On July 27, the Senate Appropriations Committee considered the Fiscal Year (FY) 2024 Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) spending bill, which passed out of committee on a bipartisan vote of 26-2. The $224.4 billion allocation is much higher than the amount approved by House appropriators, but still less than the amount appropriated in FY 23 for these programs, which was $226.8. The Senate bill also contrasted sharply with House Majority’s proposal, which eliminates funding for multiple public health programs, including the Teen Pregnancy Prevention Program and the Ending HIV Epidemic Initiative, by retaining funding for the former and increasing it for the latter.

The Bipartisan Senate bill includes continued funding for key NACCHO priorities, including Public Health Infrastructure, data modernization, immunization and preparedness programs, and the Medical Reserve Corps. It also includes key report language directing CDC to continue or expand efforts to track and ensure funds get to local health departments. It also includes earmarks for some local health department facility upgrades. Unfortunately, it does not include funding for the Public Health Workforce Loan Repayment Program, which became law late last year.

When Congress returns from August research, the Senate and House will need to compromise to avoid a government shutdown after the September 30 deadline and fund the government for FY2024. Under the recent debt limit deal, federal funding for all discretionary programs will automatically fall by one percent if Congress resorts to a continuing resolution (versus a proper FY24 appropriations law) to keep the government open after January 1, 2024.

Now that this legislation has passed the Appropriations Committee, it moves onto the full Senate for consideration, where it would not be considered until September at the earliest, given the August Congressional recess. Even if this bill passes the Senate before the end of the fiscal year on September 30, there is still a long way to go to pass FY24 appropriations into law. Given the differences between the House and Senate proposals—and the short time frame—a continuing resolution will almost certainly be necessary to keep the government open into October. The possibility of a full or partial government shutdown also remains.

A detailed list of the Senate Labor-HHS funding allocations is below:

$117 billion for the Department of Health and Human Services (HHS) (a decrease of $3.7 billion from FY2023 enacted levels)

• $9.2 billion for the Centers for Disease Control and Prevention (CDC) (no change from FY2023), including:

• Agency-wide Report Language: Local health departments were specifically called out as important recipients of funding, noting that federal funding intended for both state and local health departments does not consistently reach local health departments beyond those directly-funded. The Committee encourages CDC to require states to fund local health departments when programmatically appropriate.
• $160 million for Public Health Data Modernization Initiative (DMI) (a decrease of $15 million, which is redirect towards the Ready Response Enterprise Data Integration Platform)
• $45 million for Center for Forecasting and Outbreak Analytics (CFA)
• $157.25 million for Ending the HIV Epidemic
• $735 million for Public Health Emergency Preparedness Cooperative Agreements (PHEP) (no change from FY2023)

Report Language: Including a request for a state distribution table in FY2025, which should provide information about funding allocations to local health departments and how states make these determinations

• $71 million for Public Health Workforce at the CDC
• $681.93 million for the Section 317 Immunization Program (no change from FY2023)
• $350 million for Public Health Infrastructure and Capacity (no change from FY2023)

Report Language: Flexible funding with a directive that no less than 70 percent of this funding be distributed to local health departments

Report Language: Funding for workforce, health information and data systems, public health policy and communications, equity, financial management, community partnership development, and organizational capacity

Report Language: CDC urged to publicly track and report how funds provided to state health departments are passed onto local health departments

• $616 million for the Ending HIV Epidemic Initiative (an increase of $3 million) including:

• $223 million within the CDC’s Domestic HIV/AIDS Prevention and Research programs to develop and deploy innovative data management solutions, increase access to PrEP, and better detect and respond to HIV clusters

$47.8 billion for the National Institutes of Health (NIH) (an increase of $943 million from FY2023 levels) and, of note:

• $407 million in CURES funding
• $1.5 billion for the Advanced Research Project Agency for Health (ARPA-H)

$2.438 billion for the National Institute of Mental Health, including:

• A $100 million increase for mental health research
• Maintains funding for the BRAIN initiative

• A $60 million increase for cancer research
• $655.6 million for the Helping to End Addiction Long-term (HEAL) initiative (an increase of $20 million from FY2023 levels)
• $2.311 billion for the National Institute of Diabetes and Digestive and Kidney Diseases (an increase of $10 million from FY2023 levels)
• A $10 million increase for the IMPROVE initiative for research on maternal mortality

• $5 billion for opioid treatment and prevention (an increase of $132.5 million from FY2023), which includes:

• A $40 million increase for the Substance Use Prevention, Treatment, and Recovery Services Block Grant
• A $20 million increase for the State Opioid Response grants
• A $10 million for the Rural Communities Opioid Response Program

• $5.5 billion for mental health research, treatment, and prevention (an increase of $181 million from FY2023) including:

• $519.6 million for the Substance Abuse and Mental Health Services Administration (SAMHSA) suicide prevention Lifeline, 9-8-8 (an increase of $18 million above the enacted FY23 level)
• $400 million for Certified Community Behavioral Health Clinics (an increase of $15 million above the enacted FY23 level)
• $1.02 billion for the Mental Health Block Grant (an increase of $35 million above the enacted FY23 level) including:

• $172 million for the Behavioral Health Workforce Education and Training Program (an increase of $19 million over FY2023) to expand community-based clinical training and for repayment of education loans for individuals working in either a Mental Health Professional Shortage Area or where the overdose death rate exceeds the national average

• $400 million for Certified Community Behavioral Health Clinics (an increase of $15 million over FY2023)
• $1.4 billion for Health Professions Workforce Development
• $1.2 billion for the core Maternal and Child Health programs

$3.67 billion for the Administration for Strategic Preparedness and Response (ASPR) (an increase of $70 million over FY2023) including:

• $6.24 million for the Medical Reserve Corps (MRC) (no change from FY2023)

• Report Language: Encourages ASPR to continue to support this locally driven volunteer network and to allocate this funding, and any remaining funding from the American Rescue Plan Act, via established mechanisms to distribute funds directly to local MRC units

• A $20 million increase for the Biomedical Advanced Research and Development Authority (BARDA)
• $75 million to establish new program in manufacturing and production to ensure that medical countermeasures and ancillary supplies are manufactured in the United States
• Funding protection for programs including the Strategic National Stockpile (SNS), Project BioShield, and the National Disaster Medical System (NDMS)

Earmarks

• $1.26 million to Mineral County Health Department (WV) for facilities and equipment (Senator Capito, Senator Manchin)
• $750 thousand to Tuscarawas County General Health Department (OH) for facilities and equipment (Senator Brown)
• $1 million to Williams County Health Department (OH) for facilities and equipment (Senator Brown)