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  6. President Biden Releases FY25 Budget Proposal

President Biden Releases FY25 Budget Proposal

March 12, 2024

On March 11, the White House released President Biden’s FY25 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. 

It is important to note that FY24 funding for HHS discretionary programs (CDC, HRSA, SAMHSA, and NIH) expires on March 22 and proposed funding for these programs should be released this week. Therefore, our analysis, and that of the White House, compares funding levels to FY23.

State and territorial health officials should view the HHS Budget in Brief for details, and additional information about these programs is included in the congressional justifications below. 

Key Public Health Funding Proposal Highlights

ASTHO member priorities received the following proposed funding levels:

  • $350 million, or level funding, for CDC’s public health infrastructure and capacity grant program. The budget also includes a legislative proposal that would allow CDC to dedicate a small percentage of funding to support a team of response-ready staff for short- and long-term emergency details or deployments.
  • $224.6 million, a $49.6 million increase, for CDC’s public health data modernization initiative.
  • $8 million, or level funding, for CDC’s social determinants of health program.
  • $735 million, or level funding, for CDC’s Public Hh Emergency Preparedness Cooperative Agreement. 
  • $160 million, or level funding, for the Preventive Health and Health Services Block Grant. 
  • $240 million, or level funding, for the Hospital Preparedness Program Cooperative Agreement.  

Pandemic Preparedness

The budget request includes $20 billion in mandatory funding for HHS public health agencies in support of the Administration’s biodefense priorities as outlined in the 2022 National Biodefense Strategy and Implementation Plan for Countering Biological Threats, Enhancing Pandemic Preparedness, and Achieving Global Health Security. Of this total, $6.1 billion is proposed for CDC to modernize and build laboratory capacity and strengthen public health data systems, enhance domestic and global disease surveillance, biosafety, and biosecurity efforts, and support capabilities for monitoring and evaluating vaccine and medical countermeasure safety and effectiveness. 

National Hepatitis C Elimination Program 

The FY25 budget includes a new HHS-wide proposal to eliminate hepatitis C infections in the United States, with a specific focus on high-risk populations. This five-year program will increase access to curative medications and expand the implementation of complementary efforts such as screening, testing, and provider capacity. The budget also re-proposes the mandatory Pre-Exposure Prophylaxis (PrEP) Delivery Program to End the HIV Epidemic in the United States (PrEP Delivery Program), which justwill 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.
  • The national hepatitis C elimination program will have a significant impact on the Medicare population. An eight- to 12-week course of oral direct-acting antiviral medication cures hepatitis C in more than 95% of people. Under this program, the federal government pays 100% of cost-sharing for Medicare Part D beneficiaries.

HRSA

The request proposes $16.3 billion total, a $2.0 billion increase from FY23, for HRSA. The discretionary budget authority for HRSA is $8.2 billion, a $1.2 billion decrease from FY23. Highlights include: 

  • $1.8 billion in Maternal and Child Health Bureau, an increase of $135.7 million. Specifically:
    • $831.7 million, a $15.5 million increase, for the Title V Maternal and Child Health Block Grant. This increase is proposed for Special Projects of Regional and National Significance.
    • $172 million, a $27.5 million increase, for Healthy Start.
    • $565.8 million, a $65.8 million increase, in mandatory funding (post-sequester) for the Maternal, Infant, and Early Childhood Home Visiting Program.  
    • $30.3 million, a $15 million increase, for Innovation for Maternal Health to address maternity care deserts and respond to obstetric emergencies.
  • $2.6 billion, a $775.4 million increase, for the Bureau of Health Workforce. Specifically: 
    • $915.6 million, a $497.7 million increase, for the National Health Service Corps.
    • $254 million, a $57 million increase, for behavioral health workforce development programs.
    • $320 million, a $20 million increase, for the nursing workforce development program.
    • $10 million for a new healthcare workforce innovation program with jumpstart strategies to grow the healthcare workforce and address healthcare workforce shortages across disciplines such as physicians, nursing, and behavioral health. This new program would invest in innovative approaches to accelerate the transformation of healthcare workforce training to support a modern, robust, and diverse workforce training pipeline. 
  • $8.2 billion, a $2.4 billion increase, for Health Centers. 
  • $175 million, a $10 million increase, for Ending the HIV Epidemic Initiative. 
  • $390 million, a $104 million increase, for the Family Planning Program (Title X), which is the only program to improve access to reproductive and preventive health services.  
  • $352.4 million, or level funding, for the Federal Office of Rural Health Policy. Specifically: 
    • $145 million, or level funding, for the Rural Communities Opioid Response Program. 
    • $10.4 million, or level funding, to support the Rural Maternity and Obstetrics Management Strategies program. 

CDC

Vaccines for Adults Program & Expansion of Vaccines for Children Program

  • The budget renews its proposal for a mandatory Vaccines for Adults program that will provide uninsured adults with access to routine and outbreak vaccines recommended by the Advisory Committee on Immunization Practices. 
  • The budget would also expand the Vaccines for Children (VFC) Program to include all children under the age of 19 enrolled in a separate Children’s Health Insurance Program and make program improvements, including setting a floor for provider reimbursements for vaccine administration and cover the vaccine administration fee for uninsured children without state share, eliminating cost sharing for all VFC-eligible children. 

The request proposes $9.68 billion, a $499.2 million increase from FY23, for CDC. Highlights include:

  • $723 million, or level funding, for CDC-Wide Activities and Program Support. Specifically:
    • $350 million, or level funding, for CDC’s public health infrastructure and capacity. The budget also includes a legislative proposal that would allow CDC to dedicate a small percentage of funding to support a team of response-ready staff for short- and long-term emergency details or deployments. 
    • $50 million, or level funding, to support the Center for Forecasting and Outbreak Analytics. CDC will prioritize funding for Insight Net, the nation’s first national network focused on developing a coordinated, national security approach to prepare for disease outbreaks.
    • $160 million, or level funding, for the preventive health and health services block grant. 
    • $35 million, or level funding, for the infectious disease rapid reserve fund.
  • $943.3 million, a $38.2 million increase, for public health preparedness and response. Specifically:
    • This includes level funding for the Public Health Emergency Preparedness cooperative agreement program, Academic Centers for Public Health Preparedness, and CDC Preparedness and Response Capability.
    • $60.1 million, an increase of $38.2 million, to maintain the Response Ready Enterprise Data Integration platform, formerly known as HHS Protect.
  • $1.6 billion, a $129 million increase, for chronic disease prevention and health promotion.
    • $90 million increase for cancer prevention and control.
    • $10 million increase for tobacco use prevention.
    • $10 million increase for safe motherhood/infant health.
    • $19 million increase for school health. 
  • $969.3 million, a $50 million increase, for immunization and respiratory diseases. This increase will provide resources needed to support the nation’s readiness to detect and respond to respiratory viruses capable of causing a public health emergency.
  • $1.4 billion, or level funding, for HIV/AIDS, viral hepatitis, STI, and tuberculosis prevention. 
  • $780.8 million, a $30 million increase, for emerging and zoonotic infectious diseases. Specifically:
    • $10 million increase for antimicrobial resistance.
    • $20 million to establish a wastewater surveillance program, which has previously been supported solely by COVID-19 supplemental resources.
    • $40 million, or level funding, for the Epidemiological and Laboratory Capacity program.
  • $205 million, or level funding, for birth defects, developmental disabilities, disability, and health.
  • $363.2 million, a $400,000 increase, for occupational safety and health.
  • $692.8 million, or level funding, for global health programs.
  • $943 million, a $182 million increase, for injury prevention activities. This includes: 
    • $38 million increase to expand activities related to suicide prevention. 
    • $21 million increase for adverse childhood experiences. 
    • $22.5 million increase for firearm injury and mortality research.
    • $100 million increase for community and youth violence prevention.
    • $500,000 increase for opioid overdose prevention and surveillance.
  • In addition to $100 million in discretionary funding, the FY25 budget includes $150 million in mandatory funding for the Community Violence Intervention Initiative, for a total of $2.5 billion in discretionary and mandatory funding over 10 years. This investment will support scaling up existing community violence prevention efforts and implementing and evaluating programs, policies, and practices based on the best available evidence for preventing community violence.
  • $267 million, a $20 million increase, to support environmental health activities. Specifically:
    • $20 million, a $10 million increase, for climate and health.
    • $61 million, a $10 million increase, for childhood lead poisoning prevention.
  • $85 million, or level funding, 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.
  • Realign Harmful Algal Blooms and Prion Disease PPAs as sub-activities under Emerging Infectious Diseases. CDC requests funds in FY25 for Wastewater Surveillance as a sub-activity under Emerging Infectious Diseases to begin the establishment of core support for wastewater surveillance.

The proposal also includes a request to “provide the HHS Secretary with new data authority to permit CDC to allow for more complete and timely data sharing to support decisions at the federal, state, and local levels, while reducing the burden on providers.” 

USDA 

Special Supplemental Nutrition Program for Women, Infants, and Children  

The FY25 budget proposes $8.5 billion for critical nutrition programs, including $7.7 billion, an increase of nearly $799 million above FY24 funding levels that were approved last week, to fully fund the WIC program. This will allow for the program to reach 800,000 more women, infants, and children each month. The proposal also includes an emergency contingency fund that would provide additional resources when there are unanticipated cost pressures. 

SAMHSA 

The request proposes $8.1 billion, a $612 million increase from FY23, for SAMHSA. Highlights include:

  • $602 million, a $100 million increase, for the 988 Suicide and Crisis Lifeline to improve infrastructure, bolster state and local response, and expand the Public Awareness Campaign. Additionally, this funding would continue support for Spanish language services and specialized service access for LGBTQI+ youth and young adults. 
  • $190 million, a $50 million increase, for Project Advancing Wellness and Resiliency in Education.
  • $3.5 billion, a $736 million increase, for SAMHSA’s mental health activities. This includes $413 million for a new mandatory Community Mental Health Centers program.
  • $4.2 billion, a $37 million increase, for substance use services. This includes: 
    • $2 billion, or level funding, for the Substance Use Prevention, Treatment, and Recovery Services Block Grant.
    • $1.59 billion, a $20 million increase, for State Opioid Response Grants.
    • $10 million for a new Community Harm Reduction and Engagement Initiative.
    • $43.9 million, a $5 million increase, for pregnant and postpartum women.
    • $1.75 million for a new Women’s Behavioral Health Technical Assistance Center. 
  • $236.9 million, or level funding, for Substance Use Prevention Services.
  • $174.1 million, or level funding, for Health Surveillance and Program Support.  

ASPR

The request proposes $3.8 billion, a $138 million increase from FY23, for ASPR to activate integrated federal capabilities in response to disasters of all kinds and to build biodefense and cybersecurity functions. Highlights include: 

  • $95 million to expand and accelerate development and domestic production of medical countermeasures and improve visibility and management of medical supply chains to mitigate potential shortages of priority drugs and devices. This includes $75 million for onshore production of medical countermeasures and active pharmaceutical ingredients, consistent with Made in America and National Biodefense Strategy goals, and $20 million to expand end-to-end visibility and management of the medical and public health supply chain for priority drugs and devices.
  • $970 million, a $20 million increase, for Biomedical Advance Research and Development Authority to develop new countermeasures for antimicrobial resistance. This funding also includes $328 million for ASPR’s pandemic influenza program, which seeks to develop an end-to-end strategy for future influenza pandemics. 
  • $317.1 million, a $12 million increase, for Health Care Readiness and Recovery. The additional funding will enhance ASPR’s Office of Critical Infrastructure Protection to improve HHS-wide responses to cyber incidents in the Healthcare and Public Health sectors. This includes $240 million, or level funding, for the Hospital Preparedness Program. 
  • $820 million, or level funding, for Project BioShield.
  • $925 million, or level funding, for the Strategic National Stockpile. 
  • $66 million, a $31 million decrease, for the National Disaster Medical System. This includes the elimination of Mission Zero (-$4 million), Public Health Preparedness Equipment (-$20 million), and Pediatric Disaster Care (- $7 million).   

DOI

The Administration supports funding the renewal of our Compact of Free Association relationships with the Federated States of Micronesia, the Republic of the Marshal Islands, and the Republic of Palau. The 2025 budget continues to seek $6.5 billion in economic assistance needed to bring negotiated Compact-related agreements into force through a mandatory appropriation at the Department of the Interior.