January 11, 2023

Congress Passes FY’23 Budget 

Last month, before adjourning for the session, Congress was finally able to pass a budget for fiscal year 2023. President Biden signed the package into law on December 29. There are several key provisions that will be of interest to Academy members. While there are some modest increases to certain programs, this omnibus package largely misses the mark in funding levels necessary to end the HIV epidemic.

Ending the HIV Epidemic (EHE) Initiative

$613 million for the fourth year of the EHE, an increase of $100 million above last year

• $25 million increase for the CDC’s Ending the HIV Epidemic Initiative, which includes an emphasis to “increase equitable access to PrEP”
• While there was not explicit funding for a national PrEP program, there was the inclusion of “report language” that essentially directs the CDC to expand PrEP availability (see page 72 of the bill)
• $40 million increase for the Ryan White HIV/AIDS Program for treatment and care
• $35 million increase for Community Health Centers to focus on PrEP
• Report language also was included stating concern for a perceived “lack of quantifiable data showing outcomes of a program started in 2019.” It directs HHS to: “(1) provide a spend plan to the Committees no later than 60 days after enactment of this Act, to include resource allocation by State; (2) brief the Committees on the fiscal year 2023 plans no later than 90 days after enactment of this Act; (3) provide the Committees an update on the program’s performance data since the beginning of the Initiative through the latest available data, making sure to address each of the Initiative’s goals and performance metrics, no later than 180 days after enactment of this Act and updated annually throughout the life of the Initiative.”

Ryan White HIV/AIDS Program

$76 million increase. While this is significantly less than what was in the House or Senate bills, the distribution of funding focused more on increases to base Ryan White programs benefiting the entire nation as opposed to just the 57 EHE priority jurisdictions.

• $10.3 million to Ryan White Part A
• $20.6 million to Ryan White Part B; ADAPs are flat-funded
• $3.5 million to Ryan White Part C
• $1.1 million to Ryan White Part D
• $528,000 to the AIDS Education and Training Centers through Part F

Harm Reduction

• CDC’s Opioid Related Infectious Diseases line received $23 million – a $5 million increase over last year’s, but still considerably less than either the House or the Senate bill
• CDC’s Division of Viral Hepatitis received a $2 million increase, not nearly what’s necessary to achieve the goals outlined in HHS’ Viral Hepatitis National Strategic Plan
• Mainstreaming Addiction Treatment (MAT) Act was included in the omnibus, meaning that the buprenorphine X waiver that has restricted the ability of medical providers to easily dispense medication-assisted treatment will officially be waived
• Keeps bans on use of federal funds to purchase syringes both nationally and for the District of Columbia
• Adds new language banning the use of funding for the distribution of pipes in SAMHSA programs

HHS Minority HIV/AIDS Initiative Fund

$3.1 million increase – reflective of our most recent ask in the MHAF appropriations letter the coalition sent to Congress. Also included is language that restores the Initiative’s initial intent of funding minority-led organizations

• $2 million set aside for American Indian and Alaska Native tribal health

Housing Opportunities for Persons With AIDS Program (HOPWA)

$499 million – a $49 million increase over last year’s budget and the single largest increase in HOPWA funds in at least the last decade. However, it is $100 million less than the community ask

Reproductive Health

• Title X, which provides comprehensive and confidential family planning services and preventive health services, was flat funded at $286.5 million, for the ninth straight year
• Flat funding for the Teen Pregnancy Prevention Program (TPPP)
• Flat funding for the “Sexual Risk Avoidance” Abstinence-Only Program
• CDC’s Division of STI Prevention got a $10 million increase

In total, the omnibus provides $1.39 billion for the CDC’s HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention portfolio, a $46 million increase from last fiscal year.

The full chart showing the coalition request versus Omnibus can be viewed here.

There are a few other items of note that go beyond HIV:

• Authorization of the Bio-Preparedness Workforce Pilot Program which will provide loan repayment to health care professionals with expertise in infectious diseases, HIV and emergency preparedness who are working in health professional shortage areas or in certain federally funded facilities, including Ryan White-funded clinics. Funding for the pilot will need to be appropriated in the next budget year.
• Language declaring that the CDC director “shall be appointed by the President, by and with the advice and consent of the Senate,” making the position Senate confirmed beginning January 2025.
• A provision within HHS extends the pandemic flexibility for telehealth through the end of 2024, though does not make it permanent.
• Dedicates $11.2 billion to global health, including $445 million for HIV/AIDS programs.
• The planned phase-out of Medicaid continuous coverage requirements that have been in place since the beginning of the COVID-19 public health emergency will go into effect earlier than expected. States can begin redetermining eligibility for recipients on April 1 and the enhanced federal matching rates will end on December 31, 2023.
• The Medicaid “funding cliff” for Puerto Rico was averted by the bill’s increase of federal funding and the federal matching rate. (A “funding cliff” is a shortfall in Medicaid funding coupled with a higher match required from the territory than is required by states.)
• Report language on the importance of the 340B program was included (see page 68 of the bill) directing “HRSA to continue to use its authority and any available measures, including the imposition of civil penalties, where appropriate, to hold those drug manufacturers in violation of the law directly accountable. The Committee urges HRSA to continue to take actions to safeguard covered entities’ lawful access to discounted drugs.”
• Finally, a truly historic change to funding for the Indian Health Service (IHS) through “advance appropriations.” IHS was the only federal health care provider without basic certainty of funding from one year to the next, holding 2.5 million patients at the mercy of federal budget negotiations. With this change, IHS services will be protected from potential government shutdowns because Congress has agreed to an amount this year that becomes available immediately on October 1, 2023.