Summary of FY24 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill (2024)

March 21, 2024

On March 21, Congress released a bipartisan spending package of the remaining six appropriation bills, including the FY24 Labor, Health and Human Services, Education, and Related Agencies appropriations bill. The release of this bill follows recent approval of six appropriation bills that provided full funding for the WIC program as well as funding for EPA, the Supplemental Nutrition Assistance Program, and FDA, among other critical programs.

Overall, the bill provides $222.22 billion, which is 1% below FY23 and aligned with funding levels included in the Fiscal Responsibility Act. In addition to providing level funding for most public health programs, the bill includes $4.3 billion in COVID-19 recissions, which, importantly, are unobligated federal COVID-19 funds. ASTHO will work with our federal partners to better understand potential impact.

Outlook

Funding for HHS discretionary programs expires on Friday, March 22, and it is unclear if there will be a partial government shutdown over the weekend to allow for consideration of the spending package. However, there is strong optimism that the package will be passed by Congress and subsequently approved by the President shortly thereafter.

Resources

• Bill Text
• Joint Explanatory Text
• Legislative Summaries (Majority and Minority)

Key Public Health Funding Proposal Highlights

ASTHO member priorities saw level funding or decreases in the bill:

• $350 million, or level funding, for public health infrastructure and capacity nationwide.
• $175 million, or level funding, to modernize public health data surveillance and analytics at CDC and state and local health departments.
• $6 million, a decrease of $2 million, for CDC's social determinants of health programs.
• $735 million, or level funding, for the CDC Public Health Preparedness Cooperative Agreements.
• $240 million, or level funding, for the ASPR Hospital Preparedness Program formula grants.
• $160 million, or level funding, for the Preventive Health and Health Services Block Grant.

HRSA

The bill includes $8.89 billion, a decrease of $577.2 million from FY23, for HRSA. It is important to note most of the topline decreased funding is from cuts to “community projects” and not core HRSA programs. This funding includes:

• $1.9 billion, or level funding, for health centers.
• $1.4 billion, an increase of $14 million, for the Bureau of Health Workforce.
• $1.2 billion, a decrease of $1 million, for the Maternal and Child Health Bureau. This includes $813.7 million, a decrease of $2 million, for the Maternal and Child Health Block Grant Special Projects of National Significance. The legislation includes a $1 million increase for screening and treatment for maternal depression. Additionally, the bill requests a plan within 180 days of enactment on steps that HRSA can take to assist with birth center expansion in rural and urban maternity care deserts.
• $128.6 million, an increase of $3 million, for the National Health Service Corps.
• $364.6 million, an increase of $12.2 million, for rural health.
• $122 million, an increase of $23 million, for health systems. This increase is specifically for the organ transplantation program.
• $2.6 billion, or level funding, for the Ryan White HIV/AIDS Program. This includes $165 million, or level funding, for the Ending the HIV/AIDS Epidemic initiative.
• $286.5 million, or level funding, for the Title X family planning.

CDC

This bill includes $9.2 billion, an increase of $4.5 million from FY23, for CDC. This funding includes:

• $350 million, or level funding, for public health infrastructure and capacity nationwide.
• $175 million, or level funding, to modernize public health data surveillance and analytics at CDC and state and local health departments.
• $6 million, a decrease of $2 million, for CDC's social determinants of health programs.
• $735 million, or level funding, for the CDC Public Health Preparedness Cooperative Agreements.
• $681.9 million, or level funding, for the Section 317 Immunization Program.
• $1.4 billion, or level funding, for HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention.
• $760.3 million, an increase of $9.5 million, for emerging and zoonotic infectious diseases. This includes $72 million, an increase of $1 million, for food safety.
• $1.4 billion, an increase of $3.5 million, for chronic disease prevention and health promotion. This includes $110.5 million, an increase of $2.5 million, for the Safe Motherhood Initiative.
• $206.1 million, an increase of $500,000, for birth defects and developmental disabilities.
• $754.5 million, or level funding, for Public Health Scientific Services.
• $242.9 million, a decrease of $4 million, for environmental health programs. This includes the elimination of the Vessel Sanitation program. Which now fully operates through user fees collected from voluntary inspections.
• $761.4 million, or level funding, for injury prevention and control.
• $692.8 million, or level funding, for global health.
• $938.2 million, an increase of $55 million, for public health preparedness and response. This includes $55 million for the Ready Response Enterprise Data Integration Platform and Forecasting and Outbreak Analytics.
• $25 million, a decrease of $10 million, for the Infectious Disease Rapid Response Reserve Fund.

In addition to funding, the bill includes the following report language for CDC:

• Public Health Data Modernization—The bill urges CDC to work with representatives from state, tribal, local, and territorial (STLT) health departments through a regular convening mechanism to establish a public health data sharing process to ensure that notifiable case data are reported to CDC during an emergency response event in a timely and efficient manner that is the least burdensome for STLT public health departments. This process should include the use of an established minimal data set and transmission via existing and automated reporting mechanisms to the extent possible.
• Long-term Health Monitoring—The bill includes language encouraging CDC to continue to work with state and local health departments to develop a long-term, follow-up study of the public health impacts.
• Infectious Diseases Rapid Response Reserve Fund—The bill includes new general provisions to clarify Reserve Fund reporting requirements. Additionally, it directs CDC to provide a table to the Committees on a monthly basis on all amounts available in the Reserve Fund for the current fiscal year and the preceding two fiscal years, including (1) each individual obligation above $5,000,000; (2) with respect to each such obligation, the notification to which it relates; and (3) the total amount unobligated in the Reserve Fund.
• Local Health Departments—The bill notes that federal funding intended for both state and local health departments does not consistently reach local health departments beyond those directly funded. The agreement encourages CDC to require states to fund local health departments when programmatically appropriate.
• High Obesity Rate Counties—The bill includes language requiring land grant universities who receive this funding to work with state and local public health departments and other partners to support measurable outcomes through community and population-level, evidenced-based obesity intervention programs.
• Maternity Practices in Infant Nutrition and Care—The bill includes language directing CDC to provide a briefing within 180 days of enactment of this bill on the Maternity Practices in Infant Nutrition and Care and Levels of Care Assessment Tool surveys.

SAMHSA

This bill includes $7.45 billion, a $70 million decrease from FY23, for SAMHSA. It is important to note most of the topline decreased funding is for “community projects” and not core SAMHSA programs. This funding includes:

• $140 million, or level funding, for Project AWARE (Advancing Wellness and Resiliency in Education).
• $2.78 billion, an increase of $20 million, for SAMHSA’s mental health activities. This includes $98.89 million, an increase of $5 million, for the National Child Traumatic Stress Initiative and $520 million, an $18 million increase, for the 988 Suicide and Crisis Lifeline.
• $4.16 billion, an increase of $2 million, for substance abuse treatment. This includes:
• $1.58 billion, or level funding, for State Opioid Response Grants.
• $2 billion, or level funding, for the Substance Use Prevention, Treatment, and Recovery Services Block Grant.
• $38.9 million, or level funding, for pregnant and postpartum women.
• $4.078 billion, or level funding, for substance abuse prevention.
• $236.9 million, or level funding, for substance use prevention services.
• $241.7 million, a decrease of $91.7 million decrease, for health surveillance and program support.

In addition to funding, the bill includes the following report language for SAMHSA:

• Homelessness—The bill directs SAMHSA to provide a report within 180 days of this policy’s enactment on how SAMHSA programs prioritize substance use and mental health for populations at risk of becoming homeless.
• Opioid Use Disorder (OUD) Relapse—The bill recognizes SAMHSA’s efforts to address OUD relapse and emphasizes that OUD detoxification should be followed with medication to prevent relapse.
• Outreach in Underserved Communities—The bill directs SAMHSA to provide outreach and technical assistance to underserved grant applicants and requests a report on best practices for attracting mental health professionals to underserved communities.

ASPR

This bill includes $3.6 billion, an increase of $5 million from FY23, for ASPR. This funding includes:

• $1.02 billion, an increase of $65 million, for the Biomedical Advanced Research and Developmental Authority.
• $825 million, an increase of $5 million, for Project BioShield.
• $980 million, an increase of $15 million, for the Strategic National Stockpile.
• $335 million, an increase of $7 million, for pandemic influenza preparedness. This includes $20,000,000 in unobligated balances from pandemic influenza supplemental appropriations for BARDA pandemic influenza activities.
• $78.9 million, a decrease of $18 million, for the National Disaster Medical System.
• $240 million, or level funding, for the ASPR Hospital Preparedness Program formula grants.
• $6.24 million, or level funding, for the Medical Reserve Corps.
• $10 million in new funding for pandemic preparedness and biodefense.

In addition to funding, the bill includes the following report language for ASPR:

• Antimicrobial Resistance—The bill requests a briefing within 180 days of enactment of this Act related to the transfer of antibacterial initiatives from the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator and/or the National Institute of Infectious Diseases into the Biomedical Advanced Research and Development Authority’s (BARDA’s) advanced development portfolio and FDA’s review of antimicrobial resistance tests.
• Public Health Emergency Countermeasure Enterprise (PHEMCE)—The bill reminds ASPR of the requirement to annually update the PHEMCE multiyear budget and directs ASPR to notify the appropriate committees 14 days in advance of any anticipated delay.