Washington Report

An NIHB Publication

The Washington Report is an e-newsletter produced by the National Indian Health Board. Each issue contains a listing of current events on Capitol Hill, information on passed and upcoming legislation, Indian health policy analysis and action items.

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Biden Administration Releases Its Fiscal Year 2025 Budget

cover of a budget book The final budget proposal of President Biden’s first term has arrived with the release of the FY 2025 President’s Proposed Budget on March 11, 2024. The Budget in Brief, the U.S. Department of Health and Human Services’ (HHS) FY 2025 budget narrative, lays out the Administration’s further priorities for HHS and its agencies and operating divisions. At a high level, the Biden Administration continues to focus on the impacts of substance use disorders, opioids, and mental health on the U.S. population coming out of the COVID-19 pandemic. As part of its FY 2025 request, the Administration has also requested that the expanded tax credits for ACA health benefits coverage be made permanent. This coverage supports more families to receive coverage under the ACA, including in states that have not expanded Medicaid yet. Finally, as part of the President’s efforts to focus on health equity, the Administration focuses on improving maternal health outcomes, continuing its appropriations request to move the IHS to mandatory appropriations, and improving access to health care in rural America—including Indian Country.

In HHS’ Budget in Brief, the Administration specifically calls out its alignment with Executive Order 14112, Reforming Federal Funding and Support for Tribal Nations to Better Embrace our Trust Responsibilities and Promote the Next Era of Tribal Self-Determination, through its support of Tribal self-determination. In addition to that support, the Administration requests a 16 percent increase over FY 2023 for IHS at $8 billion. The increase continues the Administration’s commitment to close the funding gap for IHS/Tribal/Urban Indian (I/T/U) providers. It continues its budget request to move IHS funding to mandatory beginning in FY 2026, including adjustments for population, inflation, and pay cost growth, among other factors.

The proposal for IHS includes $21 million for substance and opioid use disorder treatment, $7 million for maternal health, and $15 million for its initiative Ending HIV and Hepatitis C in Indian Country. The budget proposal also includes $435 million in support of electronic health record modernization, $994 million for facilities, including $174 million for maintenance and improvement, $200 million for sanitation facilities construction, and $260 million for health care facilities construction. The President’s proposed budget does more than double the section 105(l) lease payments level to $349 million in FY 2025. It makes requests in both contract support costs and section 105(l) accounts for administrative funding for these programs capped at $10 million each.

The Indian Health Service has also dropped two of its legislative requests (A-19 proposals) in its FY 2025 Congressional Justification (CJ). IHS continues to advance many of its previous A-19 priorities, including reauthorization of the Special Diabetes Program for Indians at $250 million on a three-year, tiered reauthorization, IHS sequestration exemption, and several other critical staffing-focused proposals. In the new CJ, however, IHS has dropped two of its proposals that were included in previous fiscal years. The first proposal dropped would be to waive Indian hiring preference requirements for IHS positions. It has also dropped its A-19 proposal to extend IHS emergency hiring authority for mission-critical staff beyond 30-day appointments.

The introduction of the President’s FY 2025 Proposed Budget also begins the season for Congressional budget work. The FY 2025 budget is still subject to negotiated caps under the Fiscal Responsibility Act of 2023 (P.L. 118-5), and the Congressional budget resolution will follow those levels. The House Appropriations Subcommittees have already begun their work to solicit public testimony on the budget, the Interior-Environment Subcommittee having shared its request in late March 2024. Health-Labor Subcommittee should release its request in early April 2024. Senate Appropriations Subcommittees are expected to release their guidelines in late April or May 2024.

You can see the documents referenced here:

National Indian Health Board
50 F St NW, Suite 600 | Washington, DC 20001 | Phone: 202-507-4070 | Email: [email protected]