The new $1.3 trillion budget bill that finances the federal government through September increased funding for a number of health programs that directly impact states, including rural programs to combat the opioid crisis. There were no appropriations made to stabilize Affordable Care Act (ACA) insurance markets.
Under the budget, the Department of Health and Human Services (HHS) receives $78 billion, a $10 billion increase, and the Centers for Medicare & Medicaid Services (CMS) receives $4 billion for administrative expenses, the same as in 2017. Below is a summary of key health related spending in the federal budget.
Opioid crisis: Funding to combat the opioid crisis received a $2.55 billion hike to reach $3.6 billion. The Substance Abuse and Mental Health Services Administration (SAMHSA) received a $1.3 billion increase, bringing it to $5 billion. The legislation maintains the ban on using federal funds for the purchase of syringes and needles, but allows communities with marked increases in HIV and viral hepatitis infection rates to use federal funds for services such as substance-use counseling and treatment referrals.
The SAMHSA budget includes $1.9 billion for the Substance Abuse Block Grant, similar to last year’s appropriation, an $11 million increase in criminal justice funding (bringing it to $89 million, which includes $70 million for drug courts), and $1.7 billion to address opioid and heroin abuse (an increase of $1.5 billion), including $500 million for the state opioid response grants authorized in the 21st Century Cures Act, along with funding for programs authorized in the Comprehensive Addiction and Recovery Act.
One of the new initiatives was $105 million to expand the National Health Service Corps (NHS) to offer opioid and substance use disorder treatment in rural and underserved areas. NHS substance use disorder counselors will be eligible for loan repayment. About $30 million will be devoted to the new Rural Communities Opioid Response initiative within the Office of Rural Health.
Mental health programs: Funding for mental health programs increased about 17 percent to $3.2 billion, which includes $100 million for Certified Community Behavioral Health Clinics. That program, midway through a two-year demonstration program at 67 centers, has been used to combat the opioid crisis.
The bill also increases funding for Mental Health First Aid to $19 million and gives first responders training to help connect people having mental health or addiction crises to community help.
According to the National Council for Behavioral Health, funding was maintained for the Primary and Behavioral Healthcare Integration program, which has provided screening and treatment for conditions like diabetes and heart disease for more than 98,000 individuals living with serious mental illness or addiction at more than 213 sites.
Among the mental health programs funded by the 21st Century Cures Act, including the Mental Health Block Grant, are the National Traumatic Stress Network, the National Child Traumatic Stress Initiative, Mental and Behavioral Health Training Grants, Assisted Outpatient Treatment, and the National Suicide Prevention Lifeline. Of the new funding, 15 percent will go to states with the highest mortality rates related to opioid-use disorders.
The Health Resources and Services Administration receives $7 billion, including $315 million for the Children’s Hospital Graduate Medical Education program, $110 million for the Healthy Start program, and $652 million for the Maternal and Child Health Block Grant.
The legislation increased funding for the National Institutes of Health (NIH) by $3 billion, bringing it to $37 billion, and the Centers for Disease Control and Prevention (CDC)’s budget increased $1.1 billion, bringing it to $8.3 billion.
Impact on ACA’s public health provisions: Much of CDC’s increase results from reallocating $801 million from the ACA’s Prevention and Public Health Fund and $240 million from its Nonrecurring Expenses Fund. The CDC’s Public Health Preparedness and Response programs will get a $45 million boost, bringing it to $1.45 billion.
New ACA oversight imposed: Congress did not fund efforts to reduce premiums through cost-sharing reduction payments, nor did it fund any reinsurance programs that would allow states to spread the financial risk for high-risk individuals across insurance markets. Congress did impose more reporting requirements on ACA programs.
- CMS must now notify Congressional committees two business days before any ACA-related data or grant opportunities are released to the public.
- New “transparency” language requires the Administration to publish ACA-related spending by category since its inception.
- The Administration must publish information on the number of employees, contractors, and activities involved in implementing, administering, or enforcing ACA provisions.