Transcript Slide 1
Federal Budget Update: What to Expect in FY 2015 and Beyond NCPHA Spring Conference Raleigh, NC May 13, 2014 Federal Funds Information for States www.ffis.org Overview The federal budget and how it works What to expect this year – – FY 2015 appropriations Mandatory sequestration (across-the-board cuts) Issues to watch – – Deficit reduction, changes to Budget Control Act (BCA) ACA program expirations Where the money goes: pieces of the federal budget pie Composition of Federal Outlays in FY 2013 ($ in Billions, % of Total) Trends in state grant funding Source: FFIS Grants Database Federal grants going to North Carolina: per capita, 2013 Major Category Medicaid Per Capita $817 Rank 28 Other State Local Individual/Other 512 58 346 44 39 24 $1,733 35 Total What programs areas are supported by state/local grants? Federal grants going to North Carolina: share of funding by function What are the major health grants? Types of grants Mandatory Capped Uncapped Discretionary Block Grant Categorical Grant Formula Grant Direct Appropriation Annual Appropriation Formula Grant Project Grant Mandatory vs. discretionary health grants Health Care Reform Mandatory Funding Amended uncapped entitlements (Medicaid) Reauthorized capped entitlements (CHIP) Directly appropriated funding for new and existing programs Discretionary Funding Extended authorization of existing programs Authorized new programs that must receive annual approp. – Creative funding mechanisms (Prevention and Public Health Fund, initial direct appropriations) What agencies have benefited from Prevention and Public Health Fund? Focus on FY 2015: Budget Control Act (BCA) Recap $984 billion in cuts through FY 2021 (~$109 billion/year, half from defense, half from nondefense) FY 2013 sequestration occurred on March 1, 2013 – “Fix” reduced cuts from $109b to $85b Many mandatory and a few discretionary programs are exempt (special rules for some programs) ATB cuts in FY 2013, different process for FY 2014+ Bipartisan Budget Act (BBA) provided some sequester relief in FY 2014 and FY 2015 House, Senate, President Adhering to BBA in FY 2015 Status of FY 2015 Appropriations House is moving appropriations bills, Senate plans to begin in mid-May – – – – – 302(b) allocations Easy bills moving first Aggressive timetable Many state grants likely to be level-funded Prediction: Labor/HHS/Education will not be among the bills passed before October 1 How have major health grants fared? Program ($ in millions) Health Centers FY 2010 FY 2013 FY 2014 FY 2014 vs. FY 2010 $2,190 $2,950 $3,651 67% 662 605 634 -4% 2,312 2,249 2,319 0.3% 185 131 142 -23% 1,799 1,710 1,820 1% Mental Health BG 421 437 484 15% Immunization grants 497 469 588 18% Preventive Health BG 102 75 160 57% Public Health Emergency Preparedness 761 623 656 -14% Maternal Child Health BG Ryan White HIV/AIDS Rural Health Substance Abuse BG Budget proposals to watch Extend Medicaid primary care payment increase Potential cuts to public health programs because of new coverage under ACA – Refugee Assistance, Access to Recovery, State HighRisk Pool, Section 317 Immunizations, and National Breast and Cervical Cancer Early Detection Additional funding for substance abuse/mental health Reductions to the Prevention and Public Health Fund BCA still the law of the land Amended discretionary caps enforced by sequestration Mandatory sequestration still in place – BBA extended to FY 2023 – President proposes repeal, Congress unlikely to agree – ATB percentages applied to current-law levels Defense Nondefense FY 2014 -9.8% -7.2% FY 2015 -9.5% -7.3% Mandatory programs: FY 2015 OMB sequestration estimates Program Maternal, Infant, and Early Childhood Home Visiting PreSequester ($ in millions) Sequester Cut ($ in millions) ??? ??? $3,244 -65 Affordable Insurance Exchange Grants 836 -61 Money follows the person 434 -32 Prevention and Public Health Fund 1,000 -73 Social Services Block Grant 1,700 -124 ??? ??? ACA Health Centers (2%) Aging and Disability Resource Center What happens after FY 2015? Pressure to tackle deficit diminishing, long-term issues remain Source: CBO Budget and Economic Outlook, 2/14 House and President take different approaches to deficit reduction Discretionary caps – – Mandatory programs (health care spending) – – President’s budget increases defense and nondefense House cuts nondefense and shifts savings into defense President’s budget (-$400 billion/10yrs.): Medicare changes House (-$3 trillion/10 years): repeals ACA, converts Medicaid into block grant, modifies Medicare Tax Policy – – President’s budget increases revenues, doesn’t include comprehensive tax reform House proposes revenue-neutral tax reform Deadlines on the horizon October 1, 2014 January 1, 2015 • Enact FY 2015 budget or pass a Continuing Resolution (CR) • Aging and Disability Resource Centers (ADRCs) • HHS cannot award additional exchange grants March 15, 2015 • Raise debt limit Deadlines on the horizon April 1, 2015 • Medicaid Qualifying Individual and Transitional Medical Assistance • MIECHV • ADRCs, Area Agencies on Aging • SHIPS • Family-to-family Sept. 30, 2015 • Health Profession Opportunity Grant • Personal Responsibility Education Program • Abstinence Ed. • CHIP • Community Health Centers Beyond • Prevention of chronic disease in Medicaid (1/1/16) • Money Follows the Person (9/30/16) • DSH Cuts (10/1/16) • CMS Innovation Center (9/30/19) • PPHF (indefinite) More questions than answers FY 2015: states can expect level funding for most programs; little chance of major legislation FY 2016: – BCA: discretionary funding increases; many open questions Will Congress amend the caps? Up or down? Will deficit reduction be a focus? Will ACA programs be extended? The policies will stem from the politics. Questions? For more information: www.ffis.org, Trinity Tomsic ([email protected] )