On Oct. 4, 2023, ASTHO responded to a Request for Information from the U.S. House of Representatives' Ways and Means Committee on the subject of improving access to healthcare and rural and underserved areas, including the island jurisdictions.
President Trump Releases FY27 Budget Proposal: April 2026 President Trump Releases FY27 Budget Proposal: April 2026 Learn how the Administrations FY27 budget proposal impact public health funding in this Legislative Alert. On April 3, the White House released President Trump’s FY27 discretionary budget proposal, which outlines the Administration’s funding priorities for the upcoming fiscal year beginning on October 1, 2026. The documents reflect the Administration’s planned HHS reorganization, proposed funding levels, and various policy and legislative proposals. As a reminder, Congress has the authority to approve, reject, or modify the Administration’s budget recommendations. Therefore, public health leaders must continue to educate and inform members of Congress about the impact of public health funding and the need for sustainable, predictable resources for governmental public health activities across federal, state, territorial, and local agencies. For additional information, please review the following documents: HHS Budget in Brief (PDF) Centers for Disease Control and Prevention (PDF) Administration for a Healthy America (PDF) Administration for Strategic Preparedness and Response (PDF) Centers for Medicare and Medicaid Services (PDF) Food and Drug Administration (PDF) Office of the Secretary: General Departmental Management (PDF) Environmental Protection Agency (PDF) It is challenging to conduct a detailed analysis of the budget proposal because many programs are eliminated, funding is consolidated or moved to different agencies. As a result, the ASTHO Government Affairs team cannot make a comprehensive comparison between FY26 enacted funding levels and the FY27 budget proposal. The information provided below is pulled directly from tables in the budget documents released by the Administration. Key Public Health Funding Proposals Overall, the budget proposes $111.1 billion in discretionary budget authority for HHS, a $15.8 billion or 12.5% decrease from the 2026 enacted level. Eliminates the Prevention and Public Health Fund, which provided $1.4 billion in funding across various CDC programmatic activities in FY26. Proposes establishment of the Administration for a Healthy America (AHA) (similar to the FY26 budget proposal) as part of a major reorganization of the Department of Health and Human Services. Specifically, it consolidates and relocates programs from across the Office of the Assistant Secretary for Health (OASH), the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and from several CDC centers such as the National Center for Chronic Disease Prevention and Health Promotion, National Center for Injury Prevention and Control, and the National Center on Birth Defects and Developmental Disabilities. Establishes a new National Center for Chemicals and Toxins within CDC, to bring together complementary programs across HHS, to include: National Institute for Toxicological Research (from FDA) Agency for Toxic Substances and Disease Registry National Institute for Occupational Safety and Health (CDC) National Center for Environmental Health (CDC) National Institute for Environmental Health Sciences (from NIH) Establishes (similar to the FY26 budget proposal) a new $300 million grant program that consolidates hepatitis, STI, and tuberculosis grant funding into one program. The budget eliminates the following programs to reset the balance between federal and state responsibilities, among other reasons: Previously in CDC: Tobacco and Prevention Control Nutrition, Physical Activity, and Obesity School Health Vision and Eye Health Inflammatory Bowel Diseases Interstitial Cystitis Excessive Alcohol Use Chronic Kidney Disease Chronic Disease Education and Awareness Prevention Research Centers Heart Disease and Stroke Diabetes National Diabetes Prevention Program Oral Health Arthritis Epilepsy National Lupus Patient Registry Racial and Ethnic Approaches to Community Health (REACH) Million Hearts National Early Child Care Collaboratives Hospitals Promoting Breastfeeding Safe Motherhood/Infant Health Adverse Childhood Experiences Firearm Injury and Mortality Prevention Research Drowning Elderly Falls Other Injury Prevention Activities Injury Control Research Centers Previously in HRSA: Rural Hospital Flexibility Grants State Offices of Rural Health Rural Hospital Stabilization Pilot Program Rural Hospital Provider Assistance Program AIDS Education and Training Centers – Part F Dental Reimbursement Program – Part F Special Projects of National Significance Minority HIV/AIDS Fund Early Hearing Detection and Intervention Emergency Medical Services for Children Healthy Start Title X Family Planning Loan Repayment/Faculty Fellowships Scholarships for Disadvantaged Students Health Careers Opportunity Program Primary Care Training and Enhancement Oral Health Training Programs Medical Student Education Area Health Education Centers (AHEC) Geriatric Programs Mental and Behavioral Health Public Health/Preventative Medicine Advanced Nursing Education Nursing Workforce Diversity Nurse Education, Practice, and Retention Nurse Faculty Loan Repayment Public Health Reports Previously in SAMHSA: Seclusion and Restraint Mental Health Awareness Training Healthy Transitions Infant and Early Childhood Mental Health Children and Family Programs Consumer and Family Network Grants Mental Health System Transformation Project LAUNCH Primary and Behavioral Health Care Integration Primary and Behavioral Health Care Integration Tribal Training and Technical Assistance Center Mental Health Crisis Response Partnership Pilot Program Homelessness Prevention Programs Criminal and Juvenile Justice Program Assertive Community Treatment for Individuals with Severe Mental Illness Homelessness Prevention Programs Mental and Behavioral Health Minority AIDS Mental Health Minority Fellowship Program Tribal Behavioral Health Grants Interagency Taskforce on Trauma-Informed Care Eating Disorder Identification, Treatment, and Recovery Community Mental Health Services Block Grant Substance Use Treatment Minority AIDS SAT Minority Fellowship Program Substance Use Prevention, Treatment, and Recovery Services Block Grant State Opioid Response Grants Strategic Prevention Framework Substance Use Prevention Minority AIDS Sober Truth on Preventing Underage Drinking Minority Fellowship Program Tribal Behavioral Health Grants Drug Abuse Warning Network Behavioral Health Workforce Data and Development Hepatitis C Previously in OASH: Teen Pregnancy Prevention Kidney X Sexual Risk Avoidance Office of Adolescent Health Administration for a Healthy America The request proposes $17.5 billion for the Administration for a Healthy America (AHA). Primary Care $3 billion, for Health Centers, including $1.8 billion in discretionary funding and $1.1 billion in mandatory resources, a decrease of $3.5 billion. $59 million, or level funding, for the Organ Transplantation program. $41.3 million, a $11 million decrease, for the Cell Transplantation program and Cord Blood Stem Cell Bank program. $14 million, or level funding, for the National Hansen’s Disease program. $11 million, or level funding, for Rural Health Policy Development. $111 million, or level funding, for Rural Health Outreach Grants. $4 million, a $2 million increase, for Radiation Exposure Screening and Education Program. $12 million, or level funding, for the Black Lung Clinics program. $145 million, or level funding, for the Rural Communities Opioid Response program. $14 million, or level funding, for Rural Residency Planning and Development. $70 million, a $24.5 million increase including $20 million for chronic care telehealth centers of excellence, for the Office for the Advancement of Telehealth. $26 million, or level funding, for the Office of Disease Prevention and Health Promotion. $45 million, a $30 million decrease, for the Office of Minority Health. $19 million for a new Prevention Innovation Program. Chronic Disease and Health Prevention $448 million, a $985 million decrease, for chronic disease and prevention activities. $35 million, a $6.5 million decrease, for Alzheimer’s disease. $413 million, or level funding, for Cancer Prevention and Control. Injury Prevention and Control $588 million, a $173 million decrease, for Injury Prevention and Control (formerly in CDC). Specifically: $12 million, a $18 million decrease, for Comprehensive Suicide Prevention. $38 million for the Preventing Intimate Partner and Sexual Violence Program. This program replaces the Rape Prevention Education and Domestic Violence Prevention Enhancements and Leadership Through Alliances programs. $25 million, or level funding, for the National Violent Death Reporting System. $506 million, or level funding, for the opioid overdose prevention and surveillance. $8 million, or level funding, or traumatic brain injuries. HIV/AIDs $2.7 billion, a $923 million decrease, for HIV/AIDS programs. Specifically: $680.7 million, or level funding, for Part A- Emergency Relief Grants. $1.4 billion for Part B Comprehensive Care, which includes $900 million for the AIDS Drug Assistance program. $209 million, or level funding, for Part C Early Intervention Services. $78 million, or level funding, for Part D Women, Infants, Children, and Youth. $165 million, or level funding, for the Ryan White HIV/AIDS Ending HIV Epidemic. $220 million, or level funding, for the Ending HIV Epidemic initiative transferred from the CDC Domestic HIV Prevention and Research. $8 million, or level funding, for the Office of Infectious Disease and HIV/AIDS Policy. Maternal & Child Health $1.9 billion, a $561 million decrease, to support maternal and child health programs. $767 million, a $51 million decrease, for the Maternal and Child Health Block Grant. $17 million, or level funding, for the Alliance for Innovation for Maternal Health program. $10 million, or level funding, for the
November 2025 Federal Funding and Government Shutdown Update November 2025 Government Shutdown/Funding Update Learn about the Continuing Appropriations Act, 2026, that the Senate agreed to vote on to end the current government shutdown. On Nov. 9, 2025, the Senate agreed to vote on the Continuing Appropriations Act, 2026, to end the current government shutdown and fund portions of the federal government through a continuing resolution (CR) that would expire Jan. 30, 2026. The CR keeps current federal funding levels and applies to agencies such as CDC, HRSA, SAMHSA, and EPA. The rest of the federal government, including programs within the Department of Agriculture, FDA, the Department of Veterans Affairs, and the operations of Congress would be funded through full fiscal year appropriations bills expiring on Sept. 30, 2026. The bill also specifies a number of requirements related to federal workforce, state reimbursement, and spending which are detailed in the sections that follow. Outlook Considering the bipartisan support for this deal to end the government shutdown, the ASTHO Government Affairs team is tentatively optimistic that the Continuing Appropriations Act, 2026, will eventually become law. However, the current political environment is volatile and if anything changes, we will issue another legislative alert. After the Senate votes on the bill, which may be delayed due to negotiations on some agriculture provisions, the House will need to approve it by a simple majority vote. If the House fails to garner enough support, then the government shutdown will continue. Here is the full text of the bill, the text of various extenders, and a section-by-section summary of all sections by the Senate majority. Federal Workforce and State Finances Requires the return of all federal workforce levels prior to the current lapse of appropriations on Oct. 1, 2025. Requires that funds be apportioned to agencies at a rate that would prevent the furlough of any employee during the duration of the CR. Prevents agencies from overspending funds for grant programs during the CR period, unless funds are required to be spent for the programs during such period. It preserves the funding level for most grant programs, subject to Congress’s decision in the full-year appropriations acts. Explicitly states that agencies should spend money in the most limited way possible during the duration of the CR. Directs that funds provided by the CR are available to pay federal employees who were furloughed or excepted during the lapse. Requires reimbursement to states that carried out federal programs, to prevent a reduction in service, during the lapse. Prevents statutory PAYGO sequestration cuts to Medicare, agriculture, and other programs. Agriculture and FDA Specifically, Senators agreed to advance a three-bill package that includes FY26 funding for the Department of Agriculture and the Food and Drug Administration (Ag-FDA), the Department of Veterans Affairs, and the Legislative Branch. The Ag-FDA bill provides: A hemp products ban, which prevents the unregulated sale of intoxicating hemp-based or hemp-derived products, including Delta-8, from being sold online, in gas stations, and corner stores, while preserving non-intoxicating CBD and industrial hemp products. $8.2 billion for the Special Supplemental Nutrition Program for WIC. $460 million for the Commodity Supplemental Food Program to assist low-income seniors. $37.8 billion in mandatory funding for child nutrition programs, as requested by the Administration. $107 billion in mandatory funding for SNAP, as requested by the Administration. Reimbursement for both the SNAP and WIC contingency reserves to account for expenditures during the government shutdown. $7 billion (budget authority and user fees), a decrease of $70 million below FY25 enacted levels, for FDA. $1.2 billion for the Food Safety and Inspection Service. $4.1 billion to support rural development across the country including $1.4 billion to prioritize aging water and wastewater infrastructure. Public Health Provisions Other public health provisions in the bill include extending several programs through Jan. 30, 2026, including: Community health centers. National Health Service Corps and teaching health centers that operate general medical education programs. The Special Diabetes Program. Some of the authorities of the Pandemic and All Hazards Preparedness Act. Unfortunately, this bill did not include provisions to reauthorize HPP, PHEP, or other public health programs, which will need to be reauthorized in the new year. Extends Medicare telehealth flexibilities that were extended in the Consolidated Appropriations Act, 2023. The Sexual Risk Avoidance Education Program. The Personal Responsibility Education Program. Family-to-Family Health Information Centers. website yes
One Big Beautiful Bill Law Summary Learn how the recently passed One Big Beautiful Bill impacts key public health initiatives in this legislative alert. On July 4, 2025, President Trump signed the One Big Beautiful Bill Act (OBBBA) into law. This legislation was initially passed by the House on May 22 by a 215-214 vote and was received in the Senate and passed with an amendment by a 51-50 vote. The amended bill passed the House by a 218-214 vote on July 3. This budget package will have sweeping impacts across Medicaid, the Affordable Care Act (ACA), food nutrition programs, and more. The Congressional Budget Office (CBO) estimates the bill’s health provisions will result in 11.8 million people losing health coverage by 2034. The CBO also estimates that an additional 5.1 million people would lose health coverage due to two policy changes outside the bill including: 1) the final 2025 CMS marketplace rule implementing eligibility changes and 2) the expiration of the ACA expanded premium tax credits. In total, CBO estimates 16.9 million people could lose coverage. The new law may impact states in several ways: Increased Medicaid and ACA coverage loss for noncompliance with work requirements, eligibility changes (Medicaid), and limits on coverage for certain noncitizens (ACA and Medicaid). Limited ability to fund the state share of Medicaid and overall decreased federal funding for state Medicaid programs. Increased administrative burden for state eligibility staff and increased costs for technology systems to implement work requirements. Note: Not all provisions apply to U.S. territories, such as work requirements for expansion adults, financing (provider tax and state-directed payments), and certain eligibility changes. ASTHO is closely monitoring the anticipated impact. Resources The legislative text of the final bill is 870 pages and was modified throughout the legislative process. For more detailed information, we encourage state and territorial health officials to utilize these resources in addition to the summary of relevant public health provisions below. Full Text — H.R. 1 Congressional Budget Office — Information Concerning the Budgetary Effects of H.R. 1, as Passed by the Senate on July 1, 2025 Kaiser Family Foundation — Health Provisions in the 2025 Federal Budget Reconciliation Bill Rural Hospitals This provision was not included in the initial House-passed bill but was included in the Senate-amended (and ultimately enacted) legislation. This program seeks to address potential impacts of CBO-predicted reductions to Medicaid spending due to the Medicaid provisions in this legislation. Establishes the Rural Health Transformation Program: The Rural Health Transformation program appropriates $10 billion per fiscal year to the Centers for Medicare and Medicaid Services (CMS) for 2026-2030 ($50 billion over five years) to disperse to eligible states. States must submit an application to CMS by Dec. 31, 2025, that includes a detailed rural health transformation plan and a certification that includes specifics on the expenditure for the funding under the program. States selected for funding will receive payments for five years, and the amount each state receives is determined by the state’s rural population, the number of rural health facilities, and an analysis of the state hospitals. State Eligibility: States must submit an application that includes a rural health transformation plan detailing how the state will improve health care access and outcomes, prioritize the use of new technologies, initiate collaboration between rural health care providers, enhance the supply of health care providers through economic incentives, outline strategies for the long-term financial solvency of rural hospitals, and identify risk factors for rural hospital closure. The state must also certify that no funding would be spent on intergovernmental transfer, certified public expenditure, or any other expenditure to finance the non-federal share of expenditures required under any provision of law. Funds can be used toward a list of criteria, such as promoting evidence-based interventions to improve prevention and chronic disease management including technology-based solutions, paying providers for health care, recruiting and training rural health workforce, and other activities as designated by the Secretary. The bill does not specify which state agency should be the applicant and custodian of these funds. Medicaid Work Requirements Overview: Requires able-bodied adults aged 19-64 to work (or perform other qualifying activities) for at least 80 hours a month. There are mandatory exemptions for certain individuals (e.g., pregnant women, those with serious medical conditions, tribal members, parents/caregivers of a dependent child 13 years and under or with a disability). States may issue optional hardship waivers for specific individuals facing short-term hardship (e.g., inpatient care, related outpatient care, natural disasters, high unemployment rate within their county). Verification: States will be required to conduct a “look-back” to determine if an individual meets requirement within the three months prior to applying. States would be required to verify an individual's compliance with work requirements within one or more months of enrollment and one or more months before redetermination. Implementation Dates: June 1, 2026: HHS to release interim final rule with implementation requirements. Dec. 31, 2026 (or earlier at state option): States must implement work requirements. However, the final bill allows the Secretary to exempt states from compliance with new requirements until Dec. 31, 2028, if they demonstrate a good faith effort toward compliance. Funding: Provides $200M for HHS implementation funding and $200M for states in FY2026 (an increase from $50M and $100M, respectively, from the initial House version). Expansion Expansion FMAP for Emergency Medicaid: Effective Oct. 1, 2026, limits federal matching payments for Emergency Medicaid to the state’s regular FMAP for individuals who would otherwise be eligible for coverage through Medicaid expansion if not for their immigration status. Sunsetting increased FMAP incentive: Effective Jan. 1, 2026, states that newly adopt Medicaid expansion will no longer have provisions for the temporary incentive. In addition to the federal government providing 90% federal financing for the expansion population under a state’s Medicaid expansion, the American Rescue Plan Act provided states that expand Medicaid after March 2021 a temporary boost in FMAP — a two-year, five-percentage-point increase in FMAP for all non-expansion population. Modifying cost sharing requirements for certain expansion individuals under Medicaid: Effective Oct. 1, 2028, states are required to impose cost sharing of up to $35 per service on expansion adults with incomes 100-138% FPL. Exempts primary care, mental health, and substance use disorder services, along with services provided by federally qualified health centers (FQHCs), behavioral health clinics, and rural health clinics. Maintains the previous law that out-of-pocket costs cannot exceed 5% of family income. Provides $15M in implementation funding for 2026. The final legislation adds exemptions to cost-sharing services provided by FQHCs, behavioral health clinicals, and rural health clinics. Provider Taxes Freezes provider taxes at current levels by disallowing increases in any new provider taxes or increases on current tax amounts. Amends the hold harmless “safe harbor” threshold, which is currently 6%. In non-expansion states: Remains at 6%. In expansion states: Phases down hold harmless threshold from 6% to 3.5% by 0.5% annually starting in FY 2028. Exempts long-term care facilities. State Directed Payments Caps state directed payments for expansion states at 100% and non-expansion states at 110% of the Medicare rate. This may limit a state’s future options to incentivize high-quality care or improve access to care. Eligibility Coverage for Noncitizen Alien Medicaid Eligibility: Effective Oct. 1, 2026, Medicaid eligibility of qualified aliens who are humanitarian entrants (i.e., refugees, asylees, and humanitarian parolees), is cancelled, thus leaving Lawful Permanent Residents, certain Cuban/Haitian entrants, and Citizens of Freely Associated States in place as the only categories of noncitizens eligible for Medicaid. The final legislation includes language defining Alien Medicaid eligibility. The text restricts the definition of qualified immigrants for the purposes of Medicaid and CHIP eligibility. HHS system to prevent duplicate state enrollment: By Oct. 1, 2029, requires HHS to establish a system to prevent enrollment in multiple states. Requires states to update enrollee addresses using certain datasets by Jan. 1, 2027. Eligibility verification using Death Master File: By Jan. 1, 2028, requires states to use the SSA Death Master File to verify eligibility on a quarterly basis. Home equity cap for Long-Term Services and Supports: Effective Oct. 1, 2028, lowers the home equity cap for long-term services and supports eligibility to $1M. Limits on Retroactive Coverage: Effective Jan. 1, 2027, limits retroactive coverage to up to one month for the expansion population and two months for traditional enrollees and CHIP. Home and Community Based Services (HCBS) Effective July 1, 2028, allows states to expand home-and-community-based services program eligibility criteria and waive the requirement that individuals require nursing home level of care. This would allow a greater number of individuals with less severe needs to access HCBS programs; however, many states already face waitlists so may be unable to expand enrollment. The bill provides implementation funding including $50M in FY2026 and $100M in FY2027. CMS Eligibility/Long-Term Care Staffing Rule Delays Prohibits CMS from implementing or enforcing eligibility rules for Medicaid, CHIP,
This legislative alert provides an update on the latest FY25 continuing resolution.
The bill provides $27.1 million to address shortfalls in Medicaid funding in the Northern Mariana Islands and extends critical autism-related programs.
The Senate released its version of the FY25 LHHS appropriation bill on August 1, 2024, with significant changes in proposed public health funding than the House's proposed bill.
March 2024 Federal Funding Update wic program, environmental protection agency, appropriation bills, food and drug administration, government affairs, government shutdown, synthetic nicotine, fiscal year, federal government, public health, house and senate, food and drug administration fda, tobacco free nicotine, synthetic nicotine products, spending levels, white house, government agency, spending bill, regulate tobacco products, astho, association of state and territorial health officials ASTHO | Congress must approve legislation to provide FY24 funding for a portion of the federal government. This week, Congress must approve legislation to provide FY24 funding for a portion of the federal government. Currently, the federal government is operating on a two-tiered continuing resolution. Funding for discretionary programs in the Agriculture Appropriation bill—Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and FDA—expires on March 8. On March 3, Congress released the legislative text of the Consolidated Appropriations Act, 2024, which proposes FY24 funding for six of the 12 appropriation bills. This package includes funding for EPA, the WIC program, the Supplemental Nutrition Assistance Program (SNAP), and FDA, among other critical programs. Importantly, this legislation includes full funding for the WIC program, a priority for ASTHO and other public health organizations. Funding for HHS discretionary programs (NIH, CDC, HRSA, SAMHSA) expires on March 22. Legislative text proposing funding for these programs has not been released. Outlook Given bipartisan negotiations, ASTHO’s government affairs team believes this bill will be signed into law, avoiding a partial government shutdown on March 8. Additionally, text for the remaining six appropriation bills, including funding for HHS, is expected to be released later this week, with approval needed before March 22. According to media reports, this specific package of legislation will face a very difficult road to approval by Congress. Resources Bill Text Legislative summaries (Majority and Minority) Joint Explanatory Statement—Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriation Act, 2024 Joint Explanatory Statement—Energy and Water Development and Related Agencies Appropriations Act, 2024 Joint Explanatory Statement—Interior, Environment, and Related Agencies Appropriations Act, 2024 Key Public Health Funding Highlights Agriculture Appropriation Bill $7.03 billion for the WIC program, an increase of $1.3 billion over FY23. This ensures the program is fully funded, and it increases funding for fruits and vegetables in the WIC Food Package to meet the President’s request. $122.4 billion ($3 billion to remain available through Sept. 30, 2026, for a contingency reserve) for SNAP, a decrease of $31.5 billion from FY23. $6.7 billion, level funding, for FDA. In addition, FDA is required to address drug and device shortages, among other critical priorities. Urges FDA’s Center for Tobacco Products to immediately remove any product containing synthetic nicotine from the market, regardless of whether such product is subject to the Premarket Tobacco Product Application process. Rescinds unspent COVID resources at FDA. Environmental Protection Agency This bill includes $9.2 billion for EPA, a reduction of $232 million. $4.4 billion for State and Tribal Assistance Grants. Within this amount, the bill includes $2.8 billion for Clean Water and Drinking Water State Revolving Funds and $1.4 billion in Community Project Funding. Compact of Free Association Pages 960-1048 of the bill text include a section amending Compacts of Free Association, which is important for territorial ASTHO members. The government affairs team will review this provision and provide additional analysis to our territorial members in the upcoming weeks. Other Public Health Programs Extends funding for the following programs through December 31, 2024: Community Health Centers National Health Service Corps Teaching Health Centers that Operate graduate medical education programs Special Diabetes Program Authority for states and tribes to request temporary reassignment for federally funded personnel. website yes
December: Federal Funding Update December 2024: Federal Funding Update On Dec. 20, 2024, the House of Representatives and Senate approved, by bipartisan vote, a short-term continuing resolution funding the federal government through Mar. 14, 2025. President Biden subsequently signed the bill into law. The full text of the bill can be reviewed here. Other public health provisions in the bill include extending of a number of programs through Mar. 31, 2025, including: Community health centers National Health Service Corps and teaching health centers that operate general medical education (GME) programs Special diabetes program Some of the authorities of the Pandemic and All Hazards Preparedness Act (PAHPA) Unfortunately, this bill did not include provisions to reauthorize HPP, PHEP or other public health programs, which will need to be reauthorized in the new Congress. Some telehealth flexibilities Sexual risk avoidance education program Personal responsibility education programFunding for family-to-family information centers through Apr. 1, 2025 website yes
In anticipation of a potential government shutdown on Oct. 1, 2023, HHS released an FY24 contingency plan.
Summary of FY24 Senate LHHS Appropriations Bill maternal and child health, substance use prevention, essential health care programs, mental health, healthcare access, human services, labor health, community health centers, capitol hill, healthcare workforce, public health threats, funding levels, public health infastructure, pandemic preparedness, maternal mortality, prescription drug, access to health care, health insurance plans, united states, substance use disorder, prevention programs, alcohol and other drug, mental illnesses, child health, maternal and child, young adults, substance misuse, evidence based, based programs, cover essential health benefits, mental health conditions, affordable care act, drug misuse, astho, association of state and territorial health officials ASTHO | The Senate LHHS appropriations committee has released its version of the FY24 appropriations bill. Get the latest in this Legislative Alert. On July 27, the Senate Labor Health and Human Services and Education (LHHS) appropriations committee successfully marked up its version of the FY24 LHHS appropriation bill. It is important to note that the proposed funding levels in this bill are higher than the levels that were included as part of the House LHHS appropriations subcommittee markup that occurred earlier this month. Please remember that the proposed funding levels within the bill are also subject to change, as both chambers are expected to engage in negotiations for a final bill before the end of the current federal fiscal year on September 30, 2023. The committee did release the legislative text of the bill, and ASTHO's government affairs team will be conducting a detailed analysis in the coming days. The summary below was provided to the committee. The Senate’s bill is considered to be a high watermark for funding when compared to the House LHHS subcommittee’s bill. There are considerable differences between both bills that will require reconciliation and negotiation on both sides. Outlook Both the Senate and House are scheduled to go on recess in August and are expected to be back on Capitol Hill in early September, with limited legislative days before the expiration of FY23 funding. While we are hopeful that Congress will pass a continuing resolution to fund the federal government past September 30, if final appropriations bills are not completed, the threat of a government shutdown cannot be ruled out. It is also important to again point to the real possibility of a 1% across-the-board cut if Congress is unable to pass all 12 appropriation bills prior to the end of the calendar year. ASTHO’s government affairs team will continue to advocate on behalf of state and territorial public health departments, encouraging Congress to increase funding for state and territorial public health priorities. The full committee summary is available for review. Excerpts from Committee Summary Protects Essential Health Care Programs The bill protects essential funding to address public health threats, improve health care access and affordability, and strengthen the health care workforce. This includes: $1.86 billion for Community Health Centers, including $55 million for school-based health centers. $1.4 billion for Health Professions Workforce Development. $1.2 billion for the core Maternal and Child Health programs. $341 million for the Improving Maternal Health Initiative to combat the unacceptable levels of maternal mortality. $4.1 billion for the Centers for Medicare and Medicaid’s administrative needs. The bill also includes $350 million for Public Health Infrastructure and Capacity, maintaining the 75% increase secured in fiscal year 2023 to bolster public health infrastructure and rebuild the workforce at the state and local level to be ready to respond to emerging public health threats. The bill includes $616 million for the Ending HIV Epidemic Initiative, a $3 million increase, which provides high-need jurisdictions with prevention and treatment services for people at high risk for HIV transmission. This includes $223 million within the Centers for Disease Control and Prevention’s (CDC) 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. The bill also protects funding for reproductive health programs such as Title X and the Teen Pregnancy Prevention Program. Pandemic Preparedness and Biodefense The bill includes $3.67 billion for the Administration for Strategic Preparedness and Response (ASPR), including a $20 million increase for the Biomedical Advanced Research and Development Authority (BARDA) and $75 million to establish a new program in manufacturing and production to ensure that critical resources including medical countermeasures and ancillary supplies are manufactured in the United States. It protects funding for critical programs, including the Strategic National Stockpile (SNS), Project Bioshield, and the National Disaster Medical System (NDMS). Substance Use Prevention and Treatment The bill builds upon key investments made in fiscal year 2023 to address the rising toll of opioid overdoses fueled by fentanyl and improve access to substance use disorder treatment and prevention. The bill provides over $5 billion for opioid treatment and prevention, a more than $125 million increase over fiscal year 2023. This includes an additional: $40 million for the Substance Use Prevention, Treatment, and Recovery Services Block Grant. $20 million for the State Opioid Response grants. $10 million for the Rural Communities Opioid Response Program. $20 million for NIH opioid research programs. Mental Health The bill provides $35 million more for the Mental Health Block Grant over fiscal year 2023 and includes $172 million for the Behavioral Health Workforce Education and Training Program, a $19 million increase over fiscal year 2023, 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. Additionally, the bill provides $400 million for Certified Community Behavioral Health Clinics, a $15 million increase over fiscal year 2023, and an $18 million increase over fiscal year 2023 for the 988 Suicide Prevention Lifeline, building on the nearly $400 million increase in fiscal year 2023. The bill also includes over $100 million in investments within the Department of Education to address the shortage of school-based mental health professionals in our nation’s K-12 schools. website yes
Summary of FY24 House Appropriations Bill astho, association of state and territorial health officials, global health, ending the hiv epidemic, fy24 lhhs appropriation bill, substance abuse and mental health services administration, firearm injury and mortality prevention research, center for forecasting and analytics, agency for healthcare research and quality, public health data modernization, climate and health, public health infrastructure and capacity, government affairs, tobacco prevention and control, house labor health and human services and education, health resources and services administration, fy24 house appropriations bill, reducing new hiv infections, center for forecasting, funding opportunity, research and quality ahrq, health and human services, department of health, healthcare research and quality, agency for healthcare research, hiv aids, human services hhs, impacts of climate, gun violence, university of michigan, national institutes of health, ehe initiative, epidemic in the united, hiv prevention and treatment, real time, health effects, health impacts ASTHO | Learn about cuts to public health funding in the House Labor Health and Human Services and Education subcommittee's FY24 appropriations bill. On July 13, the House Labor Health and Human Services and Education (LHHS) appropriations subcommittee released its version of the FY24 LHHS appropriation bill and will mark up the legislation on July 14. The proposed funding levels included within the bill are subject to change as both chambers of Congress are expected to engage in negotiations before the expiration of the current fiscal year on September 30, 2023. It is important to note that the subcommittee has not released the report text, therefore ASTHO cannot complete a detailed analysis. The summary below was provided by the committee. Outlook: This bill is considered to be the low water mark for funding, compared to what the Senate is expected to propose. The Senate has yet to formally begin its work on the FY24 appropriations bills, but we expect that to occur in the coming weeks. As a reminder, any appropriations legislation must be approved on a bipartisan basis. The funding levels included in this bill are NOT final but rather are an indication of the priorities for the majority in the House. Given what is expected to be a contentious funding season, the likelihood of Congress approving a continuing resolution with a 1% across-the-board cut is extremely high and a government shutdown in October cannot be ruled out. The ASTHO government affairs team will continue to advocate on behalf of state and territorial public health departments, encouraging Congress to increase funding for state and territorial public health. The subcommittee draft text and summary are available for review. Excerpts from Subcommittee Funding Summary Centers for Disease Control and Prevention (CDC): The bill includes a total of $7.6 billion for CDC, a cut of $1.6 billion below the enacted level. The bill eliminates funding for Firearm Injury and Mortality Prevention Research, a cut of $12.5 million below the enacted level. The bill eliminates funding for Tobacco Prevention and Control, a cut of $247 million below the enacted level. The bill eliminates funding for the Ending the HIV Epidemic initiative, a cut of $220 million below the enacted level. The bill includes $100 million for Public Health Infrastructure and Capacity, a cut of $250 million below the enacted level. The bill includes $75 million for Public Health Data Modernization, a cut of $100 million below the enacted level. The bill includes $371 million for Global Health, a cut of $322 million below the enacted level. The bill eliminates funding for the Climate and Health program, a cut of $10 million below the enacted level. The bill eliminates funding for the Center for Forecasting and Analytics, a cut of $50 million below the enacted level. Substance Abuse and Mental Health Services Administration (SAMHSA): The bill funds SAMHSA at $7.1 billion, a cut of $234 million below the enacted level. Health Resources and Services Administration (HRSA): The bill includes $7.3 billion for HRSA, a cut of more than $700 million below the enacted level. (The comparison does not include Community Project Funding included in the FY 2023 enacted bill.) The bill eliminates funding for Title X Family Planning, a cut of $286 million below the enacted level. The bill includes $781 million for the Maternal and Child Health Block Grant, a cut of $35 million below the enacted level. The bill eliminates funding for Healthy Start, a cut of $145 million below the enacted level. The bill eliminates funding for the Ending HIV Epidemic Initiative, a cut of $220 million below the enacted level. The bill eliminates funding for multiple programs to support diversity in the health care workforce, including: Health Careers Opportunity Program ($16 million) Centers of Excellence ($28 million) Nursing Workforce Diversity ($24 million) Agency for Health Care Research and Quality (AHRQ): The bill eliminates funding for AHRQ, a cut of $374 million below the enacted level. Office of the Secretary—General Departmental Management (GDM): The bill includes $344 million for GDM, a cut of $258 million below the enacted level. The bill eliminates funding for the Teen Pregnancy Prevention Program, a cut of $108 million below the enacted level. The bill includes $26 million for the Office of Minority Health, a cut of $49 million below the enacted level. The bill includes $28 million for the Minority HIV/AIDS Initiative, a cut of $24 million below the enacted level. The bill includes $20 million for the Office on Women’s Health, a cut of $49 million below the enacted level. article yes
President Biden Releases FY24 Budget Proposal On March 9, the White House released President Biden’s FY24 budget proposal, which outlines the Administration’s funding priorities for the upcoming fiscal year. As a reminder, Congress has the authority to approve, reject, or modify the administration’s budget recommendations. ASTHO issued a statement in response to the FY24 President’s budget proposal. It is important to note that additional details about this budget will be released next week. Therefore, the ASTHO government affairs team was unable to conduct a detailed analysis of the budget. In addition to the proposed discretionary funding increases for ASTHO member priorities, the information provided below is meant to be a snapshot of new initiatives and policies proposed by President Biden. State and territorial health officials should view the HHS budget in brief for additional information about the federal agencies and programs beyond what is highlighted below. Key Public Health Funding Proposal Highlights ASTHO’s member priorities saw proposed increases in the President’s FY24 budget: $600 million, a $250 million increase from FY23 for public health infrastructure and capacity. $340 million, a $165 million increase from FY23 for public health data modernization. $106 million for public health workforce training and fellowship programs. Pandemic Preparedness The budget request includes $20 billion in mandatory funding (over five years) for HHS public health agencies in support of the Administration’s pandemic prevention and preparedness and biodefense priorities as outlined in the 2021 American Pandemic Preparedness: Transforming Our Capabilities plan and 2022 National Biodefense Strategy and Implementation Plan for Countering Biological Threats, Enhancing Pandemic Preparedness, and Achieving Global Health Security (National Biodefense Strategy and Implementation Plan). $10.5 billion for ASPR to: Advance research and development of vaccines. Provide therapeutics and diagnostics for high priority viral families. Scale up domestic manufacturing capacity for medical countermeasures. Support the public health workforce. $6.1 billion for CDC to: Modernize and build laboratory capacity. Strengthen public health data systems, as well as enhance domestic and global disease surveillance, biosafety, and biosecurity efforts. Support capabilities for monitoring and evaluating vaccine and medical countermeasure safety and effectiveness. $2.69 billion for NIH to: Conduct research and development of vaccines diagnostics and therapeutics against high priority viral families. Enhance biosafety and biosecurity. Expand laboratory capacify and clinical trial infrastructure. National Hepatitis C Elimination Program The FY24 budget includes a new HHS-wide proposal to eliminate hepatitis C infections in the United States, with a specific focus on high-risk populations. This five-year program will increase access to curative medications and expand implementation of complementary efforts such as screening, testing, and provider capacity. The budget also reproposes the mandatory Pre-Exposure Prophylaxis (PrEP) Delivery Program to End the HIV Epidemic in the United States (“PrEP Delivery Program”). The PrEP Delivery Program will provide PrEP and associated services at no cost to uninsured and underinsured individuals and expand the number of providers serving underserved communities. The budget also increases access for Medicaid and CHIP beneficiaries by requiring states to cover PrEP and associated laboratory services with no cost sharing, and places guardrails on utilization management practices like prior authorization and step therapy. The national hepatitis C elimination program will have a significant impact on the Medicare population. Hepatitis C disproportionately affects baby boomers, many of whom are eligible for Medicare. Untreated, hepatitis C can cause advanced liver disease, liver cancer, and death. An eight-to-12 week course of oral direct-acting antiviral medication cures hepatitis C in more than 95% of people. Under this program, the federal government pays 100% of cost-sharing for Medicare Part D beneficiaries. CDC Vaccines for Adults As a complement to the successful Vaccines for Children program, the budget establishes the Vaccines for Adults program within CDC. This new capped mandatory program will provide uninsured adults with access to routine and outbreak vaccines recommended by the Advisory Committee on Immunization Practices. FDA $103 million to support the implementation of FDA’s Overdose Prevention Framework. Specifically, the funds will support activities that include: Promoting appropriate prescribing of medications with abuse potential, including opioids, stimulants, and benzodiazepines. Expanding the availability of, and access to, overdose reversal products. Expanding the availability of, and access to, evidence-based treatments for substance use disorders. Increasing surveillance, enforcement, and indictment efforts targeting illegal, unapproved, counterfeit, and potentially dangerous products at international mail facilities, express courier hubs, and ports of entry. HRSA $130 million in new funding for Long COVID Integrated Diagnostics and Care Units, as well as support for provider training, capacity building, and consultation to provide primary care providers with knowledge about Long COVID diagnostics and treatment. SAMHSA $2 billion in mandatory funds for the Mental Health System Transformation Fund to expand access to mental health services through workforce development and service expansion. website yes
A brief summary of all the significant public health legislation passed by U.S. Congress in the summer of 2022.
On April 4, 2022, the U.S. Senate indicated that they have reached an agreement on a $10 billion bipartisan emergency supplemental funding bill for the federal COVID-19 response.
ASTHO Legislative Alert from March 9, 2022: Final Fiscal Year 2022 Labor, HHS-ED Appropriations Bill Summary and Highlights
On March 23, 2023, ASTHO President Anne Zink testified before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies regarding sustainable and flexible public health funding.
In-depth analysis on state health policy surrounding the public health workforce. This is part of ASTHO's annual legislative prospectus series.
Policy Trends Shaping Public Health Funding and Administration in 2026 Policy Trends Shaping Public Health Funding in 2026 Learn about policy trends shaping public health funding and administration in 2026, including increased funding for behavioral health and other areas. Decades of underinvestment in the nation’s public health system have impacted agencies’ ability to respond to health challenges. The COVID-19 pandemic revealed the fragility of a chronically under-resourced sector tasked with responding to a global emergency. While public health has received influxes of funding through the CARES Act and American Rescue Plan Act over the last five years, both were temporary injections of funding in response to COVID-19. There have been efforts to provide longer term funding for public health improvements through the Public Health Infrastructure Grant and the Prevention and Public Health Fund, but this funding faces an uncertain future: There have been multiple reductions in federal funding to the Prevention and Public Health Fund since its creation in 2010. Moreover, state public health agencies are preparing for the possibility of federal funding being reduced or cancelled. This, coupled with balanced budget requirements, is driving states to explore ways to improve their public health investments while bolstering infrastructure — focusing on health departments’ core services, and ensuring access to quality public health programs at the state and local levels. Increased Funding for Public Health In 2025, 47 states enacted or will enact budget bills. While overall nationwide funding for public health in FY26 was roughly equivalent to FY25, at least half of the state health departments had some form of increased funding (e.g., Medicaid, provider reimbursement rates, and specific public health initiatives and programs). For example: Behavioral Health: Colorado SB 25-206 included a $1.6 million increase in funding to provide behavioral health services in primary care settings. Certification: Illinois SB 2510 includes a $6 million increase to support licensing, inspecting, and certifying health care facilities for compliance with state and federal regulations. Maternal and Child Health: Georgia HB 68 provided a nearly $3 million increase in funding to expand a pilot program that provides home visits in at-risk and underserved communities during pregnancy and early childhood. Rural Health: Arizona’s budget bills include $4 million to expand access to health care through the development of rural medical residency programs. School-Based Health Centers: Delaware HB 225 appropriates funding to develop school-based health centers in elementary schools with more than 90% of students classified as low-income, multilingual learners, or underrepresented minorities. Leg Prospectus-2026 - Funding - Rural Health Improved Public Health Administration Several states passed legislation restructuring their public health systems. Nevada enacted SB 494, dividing the previous Department of Health and Human Services into two separate agencies. The bill gives the new health agency, called the Nevada Health Authority, the authority to oversee health programs (e.g., Medicaid and the Children's Health Insurance Program), manage health care compliance and consumer health services, and develop policy that improves health care access and cost efficiency. Hawaii’s HB 1120 formally gives the Department of Health the authority to prevent, address, and abate any issues that pose a threat to public health and/or environmental health, such as toxic materials, vector-borne diseases, and climate change. More than half of U.S. state health agencies are decentralized or largely decentralized, meaning many public health services are provided by city, county, or regional health departments that are separate from the state health agency. In 2025, at least two states enacted legislation enhancing local health departments’ abilities to provide core public health services: Utah SB 172 requires the Department of Environmental Quality to enter into cooperative agreements with local health departments to prevent and respond to potential health and safety threats from the environment. It also establishes a governance committee of state and local health department personnel to evaluate proposed policy changes affecting local health departments and ensure allocated resources meet the minimum performance standard. Washington HB 1946 modifies the membership requirements for local health boards, allowing federally recognized tribes with reservation or trust lands in the board’s jurisdiction to have members on the board. It also allows urban Indian organizations recognized by the Indian Health Service that provide services within that jurisdiction to have members. Looking Ahead ASTHO anticipates states and territories will continue considering and adopting legislation to provide state funding for public health and improve public health infrastructure, including those that: Create contingency plans or rainy-day funds in the event of reduced federal funding. Establish partnerships with neighboring states to share health data. Promote sharing services and resources within local health departments. Leverage regionalization as a tool to consolidate and share scarce public health resources. Adapt the funding and management of public health grants to ensure efficiency. Improve public health data systems to promote greater efficiency. OE22-2203 PHIG article yes
Learn how state health agencies are leveraging flexible funding to advance initiatives addressing non-medical factors that influence health.