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FY 2009 Budget Justification
 
PDF FY 2009 Budget Justification
(PDF – 2.69 MB)

OVERVIEW OF BUDGET REQUEST

INTRODUCTION AND MISSION
The Health Resources and Services Administration (HRSA), an Agency of the U.S. Department of Health and Human Services (DHHS), is the principal Federal Agency charged with increasing access to basic health care for those who are medically underserved. Health care in the United States is among the finest in the world, but it is not available to everyone. At a time when the Nation enjoys unprecedented prosperity, millions of families still face barriers to quality health care because of their income, lack of insurance, geographic isolation, or language and cultural barriers. In the report, America’s Health Care Safety Net, the Institute of Medicine concluded that the Nation’s health care safety net, while intact for the short term, is endangered over the longer term by shrinking resources (including available practitioners) and expanding responsibility. Assuring a safety net for individuals and families who live outside the economic and medical mainstream is a key HRSA role.

HRSA’s mission, as articulated in its Strategic Plan for 2005-2010, is to provide the national leadership, program resources and services needed to improve access to culturally competent, quality health care for uninsured, underserved, vulnerable, and special needs populations. HRSA programs and services target, for example:

  • The 47 million Americans who lack health insurance - many of whom are racial and ethnic minorities,
  • Over 50 million underserved Americans who live in rural and poor urban neighborhoods where health care services are scarce,
  • African American infants who still are 2.4 times as likely as white infants to die before their first birthday,
  • The more than 1 million people living with HIV/AIDS, both in and out of care,
    Over 94,000 Americans who are waiting for an organ transplant.

As the Nation’s access agency, HRSA envisions optimal health care for all, supported by a health care system that assures access to comprehensive, culturally competent, quality care.

OVERVIEW OF BUDGET REQUEST
The FY 2009 President’s Budget request for HRSA is $5,864,511,000 a decrease of $991,681,000 below the FY 2008 enacted level. Consistent with the Secretary’s policy guidance, this budget request continues support for the Administration’s priority initiatives and reflects the goals and objectives in the Department’s Strategic Plan. The FY 2009 request also continues support for the President’s High Poverty goal to place health centers in high poverty areas that currently lack a health center site.

The FY 2009 President's Budget request for HRSA is $5,864,511,000 a decrease of $991,681,000 below the FY 2008 enacted level. Consistent with the Secretarys policy guidance, this budget request continues support for the Administration's priority initiatives and reflects the goals and, objectives in the Department's Strategic Plan. The FY 2009 request also continues support for the Presidents High Poverty goal to place health centers in high poverty areas that currently lack a health center site.

Program increases:

Health Centers Presidential Goal (+$26 million).
The Presidents Health Center Initiative, which began in Fiscal Year 2002, has achieved its goal of significantly impacting over 1,200 communities through new or expanded access points. The request includes $26,000,000 for the Presidents High Poverty goal to fund up to 40 new access point grants in high poverty areas around the Nation without a Health Center site.

Health Centers Tort Claims (+$.8 million).
This increase will support claims to be paid in fiscal year 2009.

Hansen ;s Disease Center/ Buildings and Facilities/ Payment to Hawaii (+.4 million).
These programs will continue goals of increasing quality of care and improving health outcomes for Hansens Disease patients.

Nurse Loan Repayment and Scholarship Program (+$13.2 million)
This request supports an increase of $13.2 million for the Loan Repayment and Scholarship Program. The increase will support a commitment from nurses and nursing students to work in shortage facilities. The FY 2009 budget request will support 622 loan repayment awards for RNs agreeing to work in health care facilities with a critical shortage of nurses and an estimated 212 scholarships.

HIV/AIDS (+$1.1 million)
The FY 2009 request is a net increase of $1.1 million above the enacted level. This funding will continue to support over 2,300 providers that help half a million individuals living with HIV/AIDS obtain access to life-sustaining care and services. The FY 2009 Request includes an increase of $14,239,000 to support current Part B program activities and includes an increase of $6,046,000 to AIDS Drug Assistance Program that provides life-saving medications for an additional 148 people living with HIV over the FY 2008 target.

Healthcare Systems (+$3.5 million)

An additional $3.1 million is requested for the Cord Blood Stem Cell Bank and the budget requests an increase of
$.4 million for the Organ Transplantation program to continue support at the FY 2008 enacted level. The FY 2009 funds for Cord Blood will allow for continued collections by the second and third cohort of banks.

Parklawn Replacement (+$36 million).
This request includes $36.062 million to support HHS wide build-out costs for the Parklawn Replacement Prospectus.


Telehealth (+$.1million)

The funds requested will allow a new competition of the current Telehealth Network Grant Program that supports consortia of health providers to deploy telehealth technologies.


Program Decreases:


National Health Service Corps (NHSC) (-$2.5 million)
The $14 million decrease in the Field line is a reflection of the increased efficiencies and economies of scale experienced by the program. The $11.5 million increase in the Recruitment Line will focus on the recruitment of dentists into the NHSC: $1 million of this additional funding will support four new dental student scholars who will be available to serve in future years as they complete their training. The remaining $10.5 million will support new loan repayment contracts for 210 dentists over and above the 716 new loan repayment contracts that are projected to be made in this year

Faculty Loan Repayment/Minority Faculty Fellowship ($-1.3 million)
Funding is reduced by $1.3 million. This budget focuses on activities that fund the placement of nurses and other health professionals in areas that face shortages and provide direct care.


Health Professions (-$252.1 million)

This is a net decrease of $252.1 million. Funding has been reduced for activities that have demonstrated no impact on the placement of health professionals in underserved areas and invest resources to activities that have proven to be effective. Funding has been eliminated for the Health Professions Training for Diversity programs, the Training in Primary Care Medicine and Dentistry program, the Interdisciplinary, Community-Based Linkages and Public Health programs, and the Preventative Medicine and Dental Public Health Programs. Other sources of funding through partnerships are available to meet anticipated needs as the PART rated the training grants as ineffective. The FY 2009 Budget supports expanding direct health care services in high need areas. It is anticipated that programs will be supported through State, local resources or private foundations in the future. The budget request also eliminates funding for the Advanced Education Nursing Program.

Children's Hospitals Graduate Medical Education (-$301.6 million)
Funding has been eliminated for these payments as many childrens hospitals already receive payments from other public and private sources and are more likely to have positive profit margins than other hospitals.


Maternal and Child Health (-$40.4 million)

The budget request eliminates funding for the Traumatic Brain Injury, Universal Newborn Hearing and Emergency Medical Services for Children. These activities may be addressed more efficiently by a more flexible MCH Block Grant Program.


Healthcare Systems (-$17.3 million)
Funding is reduced for C.W. Bill Young Cell Transplantation Program by $.8 million, and the Poison Control Centers by $16.5 million. The FY 2009 Budget for the C.W. Bill Young Cell Transplantation Program will enable continued recruitment of new donors and continued facilitation of unrelated blood stem cell transplantation, and the budget for Poison Control Centers will assist centers in their efforts to achieve financial stability, increase access to services, and achieve certification. Ninety-five percent of poison control center are now certified, up from 78 percent in 2001.


Patient Navigator (-$2.9 million)

Funding for this program has been eliminated in FY 2009. This budget focuses on activities that fund the placement of more doctors, nurses, and other health care professions in regions of the country that face shortages.


Office of Rural Health (-$150.1 million)

This is a net decrease of $150.1 million. The majority of these programs were eliminated due to the investment in rural provisions within the Medicare Modernization Act of 2003.


Public Health Improvement (-$304.5 million)

Funding for these programs has been eliminated in FY 2009. The FY 2009 budget supports providing direct services and placing clinicians in areas with the greatest need.


HEALTH RESOURCES AND SERVICES ADMINISTRATION FY 2009 APT
(Dollars in Thousands)

Programs
FY 2007 Actual
FY 2008
Enacted
FY 2009
Request 1
Change from
FY 2008
DISCRETIONARY PROGRAMS:
PRIMARY CARE:
 Health Centers 1,943,484 2,021,737 $2,047,737 +26,000
 Health Center Tort Claims 44,555 43,285 44,055 +770
 Total, Health Centers 1,988,039 2,065,022 2,091,792 +26,770
 Free Clinics Medical Malpractice 41 40 40 -
 Hansen's Disease Center 15,972 15,693 16,109 +416
 Payment to Hawaii 1,996 1,961 1,976 +15
 Buildings and Facilities 220 157 100 -57
Total, Bureau of Primary Health Care 2,006,268 2,082,873 2,110,017 +27,144
CLINICIAN RECRUITMENT & SERVICE:
 National Health Service Corps Field 40,443
39,736 25,729 -14,007
 National Health Service Corps Recruitment 85,230 83,741 95,230 +11,489
 Nurse Loan Repayment and Scholarship  Program 31,055 30,512 43,744 +13,232
 Loan Repayment/Faculty Fellowships 1,289 1,266 - -1,266
Total, Clinician Recruitment & Service 158,017 155,255 164,703 +9,448
HEALTH PROFESSIONS:
Health Professions Training for Diversity:
 Centers of Excellence 11,880 12,773 - -12,773
 Scholarships for Disadvantaged Students 46,657 45,842 - -45,842
 Health Careers Opportunity Program 3,960 9,825 - -9,825
Subtotal, Health Professions Training for Diversity 62,497 68,440 - -68,440
 Training in Primary Care Medicine and  Dentistry 48,851 47,998 - -47,998
Interdisciplinary, Community-Based  Linkages:
Area Health Education Centers 28,681 28,180 - -28,180
 Geriatric Programs 31,548 30,997 - -30,997
 Allied Health and Other Disciplines 3,960 8,803 - -8,803
Subtotal, Interdisciplinary, Community-Based Linkages 64,189 67,980 - -67,980
Public Health Workforce Development:
 Public Health/Preventive Medicine; Dental  PH Programs 7,920 8,273 - -8,273
Subtotal, Public Health Workforce Development 7,920 8,273 - -8,273
Nursing Workforce Development:
 Advanced Education Nursing 57,061 61,875 - -61,875
 Nursing Workforce Diversity 16,107 15,826 16,107 +281
 Nurse Education, Practice and Retention 37,291 36,640 37,291 +651
 Nurse Faculty Loan Program 4,773 7,860 9,319 +1,459
 Comprehensive Geriatric Education 3,392 3,333 3,392 +59
Subtotal, Nursing Workforce Development 118,624 125,534 66,109 -59,425
 Patient Navigator Outreach & Chronic  Disease Prevention - 2,948 - -2,948
 Children's Hospitals Graduate Medical  Education Program 297,009 301,646 - -301,646
Total, Bureau of Health Professions 599,090 622,819 66,109 -556,710
 National Practitioner Data Bank (User  Fees) 16,200 18,570 18,900 +330
 Healthcare Integrity and Protection Data  Bank (User Fees) 3,825 3,758 - -3,758

HEALTH RESOURCES AND SERVICES ADMINISTRATION FY 2009 APT (Dollars in Thousands)

Programs
FY 2007 Actual
FY 2008 Enacted
FY 2009 Request
Change from
FY 2008
MATERNAL & CHILD HEALTH:
 Maternal and Child Health Block Grant 693,000 666,155 - -
 Autism and Other Developmental  Disorders - 36,354 666,155 -
 Traumatic Brain Injury 8,910 8,754 36,354 -8,754
 Sickle Cell Service Demonstrations 2,180 2,653 2,184 -469
 Universal Newborn Hearing 9,804 11,790 - -11,790
 Emergency Medical Services for Children 19,800 19,454 - -19,454
 Healthy Start
101,518 99,744 99,744 -
 Family to Family Health Information  Centers 3,000 4,000 5,000 +1,000
Total, Maternal and Child Health Bureau 838,212 848,904 809,437 -39,467
HIV/AIDS:
 Emergency Relief - Part A 603,993 627,149 619,424 -7,725
 Comprehensive Care - Part B 1,195,500 1,195,248 1,209,487 +14,239
 AIDS Drug Assistance Program
 (Non-Add)
789,546 808,500 814,546 +6,046
 Early Intervention - Part C 193,721 198,754 198,754 -
 Children, Youth, Women & Families -  Part  D
71,794 73,690 73,690 -
 Education and Training Centers - Part F 34,701 34,094 28,700 -5,394
 Dental Services Part F 13,086 12,857 12,857 -
 SPNS Evaluation Funding 25,000 25,000
25,000 -
Total, HIV/AIDS Bureau 2,137,795 2,166,792 2,167,912 +1,120
HEALTHCARE SYSTEMS:
 Organ Transplantation 23,049 22,646 23,049 +403
 Cord Blood Stem Cell Bank 3,963 8,843 11,966 +3,123
 C.W. Bill Young Cell Transplantation  Program 25,168 23,517 22,701
-816
 Poison Control Centers 23,000 26,528 10,000 -16,528
 340b Drug Pricing Program/Office of  Pharmacy Affairs
- - - -
 Trauma/Emergency Medical Services
- - - -
 State Health Access Grants - - - -
Total, Healthcare Systems Bureau 75,180 81,534 67,716 -13,818
RURAL HEALTH:
 Rural Health Policy Development 8,737 8,584 8,737 +153
 Rural Health Outreach Grants 38,885 48,031   -48,031
 Rural & Community Access to  Emergency  Devices 1,487 1,461 - -1,461
 Rural Hospital Flexibility Grants 63,538 37,865
- -37,865
 Delta Health Initiative - 24,563 8,141 -24,563
 State Offices of Rural Health 8,141 7,999 - +142
 Denali Project 39,283 38,597 - -38,597
 Radiogenic Diseases 1,919 1,884 1,904 +20
 Black Lung 5,891 5,788 5,886 +98
Total, Office of Rural Health Policy 167,881 174,772 24,668 -150,104
 Public Health Improvement (Facilities and  Other Projects) - 304,475 36,062 -304,475
 Parklawn Replacement - -6,700 6,819 +36,062
 Telehealth 6,819 141,087 141,087 +119
 Program Management 146,283 299,981 299,981 -
 Family Planning 283,146     -
 Undistributed Reductions   - - -

HEALTH RESOURCES AND SERVICES ADMINISTRATION FY 2009 APT (Dollars in Thousands)

Programs
FY 2007
Actual
FY 2008 Enacted
FY 2009
Request
Change from
FY 2008
Total, Discretionary Appropriation 6,390,691 6,856,192 5,864,511 -991,681
 SPNS Evaluation Funding 25,000 25,000 25,000 -
 National Practitioner Data Bank (User  Fees)
16,200
18,570
18,900
+330
 Healthcare Integrity and Protection Data  Bank (User Fees)
3,825

3,758

-3,758
Total, HRS Discretionary Program Level 6,435,716 6,903,520 5,908,411 -995,109
 HEAL Direct Operations 2,898 2,847 2,906 +59
 Vaccine Direct Operations
3,982
5,404
4,528
-876
Total, HRSA Discretionary Program Level
6,442,596
6,911,771
5,915,845
-995,926
 SPNS Evaluation Funding -25,000
-25,000
-25,000
-
 National Practitioner Data Bank (User  Fees) -16,200 -18,570 -18,900 -330
 Healthcare Integrity and Protection Data  Bank (User Fees) -3,825 -3,758 - +3,758
Total, HRSA Discretionary B. A 6,397,571 6,864,443 5,871,945 -992,498
MANDATORY PROGRAMS:
 Family to Family Health Information  Centers 3,000 4,000 5,000 +1,000
Total, HRSA Mandatory B.A 3,000 4,000 5,000 +1,000

 

Total, Discretionary Programs, B.A. 6,397,571 6,84,443 5,871,945 -992,248
Total, Mandatory Programs, B.A. 3,000 4,000 5,000 +1000
Total, B.A. 6,4000,571 6,868,443 5,876,945 -001,498

1 The FY 2009 Budget proposes a $5 million rescission for the Health Centers Gurantee Loan Program and a $100 million rescission for the Health Professions Student Loan Program.