On February 13, 2012, President Obama released his Administration’s budget requests for Fiscal Year 2013. The budget in many ways reflects the nation’s growing concern with federal spending and the national deficit. Overall, the Substance Abuse and Mental Health Services Administration (SAMHSA) program request for 2013 is $3.4 billion, a $141.9 million (or 4%) decrease from FY 2012. The $3.4 billion is comprised of $3.2 billion in actual SAMHSA budget authority (a $195.5 million drop from 2012), plus $164.8 million in PHS Evaluation funds and $105 million from the Prevention and Public Health Fund created in the Affordable Care Act.
SAMHSA noted in the justification for its budget request that tough decisions had to be made, with an eye towards strategic reductions that maintain support for key agency priorities like prevention. Overall, this year’s budget requests represent a mixed bag for SAMHSA. Many programs have been sharply cut, while some new programs (particularly around prevention and trauma) have been created. Still other programs will see existing program activity maintained, though funding will not be available to support new grants.
It is important to note when interpreting this year’s budget requests that many apparent cuts are the result of funding being shifted among categories and will not affect existing program activities. In some cases, what appears to be a program cut may actually represent level funding or even support for new program activities. For this reason, the National Council strongly encourages you to read our 2013 budget analysis in order to understand the impact of this year’s budget numbers on your particular programs of interest.
Among the key requests in the President’s 2013 budget proposal:
- Mental Health activities: $951.9 million (-$46.9 million vs. FY12)
- Substance Abuse Prevention activities: $470.4 million (-$59.8 million vs. FY12)
- Substance Abuse Treatment activities: $1.8 billion (-$68.6 million vs. FY12)
- Health Surveillance and Program Support (a new category of activities): $187.7 million (+$33.4 million vs. FY12)
- Mental Health Block Grant: $459.8 million (level to FY12)
- Substance Abuse Block Grant: $1.45 billion (-$7.5 million vs. the comparable portion for FY12, reflecting the shift of the 20% prevention set-aside into a new line item for prevention grants)
- Primary-Behavioral Health Care Integration grants: $26 million (-$39 million vs. FY12, with all funding being shifted away from SAMHSA budget authority and onto the Prevention and Public Health Fund created in the Affordable Care Act)
- Mental Health – State Prevention Grants (a new program to support the early identification and prevention of mental illness among youth, building off the successful Project LAUNCH): $55 million
- Substance Abuse – State Prevention Grants (a new program to combine existing prevention activities into a line item that – at the direction of Congress – is used exclusively for prevention): $404.5 million
- Grants for Adult Trauma Screening and Brief Intervention (a new program to address trauma in common health care settings, such as emergency departments, primary care, and OB/GYN): $2.9 million
The National Council is disappointed by SAMHSA’s move to fund primary and behavioral health integration activities solely with ACA Prevention Fund monies. This shift jeopardizes the ability of people with serious mental illness to access critical healthcare services by moving the program toward reliance on a vulnerable funding stream. Opponents of the Affordable Care Act have repeatedly tried to repeal the Prevention and Public Health Fund, and the results of the 2012 elections may seriously undermine or even eliminate the Fund. Moreover, Congress has already begun chipping away at it, with the announcement just this week that $5 billion from the Prevention Fund (a third of its total funding) would be used to help pay for the Medicare physician payment fix. The National Council urges Congress to restore the PBHCI program to SAMHSA budget authority so as to preserve the critical prevention and treatment services that it supports.
Click here to read the National Council’s full analysis of the 2013 budget requests, including additional SAMHSA programs not covered above.
In addition to the President’s budget requests for specific programmatic activities, his 2013 proposals also included a number of suggested changes to Medicaid and Medicare. These changes are projected to save approximately $364 billion over the next ten years. They include:
- Creating a “blended” Medicaid and CHIP match rate, which consolidates states’ current complicated patchwork of matching formulas into a single federal match rate for each state
- Permanently fixing the “SGR” physician payment formula that calls for ever-increasing pay cuts each year (and which Congress has consistently overridden since 2002)
- Instituting co-pays for home health Medicare services for new beneficiaries beginning in 2017
- Reducing the federal share of Medicare premiums and deductibles for beneficiaries who are most able to afford it
- Reducing waste, fraud, and abuse in Medicare, Medicaid, and the Children’s Health Insurance Program
Because Medicaid and Medicare are entitlement programs, they are not subject to annual Congressional appropriations. Instead, were Congress to decide that it wanted to enact the President’s proposals, it would have to introduce legislation outside of the 12 annual appropriations bills.