On March 28, President Biden submitted his $5.8 trillion budget request to Congress for federal fiscal year (FFY) 2023.
Included in the overall request is $127.3 billion in discretionary spending and $1.7 trillion in mandatory budget authority in FFY 2023 for the Department of Health and Human Services (HHS).
The budget should be viewed as further confirmation of the president’s priorities and where he would like to see Congress appropriate discretionary funding. Ultimately, Congress will determine funding levels. Specific to health care, President Biden’s budget request places particular emphasis on public health, mental health, addressing health care disparities, and pandemic response. Specific initiatives and funding levels are summarized below.
- Expand Access to Mental Health Services: The budget would reform health coverage and make investments in the mental health workforce. For the privately insured, the budget requires all health plans to cover mental health benefits and ensures that plans have an adequate network of behavioral health providers. For Medicare, TRICARE, the Department of Veterans Affairs health care system, health insurance issuers, group health plans, and the Federal Health Employee Benefit Program, the budget would require coverage of three behavioral health visits without cost-sharing. The budget also requires parity in coverage between behavioral health and medical benefits and expands coverage for behavioral health providers under Medicare. The budget invests in increasing the number of mental health providers serving Medicaid beneficiaries, as well as in mental health workforce development and service expansion, including at primary care clinics and non-traditional sites.
- Address Maternal Health and Health Equity: Among other approaches, the budget includes $470 million to reduce maternal mortality and morbidity rates, expand maternal health initiatives in rural communities, implement implicit bias training for health care providers, and address the highest rates of perinatal health disparities. To address the lack of data on health disparities and further improve access to care, the budget strengthens collection and evaluation of health equity data.
- End the AIDS Epidemic: The budget requests $850 million across HHS to increase access to HIV prevention and care programs and support services. This includes increasing access to pre-exposure prophylaxis (also known as PrEP) among Medicaid beneficiaries, which is expected to improve outcomes and lower treatment. The budget also proposes a new mandatory program to guarantee PrEP at no cost for all uninsured and underinsured individuals, provide essential wrap-around services through states and localities, and establish a network of community providers to reach underserved areas and populations.
- Respond to Future Pandemics: The president’s budget asks for $81.7 billion over five years across the agencies that comprise HHS. The goal is to make vaccines and therapeutics available within 100 days of identifying a new pathogen through investments in research and development of medical countermeasures for certain viral families and biological threats.
- Expand Public Health Infrastructure: The budget includes $9.9 billion in discretionary funding to build capacity at the Centers for Disease Control and Prevention and at the state and local levels. These resources would be used to improve the immunization program, expand public health infrastructure in states and territories, expand the public health workforce, and support efforts to modernize public health data collection.
- Increase Access to Vaccines: The budget requests funds to create a new Vaccines for Adults program, which would provide uninsured adults with access to all recommended vaccines recommended at no cost.
Beyond the broad initiatives described above, the Centers for Medicare & Medicaid Services budget includes a request for approximately $500 million for survey and certification activities to support health and safety inspections at nursing homes. Additionally, the HHS budget expresses the president’s support for extending telehealth coverage under Medicare beyond the COVID-19 public health emergency to study its impact on utilization of services and access to care.