatory Funding||-4,375||-4,232||--||+4,232|
|New Mandatory Proposals||--||--||-4,375||-4,375|
|Total, Discretionary Budget Authority||6,147||6,150||5,548||-602|
1/ In addition, the FY 2016 Zika Response and Preparedness Act (P.L. 114-223) provided $387 million in supplemental resources to the Public Health and Social Services Emergency Fund for Zika response and preparedness activities, of which $66 million was allocated for HRSA.
2/ Reflects the annualized level of the Continuing Resolution that ended April 28, 2017, including the across the board reduction, the 21st Century Cures Act, and directed transfers.
The Health Resources and Services Administration is the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable. The FY 2018 Budget provides a total of $9.9 billion in funding for HRSA, which is $460 million below the funding level provided by the FY 2017 Continuing Resolution, and prioritizes the provision of direct health care services.
Ensuring Access to Direct Health Care Services
The Fiscal Year (FY) 2018 President’s Budget prioritizes direct health care services within the Health Resources and Services Administration (HRSA), including Health Centers and Ryan White HIV/AIDS programs. These safety-net providers deliver critical health care services to low-income and vulnerable populations.
For over 50 years, health centers have provided high-quality preventive and primary health care to Americans across the country. More than 24 million people—1 in 13 nationwide—receive direct health care services at health centers. Health centers advance a model of coordinated, comprehensive, and patient-centered medical, dental, behavioral, and patient services. Today, nearly 1,400 health centers operate over 10,400 service delivery sites and provide affordable health care services to patients in every State, the District of Columbia, Puerto Rico, U.S. Virgin Islands, and the Pacific Basin. The FY 2018 Budget provides $5.1 billion for Health Centers, which includes an additional $3.6 billion in new mandatory resources in Fiscal Years 2018 and 2019. At this funding level, health centers will serve nearly 26 million patients across the United States and its Territories in FY 2018. Within this funding, the FY 2018 Budget continues $50 million for grants from the prior year related to the treatment, prevention, and awareness of opioid abuse.
Ryan White HIV/AIDS Programs
For nearly three decades, the Ryan White HIV/AIDS Program has provided medical and support services to low-income individuals living with HIV/AIDS who do not have sufficient health care coverage or resources to access lifesaving care. As the largest Federal program focused exclusively on domestic HIV/AIDS care, the Ryan White HIV/AIDS Program reduces the use of more costly inpatient care, increases access to health services for underserved populations, improves survival, and reduces HIV transmission.
The FY 2018 Budget provides $2.3 billion—$59 million below the FY 2017 Continuing Resolution—for the Ryan White HIV/AIDS Program. The Ryan White HIV/AIDS Program provides a comprehensive system of primary medical care, treatment, and supportive services to more than half of the people in the United States who have been diagnosed with HIV. The Budget proposes prioritizing funding for direct health care services to people living with HIV by discontinuing the Ryan White HIV/AIDS Part F AIDS Education and Training Programs and Special Projects of National Significance.
DIRECT SERVICES PROGRAM
Ryan White HIV/AIDS ProgramIndividuals receiving HIV care through Ryan White achieve higher viral suppression, in comparison to the national average of 54.7 percent. In 2015, 83.4 percent of clients served by the Ryan White HIV/AIDS Program achieved viral suppression.
Within the requested funding level, the Budget provides $899 million, the same level as the FY 2017 Continuing Resolution for the AIDS Drug Assistance Program. This essential program provides grants to States to pay for HIV/AIDS medications and related services for uninsured, underinsured, and low-income patients who cannot afford them.
The Administration looks forward to working with Congress to reauthorize the Ryan White program to ensure that Federal funds are allocated to address the changing landscape of HIV across the United States. Reauthorization of the Ryan White program should include changes to the funding methodologies for Parts A and B to ensure that funds may be allocated to target populations experiencing high or increasing levels of HIV infections/diagnoses, such as minority populations, while continuing to support Americans that are already living with HIV across the nation. African Americans, for example, account for a higher proportion of new HIV diagnoses, those living with HIV, and those ever diagnosed with AIDS as compared to other races/ethnicities. The new Ryan White authorization should allow for resources to be focused on populations with disproportionately high rates of new infections/diagnoses.
Optimizing the Nation’s Health Workforce
The FY 2018 Budget provides $771 million in mandatory and discretionary resources for HRSA health workforce programs, which is $377 million below the FY 2017 Continuing Resolution. At this level, funding is maintained for activities that directly increase the number of health care professionals working in communities facing a shortage of such specialists by providing scholarships and loan repayments and by requiring service commitment.
National Health Service Corps
Since its inception in 1972, the National Health Service Corps has been committed to providing services to underserved populations. The National Health Service Corps provides scholarships and loan repayment to health care professionals in return for service commitments in communities experiencing a shortage of health professionals. The Budget includes $310 million in new mandatory resources for the National Health Service Corps in both FY 2018 and FY 2019, which will support an approximate field strength of 8,600 providers in FY 2018. The program continues to be one of the Nation’s most effective programs in placing health care professionals in communities with the greatest need.
Children’s Hospitals Graduate Medical Education
The Budget provides $295 million in discretionary funding for the Children’s Hospital Graduate Medical Education Program, which advances children’s health by providing funding to eligible freestanding hospitals to support the training of pediatricians and other residents. This program enables residents to provide health care services dedicated to children’s unique health care needs. Adequate residency training in pediatric care is important for residents who pursue a variety of specialties. In FY 2015, Children’s Hospitals Graduate Medical Education grantees reported training a total of 6,877 resident full-time equivalents on- and off-site. The Budget request will maintain this resident FTE level in FY 2018.
Teaching Health Center Graduate Medical Education
The Budget maintains funding for the Teaching Health Center Graduate Medical Education Program and requests $60 million in new mandatory funding in both FY 2018 and FY 2019. This program increases health care access in underserved communities by supporting primary care resident training in community-based, patient care settings. Since the Teaching Health Center Graduate Medical Education program’s inception in 2010, the number of supported programs has grown from 11 residency programs in the first year of funding to 59 programs in Academic Year 2016-2017 located in 24 different States across the Nation.
NURSE Corps Scholarship and Loan Repayment Program
The NURSE Corps Scholarship and Loan Repayment Program provides scholarships and loan repayment for individuals who are enrolled in an accredited school of nursing or nurses with eligible nursing educational loans in exchange for health care services in areas with critical nursing shortages. The Budget provides $83 million—the same level as the FY 2017 Continuing Resolution—to support over 1,200 nurses and nursing students.
Health Care Workforce Assessment
The Health Care Workforce Assessment Program supports the collection and analysis of data and information necessary to evaluate the effectiveness of the health workforce nation-wide. The Budget provides $5 million for this program—the same level as the FY 2017 Continuing Resolution—to continue supporting high-quality information collection and up-to-date research on the impacts of health workforce activities.
Workforce Program Eliminations
Priority is given to health workforce programs that support more targeted efforts to provide direct health care services to patients in primary care settings and in medically underserved communities. The Budget reduces funding for health workforce activities by $403 million by discontinuing diversity training programs, mental and behavioral health programs, oral health programs, and select nursing and physician training programs.
Keeping Families and Communities Healthy
Maternal and Child Health
The FY 2018 Budget prioritizes direct health care services and provides States and communities the flexibility to meet local needs. The request increases the funding that States receive through the Maternal and Child Health Block Grant to $667 million, which is an increase of $30 million above the FY 2017 Continuing Resolution. This funding supports services to more than half of the pregnant women and nearly one-third of all infants and children in the country. The additional funding will support greater State investment to improve the health of all mothers, children, and adolescents, particularly those in low-income families. The FY 2018 Budget also provides $128 million for the Healthy Start Program, which is a $10 million increase above the FY 2017 Continuing Resolution. The Healthy Start Program connects individuals with services that can reduce infant mortality and improve perinatal outcomes while allowing grantees to tailor services according to community need. In prioritizing the Maternal and Child Health Block Grant and Healthy Start, the Budget achieves a savings of $103 million by discontinuing smaller maternal and child health programs. States may continue to support these activities with their Maternal and Child Health Block Grant awards.
Response to Zika
In FY 2017, HRSA received $66 million in emergency supplemental funds to provide access to comprehensive health care and support services for children and families affected by the Zika virus in the United States and its Territories. Additionally, this funding played a critical role in increased clinical expertise of pediatric clinicians to provide care, and provided training and technical assistance on family-to-family support and referral services for children exposed to or affected by Zika in United States and its Territories.
The Budget also provides $400 million in new mandatory resources in Fiscal Years 2018 and 2019 for grants to States to provide home visiting services to at-risk pregnant women, mothers, and their families. These services build upon decades of scientific research that shows that home visits by a nurse, social worker, or early childhood educator during pregnancy and in the first years of life have the potential to improve the lives of children and families. Additionally, research shows that home visits provide a positive return on investment by reducing reliance upon emergency room visits and public benefits receipt, decreasing interaction with child protective services, and increasing parental earnings.
The Federal Office of Rural Health Policy provides technical assistance, conducts research, and makes grants to enhance health care delivery in rural communities. The President’s Budget provides $74 million—$75 million below the FY 2017 Continuing Resolution—to target funding for critical rural health activities such as Rural Health Outreach Network and Quality Improvement Grants, Rural Health Policy Development, Black Lung Clinics, and Telehealth. These investments will improve access to quality health care services in rural and underserved areas. Rural Hospital Flexibility Grants and State Offices of Rural Health are discontinued to prioritize programs that provide direct services.
The Budget provides $286 million—the same level as the FY 2017 Continuing Resolution—to support low-income individuals with comprehensive family planning and related preventive health services through the Title X Family Planning program. Historically, 90 percent of family planning clients have family incomes at or below 200 percent of the Federal poverty level. In FY 2017, approximately 90 percent of family planning funding will be used for clinical services, including the treatment and prevention of sexually transmitted diseases and cervical cancer. These services, along with community-based education and outreach, assist individuals and families with pregnancy leading to healthy birth outcomes and preventing unintended pregnancies.
Additional HRSA Programs
340B Drug Pricing Program
The 340B Drug Pricing Program requires drug manufacturers to provide outpatient prescription drugs to eligible health care organizations at reduced prices. This program helps safety-net health care providers to optimize scarce resources and expand access to care. The Budget provides $10 million for the 340B Drug Pricing Program, the same level as the FY 2017 Continuing Resolution. Additionally, the Budget proposes to update regulatory authority in the 340B Drug Pricing Program to increase transparency and improve program integrity.
The Budget requests $152 million—which is $2 million below the FY 2017 Continuing Resolution—to support the infrastructure necessary to operate HRSA programs. Funding in FY 2018 will allow HRSA to maintain oversight of grant and contract recipients, support program integrity efforts and reduce improper payments, develop and maintain its information technology infrastructure, train and support skilled staff, improve processes and business operations, and eliminate duplication.