Early on March 21st, Congress released the final minibus package for Fiscal Year 2024 which includes the Labor-HHS bill, and now must work quickly pass it before a partial shutdown occurs. On March 22nd, the House passed the package, and the Senate is expected to pass it over the weekend, averting a partial government shutdown. Notably, HHS received $117 billion, or roughly $955 million more than FY23, while other parts of the L-HHS bill received small cuts. This increase is significant in a difficult federal funding environment where non-defense discretionary spending was capped by the Fiscal Responsibility Act, the debt-ceiling agreement reached last spring. As expected, the bill rescinds $4.3 billion in COVID-19 supplemental funds which will come from unobligated funds across HHS. The impact of these recissions for the agencies within HHS will be determined over the next several weeks. We wrote an explainer on COVID-19 recissions earlier this year which you can find here.
While previous reporting indicated there was discussion of including several health-related bills, ultimately these did not make it into the final agreement, leaving the Pandemic All Hazards Preparedness Act yet to be reauthorized. However, the President’s Emergency Plan for AIDS Relief (PEPFAR), which lapsed six months ago, will be extended for another year as-is, along with the Hyde amendment and other legacy policy riders. Throughout the FY24 negotiations, NACCHO advocated to protect public health programs across the federal government and put a spotlight on programs that are critical to local health departments.
Overall, the bill includes $9.2 billion for CDC, with a small increase of $4.5 million above FY23. This topline includes $1.2 billion in transfers from the Prevention and Public Health Fund. For SAMHSA, the agreement includes $7.4 billion, a decrease of approximately $70 million from FY23. For HRSA, the bill includes $8.9 billion, a decrease of approximately $600 million from FY23. Within HRSA, the bill includes $2.6 billion for the Ryan White HIV/AIDS program and $286 million for Title X Family Planning, both of which are equal to FY23 levels. For FDA, the agreement includes $6.7 billion, which is a $49 million increase above FY23.
Additionally, the bill provides $3.6 billion for ASPR, which is a slight increase of $4.9 million above FY23. The majority of public health programs received level funding. Notable programs for preparedness for public health emergencies included in the agreement are:
- $1 billion for the Biomedical Advanced Research and Development Authority (BARDA), an increase of $65 million above FY23
- $825 million for Project BioShield, an increase of $5 million above FY23
- $980 million for the Strategic National Stockpile, an increase of $15 million above FY23
- $335 million for pandemic influenza preparedness, equal to FY23
Other key programs to local health departments:
- $350 million for the Public Health Infrastructure and Capacity, equal to FY23
- $175 million for the Public Health Data Modernization Initiative, equal to FY23
- $735 million for the Public Health Emergency Preparedness Cooperative Agreements, equal to FY23
- $681.9 million for the 317 Vaccine Program, equal to FY23
- $6.24 million for the Medical Reserve Corps, equal to FY23
The joint explanatory text, also commonly referred to as report language, explains various elements of the agreement in relation to the positions the House and Senate committed to while in conference. Notable elements for local public health include:
- Local Health Departments- The agreement 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.
- Public Health Data Modernization- The agreement 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.
| FY24 | FY23 Enacted | + / - FY23 | |
| Centers for Disease Control and Prevention | $9.2 billion | $9.18 billion | +$4.5 million |
| Vaccines for Children | $5.814 billion | $5.217 billion | +$597 million |
| Immunization and Respiratory Diseases | $919.3 million | $919.3 million | $0 |
| Influenza Planning and Response | $231,358 million | $231.358 million | $0 |
| HIV, Viral Hepatitis, Sexually Transmitted Infections, and Tuberculosis | $1.4 billion | $1.4 billion | $0 |
| Domestic HIV Prevention and Research | $1.013 billion | $1.013 billion | $0 |
| Viral Hepatitis Prevention | $43 million | $43 million | $0 |
| Sexually Transmitted Infections Prevention | $174.310 million | $174.310 million | $0 |
| Tuberculosis Prevention | $137.034 million | $137.034 million | $0 |
| Infectious Diseases and the Opioid Epidemic | $23 million | $23 million | $0 |
| Emerging and Zoonotic Infectious Diseases | $760.272 million | $750.772 million | +$9.5 million |
| Emerging Infectious Diseases | $213.997 million | $213.997 million | $0 |
| Food Safety | $72 million | $71 million | +$1 million |
| Epidemiology and Laboratory Capacity Grants (Prevention and Public Health Fund) | $40 million | $40 million | $0 |
| National Healthcare Safety Network | $24 million | $24 million | $0 |
| Advanced Molecular Detection (AMD) | $40 million | $40 million | $0 |
| Chronic Disease Prevention and Health Promotion | $1.43 billion | $1.43 billion | +$3.5 million |
| Racial and Ethnic Approaches to Community Health | $68.95 million | $68.95 million | $0 |
| Tobacco | $246.5 million | $246.5 million | $0 |
| Million Hearts (PPHF) | $5 million | $5 million | $0 |
| Safe Motherhood/Infant Health | $110.5 million | $108 million | +$2.5 million |
| Diabetes Prevention Program | $37.3 million | $37.3 million | $0 |
| Diabetes Prevention Program (PPHF) | $66.412 million | $52.275 million | +$14.137 million |
| School Health | $19.4 million | $19.081 million | +$319,000 |
| Birth Defects, Developmental Disabilities, Disabilities and Health | $206.06 million | $205.56 million | +$500,000 |
| Surveillance for Emerging Threats to Mothers and Babies (SET-NET) | $23 million | $23 million | $0 |
| Environmental Health | $242.850 million | $246.850 million | -$4 million |
| Climate and Health | $10 million | ||
| Environmental Health Activities | $51 million | $52.6 million | -$1.6 million |
| Childhood Lead Poisoning Prevention | $51 million | $51 million | $0 |
| Asthma | $33.5 million | $33.5 million | $0 |
| Environmental and Health Outcome Tracking Network | $34 million | $34 million | $0 |
| Injury Prevention and Control | $761.379 million | $761.379 million | $0 |
| National Violent Death Reporting System (NVDRS) | $24.5 million | $24.5 million | $0 |
| Injury Prevention Activities | $29.950 million | $29.950 million | $0 |
| Opioid Abuse and Overdose Prevention and Surveillance | $505.579 million | $505.079 million | $500,000 |
| Public Health Preparedness and Response | $938.2 million | $883.2 million | +$55 million |
| Public Health Scientific Services | $711.553 million | $754.497 million | -$42.944 million |
| Public Health Workforce Development | $71 million | $71 million | $0 |
| Surveillance, Epidemiology, and Public Health Informatics | $298.1 million | $298.1 million | $0 |
| Health Statistics | $187.397 million | $187.397 million | $0 |
| CDC-Wide Activities and Program Support | $663.570 million | $723.570 million | -$60 million |
| Public Health Leadership and Support | $128.570 million | $128.570 million | $0 |
| Preventative Health and Health Services Block Grant (PPHF) | $160 million | $160 million | $0 |
| Infectious Disease Rapid Response Reserve Fund | $25 million | $35 million | -$10million |
| Public Health Infrastructure and Capacity | $350 million | $350 million | $0 |
| FY24 | FY23 Enacted | + / - FY23 | |
| Assistant Secretary for Preparedness and Response (ASPR) | $3.634 billion | $3.629 billion | +$4.9 million |
| Medical Reserve Corps | $6.24 million | $6.24 million | $0 |
| Health Care Readiness and Recovery (formerly Hospital Preparedness Program) | $305.055 million | $305.055 million | $0 |
| Biomedical Advanced Research and Development Authority | $1 billion | $950 million | +$65 million |
| Strategic National Stockpile | $980 million | $965 million | +$15 million |
| Project BioShield | $825 million | $820 million | +$5 million |
| FY24 | FY23 Enacted | + / - FY23 | |
| Health Resources and Administration (HRSA-Discretionary) | $8.9 billion | $9.5 billion | -$600 million |
| Public Health and Preventative Medicine | $18 million | $18 million | $0 |
| Maternal and Child Health Block Grant | $813.7 million | $815.7 million | -$2 million |
| Healthy Start | $145 million | $145 million | $0 |
| Ryan White Part A | $680.752 million | $680.752 million | $0 |
| Ryan White Part B | $1.365 billion | $1.365 billion | $0 |
| Ending the HIV Epidemic Initiative | $165 million | $165 million | $0 |
| FY24 | FY23 Enacted | +/- FY23 | |
| United States Department of Agriculture (USDA) | |||
| Special Supplemental Nutrition Program for Women, Infacts, and Children (WIC) | $7.03 billion | $6 billion | +$1.03 billion |
| FY24 | FY23 Enacted | +/- FY23 | |
| Department of Health and Human Services (HHS) | $117 billion | $116.045 billion | +$955 million |
| Title X Family Planning Program | $286 million | $286 million | $0 |
For additional information on the FY24 minibus package, please refer to these:
FURTHER CONSOLIDATED APPROPRIATIONS ACT, 2024 (Bill Text)