Analysis: President Biden’s FY24 Budget Proposal

April 24, 2023

On March 9, the White House released President Biden’s FY24 budget proposal, which outlines the Administration’s funding priorities for the upcoming fiscal year. As a reminder, Congress has the authority to approve, reject, or modify the Administration’s budget recommendations.

ASTHO issued a statement in response to the FY24 President’s budget proposal and a legislative alert outlining a snapshot of the new initiatives and policies proposed by President Biden.

State and territorial health officials should view the HHS budget in brief for details and additional information about these programs included in the Congressional justifications hyperlinked below.

• Centers for Disease Control and Prevention (CDC)
• Health Resources and Services Administration (HRSA)
• Substance Abuse and Mental Health Services Administration (SAMHSA)
• Assistant Secretary for Preparedness and Response (ASPR)
• Food and Drug Administration (FDA)
• Department of Interior (DOI)

HRSA

The request proposes $15.9 billion for HRSA, an increase of $1.5 billion above FY23. Highlights include:

• $290 million, an increase of $125 million, to end the HIV epidemic.
• $512 million, an increase of $225.5 million, for the Title X Family Planning program to improve access to reproductive and preventive health services.
• $937.3 million, an increase of $121.6 million, for the Title V Maternal and Child Health Block Grant. This includes $333.7 million for Special Projects of Regional and National Significance funding and $145 million to support investments to improve maternal health and address disparities in maternal mortality and morbidity.
• $415.9 million, an increase of $63.4 million, to expand access and improve healthcare in rural communities. This includes $165 million, an increase of $20 million, for the rural communities opioid response program.
• $2.7 billion, an increase of $892.5 million, for HRSA workforce programs. This includes:
• $965.6 million, an increase of $547.7 million, for the National Health Service Corps.
• $387.4 million to train mental health and substance use disorder providers.
• $27.5 million to support new approaches to recruiting, supporting, and training new healthcare providers.
• $25 million to support the mental health and well-being of healthcare providers.
• $110.2 million to expand the diversity of the health profession workforce.
• $7.1 billion, an increase of $1.3 billion, for health centers. This includes $1.9 billion in discretionary funding and $5.2 billion in new proposed mandatory funding, considering the expiration of the current authorization at the end of FY23.
• $415.9 million, an increase of $63.4 million, for rural health related activities.
• $130 million for a new program to support patients diagnosed with Long COVID.
• $276 million, an increase of $119.4 million, to improve maternal health.

CDC

The request proposes $11.58 billion for CDC, an increase of $2.4 billion above FY23. Highlights include:

• $600 million, an increase of $250 million, to support public health infrastructure and capacity.
• $340 million, an increase of $165 million, for public health data modernization.
• $100 million, an increase of $92 million, for social determinants of health.
• $160 million, level funding, for the preventive health and health services block grant.
• $100 million, an increase of $50 million, for the Center for Forecasting and Outbreak Analytics.
• $1.26 billion, an increase of $336.6 million, for Immunization and Respiratory Diseases. This includes $999 million, an increase of $317 million, for the Section 317 immunization program and $251 million for the influenza program.
• $764.8 million, an increase of $72 million, for global health programs.
• $106 million, an increase of $35 million, for Public Health Workforce and Career Development.
• $35 million for the Infectious Disease Rapid Response Reserve Fund.
• $1.54 billion, an increase of $153 million, for HIV/AIDS, Vital Hepatitis, STI, and Tuberculosis prevention. This includes $310 million for the Ending HIV Epidemic Initiative, an increase of $90 million.
• $1.4 billion, an increase of $590.3 million, for injury prevention and control. This includes:
• $713.7 million, an increase of $207.8 million, for opioid abuse and overdose prevention and surveillance.
• $15 million, an increase of $6 million, for addressing adverse childhood experiences.
• $35 million, an increase of $22.5 million, for firearm injury and mortality prevention research.
• $268.1 million, an increase of $250 million, for youth and community violence prevention.
• $420.8 million, an increase of $174 million, for environmental health programs.
• $362.8 million for occupational safety and health.
• $1.8 billion, an increase of $388.2 million, for chronic disease prevention and health promotion.
• $943.2 million, an increase of $38.1 million, for public health preparedness and response.
• $845.8 million, an increase of $95 million, for emerging and zoonotic infectious diseases.
• $86 million, an increase of $1 million, for the Agency for Toxic Substances and Disease Registry.

The proposal also includes the following realignments that will help CDC increase accountability, reduce administrative burden, and provide programmatic flexibility:

• Realign $26 million for Lyme Disease to be included as a non-add under the Vector-Borne Diseases program, project, or activity (PPA).
• Consolidate the Public Health Emergency Preparedness Cooperative Agreement, Academic Center for Public Health Preparedness, and all other CDC Preparedness programs into a single PPA labeled “Domestic Preparedness” to provide CDC with greater flexibility to respond to public health emergencies.
• Consolidate all other Environmental Health, Climate and Health, and Safe Water PPAs into a single PPA labeled “Environmental Health Capacity” under the Environmental Health Activities budget activity.

SAMHSA

The request includes $10.8 billion for SAMHSA, an increase of $3.3 billion above FY23. Highlights include:

• $4.9 billion, an increase of $2.1 billion, for SAMHSA’s mental health activities. This includes $1.65 billion for the Community Mental Health Block Grant.
• $836 million, an increase of $334.4 million, to the 9-8-8 and Behavioral Health Crisis Services program.
• $5.5 billion, an increase of $1.3 billion, for substance use services that include harm reduction, treatment, and recovery services. This includes:
• $2 billion, an increase of $425 million, for state opioid response grants.
• $2.7 billion, an increase of $425 million, for the Substance Use Prevention, Treatment, and Recovery Services Block Grant.
• $183.8 million, a decrease of $151.1 million, for Health Surveillance and Program Support.
• $245.7 million, an increase of $8.9 million, for substance use prevention.

ASPR

The request proposes $4.3 billion for ASPR, an increase of $642.2 million above FY23. Highlights include:

• $995 million, an increase of $30 million, for the strategic national stockpile.
• $312.1 million, an increase of $7 million, for the Health Care Readiness and Recovery (formerly the Hospital Preparedness) program. Within this total, $240 million is provided for formula-based cooperative agreements to states, territories, and freely associated states, Washington, D.C., and three high-risk political subdivisions.

FDA

• $780.0 million for the tobacco program. With these resources, FDA will continue to invest in product review and evaluation, research, compliance and enforcement, public education campaigns, and policy development. The budget also requests an additional $100 million in user fees and requests authority to include manufacturers and importers of all deemed products among the tobacco product classes for which FDA assesses tobacco user fees. To ensure that resources keep up with new tobacco products, the proposal would also index future collections to inflation. This proposal would ensure FDA has the resources to address all regulated tobacco products, including e-cigarettes, which currently have high rates of youth use, as well as future novel products.
• $1.7 billion for food safety, nutrition, and cosmetics, an increase of $210.6 million above FY23, to support efforts and commitment to strengthen FDA’s food safety and nutrition capacity.

DOI

The Administration supports funding the renewal of our Compacts of Free Association relationships with the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. The Administration intends on seeking $6.5 billion in economic assistance over 20 years to be provided through a mandatory appropriation at the Department of State, and language calling for continued implementation of the Compacts at the Department of the Interior. Overall, the United States remains committed to its long-standing partnerships with the governments and people of the freely associated states.