Keeping track of Health Center funding – what’s been made available, how much is going out, for what, and when – is the full-time job of a number of us here on NACHC’s Federal Affairs team. The funding cycle that starts with the President’s budget request, continues with Congressional action (“appropriations”) and ends with HRSA making awards – theoretically happens on an annual cycle, starting in February and ending in October. Though once you add larger Congressional fights over budget numbers to the mix, the timeline is rarely clean.
That brings us to this year’s Health Center funding. As Health Center advocates will recall, the current fiscal year’s (FY15) appropriation represented the biggest increase in funding – $1.4 billion over last year, for a total of $5.1 billion – ever made available by Congress for the program. In February, the President’s Budget called for “holding back” a portion of that increase – $541 million, to be exact – to use in case Congress failed to fix the Health Center Funding Cliff by the deadline of September 30th. At the time, that made sense – there was too much uncertainty surrounding the program’s future.
However, since Congress passed H.R. 2 in April, which extended mandatory funding for Health Centers for an additional 2 years, the threat of the cliff has been pushed back. We at NACHC have been urging the Obama administration (HRSA, HHS, and the White House) to ensure that all available funds – the full $1.4 billion – go out this year to the Health Centers where they are most needed. In May, NACHC CEO Tom Van Coverden sent a letter to HHS Secretary Mathews Burwell urging the administration to “fully utilize” the resources made available by Congress. A bipartisan group of Senators followed suit with their own letter in June. Thanks to your advocacy, many other Members of Congress have weighed in.
So, with the end of the Fiscal Year just over 2 months away, where do we stand?
Of the $1.4 billion increase, funds have gone out in the following amounts:
- $36.3 million in Quality Improvement grants to 1,113 Health Centers
- $51.3 million for 210 Behavioral Health Integration awards
- $101 million for 164 New Access Points in underserved communities
- $350 million for Expanded Services awards to all Health Centers
- $150 million for 150-175 Health Infrastructure Investment Program capital grants
That’s what’s gone out so far. Additionally, in last year’s final appropriations bill (remember the “CROmnibus”?), Congress required that HRSA allocate no less than $165 million to base grant adjustments. Lastly, approximately $100 million was cut from the program due to mandatory across-the-board “sequester” cuts.
That leaves approximately $446 million in resources that have yet to be spent (or “obligated”, in the DC budget parlance). In our conversations with the administration, we’ve urged these funds to go to several things: additional New Access Point awards (currently there are 302 so-called “approved unfunded” awards from this last round awaiting approval), additional capacity awards to health centers and additional base grant adjustments to take into account increases in the cost of care or to maintain fiscal stability or viability.
With budget pressures very tight on Capitol Hill and everything “on the table” for cuts at the end of the year, it is not realistic to think that if these funds are not allocated, the administration will simply be able to “carry them forward” into next year. Even more importantly, with the need for Health Center services and sites at all-time highs in communities around the country, with qualified applications already submitted, and with Congressional action having provided near-term stability to the program, there is no reason to wait on these investments.
We’re hopeful this message has been heard by the administration, but we’ll need to keep up the drumbeat. If you want more background or pointers on how to talk to your Member of Congress on this issue, email email@example.com.