President Obama’s fiscal year (FY) 2014 budget for the U.S. Department of Health and Human Services (HHS) would save an estimated $361.1 billion over 10 years. The HHS budget totals $967.3 billion in outlays and proposes $80.1 billion in discretionary budget authority. Some of the budget requests that affect programs of interest to dental education on the state level are highlighted below:
The Centers for Medicare & Medicaid Services (CMS):
- Federal Health Insurance Marketplaces (Exchanges)
CMS’ program-level request for the marketplaces totals $2 billion in FY 2014, to support the first year of program operations. This program level consists of a request for $1.5 billion in discretionary program management resources and $450 million in anticipated user-fee collections. This funding will be used to implement several key activities, including: eligibility, enrollment, and appeals services; outreach and education; plan oversight; Small Business Health Option Program (SHOP) and employer support; information technology (IT) systems; and financial management. Twenty-six states have indicated that they will not operate a state-based marketplace or a state-federal partnership, and as a result, HHS will operate a federal marketplace (also called a federally facilitated exchange) in those states.
- Health Care Fraud and Abuse Control (HCFAC)
CMS requests $640 million in additional health care fraud and abuse control (HCFAC) funding in
FY 2014, $311 million in ongoing discretionary funding and $329 million in proposed mandatory funding. The additional funding will allow CMS and its law enforcement partners to continue investing in activities that will reduce fraud in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
- Grants to States for Medicaid
The FY 2014 Medicaid request totals $284.2 billion, an increase of $13.5 billion above the FY 2012 level. The majority of this increase is attributed to the Affordable Care Act (ACA) Medicaid expansion in FY 2014. This appropriation consists of $177.9 billion for FY 2014 and $106.3 billion in an anticipated advance appropriation from FY 2013. However, CMS notes that the FY 2014 Medicaid target is to increase the national rates of preventive dental service to 50%, 6 percentage points over the FY 2011 baseline.
- Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) authorized funding for states, commonwealths, and territories in the amount of $17.4 billion in FY 2013. Under this appropriation, funding to states will increase $44 billion above the baseline over five years. In addition to CHIPRA, the ACA extends federal funding for the Children’s Health Insurance Program (CHIP) through FY 2015, appropriating $19.1 billion in FY 2014 and $21 billion in FY 2015. The FY 2014 target is to increase CHIP and Medicaid enrollment to more than 46.6 million children (Medicaid: 38,083,596/CHIP: 8,533,789), nearly 25% more children than were covered in FY 2008. The FY 2014 combined target is based on CMS’ assumption that approximately 3.1 million more children will be enrolled than in FY 2011. The increase is expected due to a combination of population increases, loss of employer-sponsored insurance, and extensive outreach to enroll children who are eligible, but unenrolled in light of the ACA coverage expansions.
Health Resources and Services Administration (HRSA):
- The National Health Service Corps (NHSC) FY 2014 budget requests an additional $10 million. The NHSC is funded from the Affordable Care Act in FY 2014. Funding will support scholarships and loan repayment awards, including 285 new State Loan Repayment Program awards. The State Loan Repayment Program (SLRP) is a grant program that offers a dollar-for-dollar match between the state and the NHSC for loan repayment contracts to health providers, including dentists and dental hygienists, who practice in a health professional shortage area (HPSA) in that state.