President’s FY2024 Budget Request
On March 9, President Biden released his Executive Budget Request to Congress for fiscal year 2024 (FY2024). The Administration also released the HHS Budget in Brief, which outlines $144.3 billion in discretionary funding for the Department of Health and Human Services (HHS). Notably, the FY2024 budget request introduced a request for a new 5-year national hepatitis C virus (HCV) elimination program. In addition, the budget request proposes $850 million in funding the Ending the HIV Epidemic Initiative (EHE), while maintaining a proposal for $237 million in mandatory spending for a national PrEP program and a new $50 million harm reduction program housed in the Substance Abuse and Mental Health Services Administration (SAMHSA).
The budget request proposes making permanent the expanded Affordable Care Act (ACA) premium tax credits that were extended in the Inflation Reduction Act. It also proposes Medicaid-like coverage to individuals in states that have not adopted Medicaid expansion under the ACA, paired with financial incentives to ensure states maintain their existing expansions.
It is important to note that this is a budget request and does not have the power of the law. Only Congress has the power to appropriate funds. NASTAD will continue to monitor the FY2024 appropriations process and advocate for the highest possible funding levels on behalf of HIV and hepatitis programs.
Centers for Disease Control and Prevention (CDC)
The CDC released their Justification of Estimates for Appropriation Committees that presents a detailed explanation of the President’s Budget Request for CDC. The President’s budget increases CDC funding by $2.2 billion over FY2023 levels. The budget provides $1.545 billion, an increase of $153.5 million, for the CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention (NCHHSTP).
|
Budget Activity |
Final FY2023 |
FY2024 President’s Request |
|
Domestic HIV Prevention and Research |
$986.7 m (+$22 m) |
$1,099 b (+$113 m) |
|
HIV Prevention |
$755.6 m ($0) |
$755.6 m ($0) |
|
EHE Initiative |
$220 m (+$25 m) |
$310 m (+$90 m) |
|
School Health |
$38.1 m (+$2 m) |
$90.1 m (+$52 m) |
|
Viral Hepatitis |
$43 m (+$2 m) |
$54.5 m (+$11.5 m) |
|
Infectious Diseases and the Opioid Epidemic |
$23 m (+$5 m) |
$23 m (+0) |
Division of HIV Prevention
The budget request provides flat funding for the Division of HIV Prevention core funding line. There is a proposed $90 million increase for CDC’s EHE efforts.
Division of Viral Hepatitis
The budget proposes an increase of $11.5 million for the Division of Viral Hepatitis, totaling $54.5 million in FY2024. The increase in funding will support greater testing for hepatitis B virus (HBV) and HCV in order to detect chronic infections and link people to treatment, support hepatitis prevention through technical assistance for jurisdictions implementing community-based syringe service programs (SSPs), improve the surveillance infrastructure at health departments to monitor and control the spread of hepatitis, and improve jurisdictional capacity to respond to outbreaks.
“This increase will support 59 health departments conducting viral hepatitis outbreak response and surveillance, support viral hepatitis elimination planning and implementation in target jurisdictions, and work with health clinics and community organizations to promote awareness and uptake of updated national viral hepatitis testing and vaccination recommendations.”
Infectious Diseases and the Opioid Epidemic
The budget proposes flat funding for the Infectious Diseases and the Opioid Epidemic program, totaling $23 million in FY2024. The proposed funding will support the implementation of high-quality syringe service programs across the country and boost access to the critical services they provide, such as HIV and hepatitis testing and linkage to health care and substance use disorder treatment. The budget highlighted the Strengthening Syringe Services Programs (SSPs) cooperative agreement, which will award $6 million in direct funding to SSPs, and special projects addressing infectious diseases.
STD Prevention
The budget proposed flat funding for STD prevention, totaling $174.3 million for FY2024.
TB Prevention
TB Prevention is funded at $137 million, which is level with FY2023.
Health Resources and Services Administration (HRSA)
HRSA detailed their FY2024 President’s Budget Request in the Justification of Estimates for Appropriation Committees. The budget would provide $9.2 billion in discretionary funding for HRSA. This would be $282 million less than the $9.4 billion in FY2023 HRSA funding that was recently passed and enacted.
Ryan White Program
The budget requests a $125 million increase for the Ryan White Program, with a proposed increase $125 million for EHE.
|
Budget Activity |
Final FY2023 |
FY2024 POTUS Request |
|
Ryan White |
$2.571 b (+$76.2 m) |
$2.696 b (+$125 m) |
|
Part A |
$680.8 m (+$10.3 m) |
$680.8 m ($0) |
|
Part B |
$464.6 m (+$20.6 m) |
$464.6 m ($0) |
|
Part B ADAP |
$900.3 m ($0) |
$900.3 m ($0) |
|
Part C |
$209 m (+$3.5 m) |
$209 m ($0) |
|
Part D |
$77.9 m (+$1.1 m) |
$77.9 m ($0) |
|
Part F: AETCs |
$34.9 m (+$0.5 m) |
$34.9 m ($0) |
|
Dental |
$13.6 m (+$0.2) |
$13.6 m ($0) |
|
SPNS |
$25 m ($0) |
$25 m ($0) |
|
Ryan White EHE |
$165m (+$40 m) |
$290 m (+$125 m) |
Bureau of Primary Care
As part of EHE, the budget includes a $15 million proposed increase for community health centers, bringing their EHE total to $172.3 million.
“In FY2024, the Budget includes a total of $172 million, an increase of $15 million above the FY2023 Enacted level, which will support the total participation of approximately 400 health centers in the EHE initiative targeted jurisdictions.”
Title X Family Planning Program
The Title X Family Planning Program is proposed at $512 million, an increase of $225.5 million over FY2023.
Department of Health and Human Services
The HHS Budget in Brief includes language on a proposed National PrEP Program that includes a proposed $237 million in FY2024 mandatory spending.
“The budget also reproposes the mandatory Pre-Exposure Prophylaxis (PrEP) Delivery Program to End the HIV Epidemic in the United States (“PrEP Delivery Program”). The PrEP Delivery Program will provide PrEP and associated services at no cost to uninsured and underinsured individuals and expand the number of providers serving underserved communities. The budget also increases access for Medicaid and CHIP beneficiaries by requiring states to cover PrEP and associated laboratory services with no cost sharing, and places guardrails on utilization management practices like prior authorization and step therapy. Together these two proposals will produce net savings over 10 years while saving lives."
Additionally, the HHS Budget in Brief calls for $11.3 billion in FY2024 mandatory spending to launch a new 5-year national program that aims to eliminate HCV in the US. The program will accelerate the availability of point-of-care HCV diagnostic tests, provide broad access to curative HCV treatment through a national prescription drug procurement model and Medicare co-pay assistance, and scale up existing hepatitis prevention, community outreach, and provider education efforts. Although the program carries a hefty FY2024 price tag, requiring authorization of $11.3 billion over five years, the investment is a downpayment that will pay off in by preventing downstream hepatitis-related health costs. In fact, the Office of Management and Budget (OMB) assessed that the net cost to the federal government across all accounts is $5.1 billion over ten years.
Other include language of interest:
“The budget includes $310 million, an increase of $90 million above FY 2023 enacted, to continue to advance HHS’s efforts to end the HIV/AIDS epidemic. This work will reach disproportionately affected populations, including gay and bisexual men of color, transgender and cisgender Black/African American women, and people who inject drugs. In FY 2024, the CDC will expand innovations, implement approaches that integrate health equity into the entire HIV prevention portfolio, test innovative service delivery models designed to increase access to prevention services, and strengthen engagement of community-based organizations in implementing the Ending the HIV Epidemic in the U.S. initiative.”
Minority HIV/AIDS Fund
The budget proposed $60 million for the Minority HIV/AIDS Fund, flat funding over FY2023.
Substance Abuse and Mental Health Services Administration (SAMHSA)
The FY2024 SAMHSA budget justification includes a strong focus on preventing overdose, including adoption of harm reduction approaches across SAMHSA programs. Notably, the budget requests $50 million for the Community Harm Reduction and Engagement Initiative, a new program that aims to bridge harm reduction and low-threshold treatment of opioid use disorder, including $3 million in additional funding for the National Harm Reduction Technical Assistance Center and $17 million for new grants targeted to small, community-based organizations. The program aims to connect people who inject drugs with overdose education and counseling, naloxone, infectious disease testing, and linkage to health care and coverage. Additionally, the SAMSHA budget justification proposes to remove the ban on federal funds to purchase syringes.
National Institutes of Health (NIH)
The NIH received flat funding for its EHE activities, at $26 million.
“The FY 2024 budget includes $26 million, flat with FY 2023 enacted, for NIH-sponsored Centers for AIDS Research and HIV/AIDS Research Centers to continue efforts toward accomplishing HHS’s initiative to end the HIV epidemic in the United States by 2030.”
Department of Interior
Indian Health Services
The budget provides $52 million to Indian Health Services for EHE activities, a proposed increase of $47 million.
Department of Housing and Urban Development
HOPWA
An increase of $6 million for HOPWA was proposed in the budget, for a funding total of $505 million.