March 25 Federal Update: FY2024 Budget Process Draws to a Close

Last week, Congress passed the second and final package of bills that make up the federal budget. President Joe Biden signed it over the weekend. This marks the end of a drawn-out period characterized by months of continuing resolutions to bide time for negotiations. The Labor, Health and Human Services, Education bill included $225.4 billion, a $200 million reduction compared with FY2023. The bill includes a $1 billion increase for childcare and early learning programs within the Department of Health and Human Services (HHS). Head Start will receive $12 billion and the Child Care and Development Block Grant will receive almost $9 billion, a 9% increase over last year.

Other highlights include an $18 million increase for the 988 Suicide Prevention Lifeline and $4.6 billion for substance use prevention and treatment programs. Title I-A grants and Individuals with Disabilities Education Act (IDEA) programs saw $20 million increases and school districts will receive $160 million to fund school-based mental health professionals. Finally, 12,000 Afghans will receive Special Immigrant Visas. With the two packages combined, defense spending equaled $886 billion, a 3% increase from FY2023, and nondefense spending totaled $773 billion, which is even with last year.

Sources: NPR and Senate Appropriations Committee

Administration Bolsters Patient-Focused Primary Care Model

The Biden-Harris administration has launched a new initiative to enhance investments in patient-focused primary care. Through the Accountable Care Organization (ACO) Primary Care (PC) Flex Model, primary care providers within eligible ACOs will deliver innovative, team-based care to Medicare beneficiaries. This model, administered by HHS and the Centers for Medicare and Medicaid Services (CMS), provides ACOs with a one-time advanced shared-savings payment as well as monthly prospective primary care payments. By equipping ACOs with resources and flexibility, it aims to cover formation and administrative costs to ensure optimal care provision. This initiative reflects the CMS commitment to fortifying the primary care system and promoting competition in healthcare.

By incorporating health equity considerations and incentivizing team-based care, the new model strives to address disparities. Implemented within the Medicare Shared Savings Program, it focuses on low revenue ACOs, aiming to improve efficiency and quality. The ACO PC Flex Model, a five-year voluntary initiative, will commence Jan. 1, 2025, with about 130 ACOs planned for participation.

New Executive Order on Women’s Health Research

President Joe Biden has issued an executive order aimed at bolstering women’s health research. This initiative, as part of a broader effort to address longstanding disparities, emphasizes the administration’s commitment to economic empowerment for women. Key provisions of the order include directing federal agencies like the National Science Foundation and HHS to explore the use of artificial intelligence in advancing women’s health research. It also mandates the expansion of data collection on women’s midlife health and prioritizes investments in menopause-related research.

Historically, women’s health research has faced disparities in funding and representation in clinical trials. To address this, the White House has proposed a $12 billion research fund for women’s health at the National Institute of Health as well as the establishment of a national network of women’s research centers. The order also focuses on menopause research, instructing the Defense and Veterans Affairs departments to study and improve treatment for women in the military and veterans. This initiative underscores the administration’s commitment to addressing all diseases affecting women and aims to provide comprehensive support for women’s health and well-being.

Hearing on the Social Security Administration

The Senate Special Committee on Aging hosted a hearing titled “Keeping Our Promise to Older Adults and People with Disabilities: The Status of Social Security Today,” featuring Martin O’Malley, the Commissioner of the Social Security Administration (SSA). O’Malley opened by saying the SSA faces significant challenges due to increased demand for services coupled with decreased staffing levels. After a FY 2018-2021 budget freeze, a $785 million funding increase in FY 2023 helped rebuild staff levels. However, due to a continuing resolution in FY 2024, hiring stopped, leading to a staffing decline and potential all-time low of around 55,000 staff.

Despite the lack of sufficient funding, O’Malley said the SSA has prioritized addressing challenges in service delivery. Through extensive engagement with employees and stakeholders nationwide via town halls and field visits, they gathered insights and ideas. By implementing quick fixes and long-term strategies such as technology upgrades and streamlined processes, SSA aims to improve both employee and customer experiences through reduced wait times and enhanced efficiency. Additionally, plans for increased onsite presence and automated data exchange demonstrate a commitment to innovation and responsiveness to feedback, ultimately enhancing the agency’s ability to serve the public effectively.

O’Malley emphasized that President Biden’s FY 2025 Budget proposal for SSA highlights the urgent need for increased funding to address staffing shortages and improve customer service. With a requested budget of $15.4 billion, the agency aims to restore staffing levels, reduce wait times for services such as the National 800 Number, and process more disability claims promptly. Approval of the budget would enable significant improvements in staffing, service delivery, and backlog reduction efforts, ultimately benefiting millions of beneficiaries.

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