Here’s what local health departments need to know

On March 11, the Fiscal Year 2025 budget proposal was released, outlining the Administration’s funding priorities for the upcoming fiscal year. While the President’s Budget is an important marker to see requested funding levels and new policy proposals, it is not binding. Ultimately, Congress is responsible for setting the budget and appropriating funds. This year is particularly complicated, as Congress is still working to finalize full-year funding for some key agencies, including the Department of Health and Human Services, through the rest of Fiscal Year 2024 (ending September 30, 2024), while simultaneously beginning its work on funding the full government for Fiscal Year 2025.

Notably, this year’s Presidential Budget Request is lower than last year’s requests, as the proposal adhered to the agreed upon budget caps from the debt-ceiling deal in the spring (Fiscal Responsibility Act for FY25). This limits overall spending for FY25 and results in a budget for public health programs that is largely flat-funded or allows for only small increases.

Overall, the President’s Budget requests $130.1 billion for HHS, a 9.4% decrease from the FY24 Presidential request, but a 3% increase from the FY23 enacted level. For CDC, the request proposes $9.68 billion, which is a $499.2 million increase from FY23 enacted levels. For HRSA, the budget proposes $8 billion in discretionary, a 17% decrease from FY23. The budget also includes $8.1 billion for SAMHSA, an 8% increase from FY23. For ASPR, the budget proposes $3.8 billion, an increase of $138 million above FY23. For FDA, the budget proposes $7.2 billion a 7.4% increase from FY23.

Key programs for local health departments received flat or nominal increases from FY23:

• Public Health Infrastructure and Capacity, $350 million (no change)
• Public Health Data Modernization Initiative, $224.6 million (+ $49.6 million)
• Public Health Emergency Preparedness Cooperative Agreements, $735 million (no change)
• 317 Vaccine Program, $732 million (+$50 million)
• Medical Reserve Corps, $6.24 million (no change)

Notable increases in other CDC programs include $1.6 billion, a $129 million increase, for chronic disease prevention and health promotion and $943,379,000, an increase of $182 million for CDC’s Injury Center to address community violence and suicide prevention, among other topics.

Additionally, the budget includes specific policy proposals the Administration would like to see enacted by Congress. These include:

• Creation of a mandatory Vaccines for Adults program to provide uninsured adults with access to routine and outbreak vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). NACCHO supports this effort, which was also proposed in the President’s FY24 Budget.
• Expansion of the Vaccines for Children (VFC) Program to include all children under the age of 19 enrolled in a separate Children’s Health Insurance Program and other specific changes, including setting a floor for provider reimbursements for vaccine administration, covering the vaccine administration fee for uninsured children without state share, and eliminating cost sharing for all VFC-eligible children.
• Provision of new data authority, which CDC says, “will be able to allow for more complete and timely data sharing to support decisions at the federal, state, and local levels, while reducing burden on providers.”
• Authority to use a subset of CDC funds to train and support a group of staff to deploy out to the field in a current or possible emergency.
• Creation of $20 billion in mandatory funding across HHS to prepare for pandemics and other biological threats, with $6.1 billion going to CDC to “modernize and build laboratory capacity and strengthen public health data systems; enhance domestic and global disease surveillance, biosafety, and biosecurity efforts; and support capabilities for monitoring and evaluating vaccine and medical countermeasure safety and effectiveness.”

• Ability to deem Medical Reserve Corps members as time-limited federal employees for the purposes of liability coverage and medical license credentials.
• Developing a new mandatory Pre-Exposure Prophylaxis (PrEP) Delivery Program to End the HIV Epidemic in the United States (“PrEP Delivery Program”), aimed at “provid[ing] PrEP and associated services at no cost to uninsured and underinsured individuals and expand the number of providers serving underserved communities.”

As FY24 appropriations have not yet been completed, the chart below compares enacted FY23 levels and FY25 President’s budget proposals.

For additional detail on any of the above information, see:

• HHS Budget in Brief
• CDC Congressional Justification
• ASPR Congressional Justification
• HRSA Congressional Justification
• FDA Congressional Justification