The Fiscal Year (FY) 2018 House and Senate Appropriations Committee Bills Cut $300 Million and $2 Million in Funding to Some Health Programs That Assist Homeless People and People At-Risk of Homelessness

The House bill and Senate bill for the Department of Health & Human Services (HHS), that passed out of Committee propose various funding levels to provide health, mental health, substance abuse, and support services to people, including homeless people and people at-risk of homelessness, compared to the enacted FY2016 and the enacted FY2017 funding levels, the latter which was not enacted at the time the budget request was prepared, with cuts to some programs totaling $300 million in the House Committee Bill and $2 million in the Senate Committee Bill.

For Primary Health Care, which includes funding for Community Health Centers and Free Clinics Medical Malpractice, the Senate and House Committee Bills propose discretionary funding of $1.491 billion, which is the same amount as the enacted FY2017 level, but do not appears to provide the $3.6 billion in mandatory funding for Community Health Centers provided each year for the past three fiscal years and requested by the Administration for FY2018.  Both the House and Senate should authorize and appropriate this mandatory funding so that Community Health Centers can continue to provide the same levels of care for 25 million low-income persons, including 1 million homeless persons as in 2016 (the most recent year for which data are available).

For Mental Health Programs, the Senate Committee Bill proposes discretionary funding of $1.181 billion, which is the same amount as the enacted FY2017 level, but the House Committee Bill proposes discretionary funding of $950 million, which is $231 million less than the enacted FY2017 level.  More than half of the funding reduction in the House Committee Bill is composed of a $141 million decrease in funding for the Mental Health Block Grant, which provides funds to states to support mental illness prevention, treatment, and rehabilitation services and funds priority treatment and support services that demonstrate success in improving outcomes and/or supporting recovering that are not covered by health insurance.  The House should provide increased or level funding instead of a 25% decrease in funding for the Mental Health Block Grant to provide mental health services for people, including the 100,000 homeless people with severe mental illness and 45,000 unsheltered homeless people with severe mental illness on a given night.

For Substance Abuse Prevention programs, the Senate Committee Bill provides $238 million, which is $15 million more than the enacted FY2017 level, but the House Committee Bill only provides $165 million, which is $57 million less than the enacted FY2017 level.  Funding for Substance Abuse Prevention programs in the Senate Committee Bill and House Committee Bill include $109 million and $74 million in funding for Strategic Prevention Framework/Partnership for Success, which is the same as and $35 million less than the enacted FY2017 level.  The Strategic Prevention Framework/Partnership for Success grants provide funding for prescription drug misuse among persons aged 12 to 25 and for underage drinking among persons aged 12 to 20 and may also target data-driven substance abuse prevention priorities for other drugs in a particular state/tribe.  Funding for Substance Abuse Prevention and for the Strategic Prevention Framework/Partnership for Success should be maintained or increased, instead of decreased, to prevent addiction to opioids and heroin and to other drugs, such as cocaine, which are also being unknowingly laced with deadly levels of opioids and thousands of people and hundreds of homeless people from New York to Orange County, California have died in recent years from drugs before they were able to receive treatment.

For Health Surveillance and Program Support, the Senate Committee Bill and House Committee Bill provide $145 million and $132 million, which are $2 million less and $15 million less than the enacted FY2017 level.  Funding for this activity is important and should be maintained because it supports national survey efforts and analyses that provide essential information on mental health and substance abuse and helps ensure appropriate management and spending of federal resources.

For the Social Services Block Grant, both the Senate Committee Bill and the House Committee Bill provide $1.7 billion, which is the same amount as the enacted FY2017 level.  Therefore, funding in the most recent report of $24 million for Counseling Services, $58 million for Residential Treatment, and $13 million for Substance Abuse Services should be able to be maintained.  Both the Senate Committee Bill and the House Committee Bill do not change the mandatory levels of funding of $16.739 billion for the TANF Block Grant and $608 billion for the TANF Contingency Fund.  Therefore, funding in the most recent report of TANF Transfer Funds to the Social Services Block Grant of $42 million provided for Counseling Services, $33 million provided for Residential Treatment, and $297,000 provided for Substance Abuse Services should be able to be maintained.  As discussed with regard to the Substance Abuse and Mental Health Services Administration funding, funding for these mental health and substance abuse services should be increased, instead of decreased, because they are critical and life-saving.

For the State Response to the Opioid Abuse Crisis Account, both the Senate Committee Bill and the House Committee Bill provide $500 million in mandatory funding, which is the same amount as for FY2017.  As with funding for Substance Abuse Treatment and Prevention, this funding is critical because opioid overdose deaths are in the tens of thousands and have been dramatically increasing in recent years and hundreds of homeless people have died in recent years from drugs before they were able to receive treatment.

Overall, the Senate and House Committee Bills propose to decrease funding for several important programs that provide health, mental health, substance abuse, and supportive services to homeless individuals and families and to those at risk of homelessness.  With more than a quarter of a million homeless persons without health insurance and with 100,000 persons with severe mental illness and/or chronic substance abuse who are homeless and more than 40,000 people with severe mental illness and/or substance abuse without even a basic shelter on a given night, Congress should maintain and increase, instead of decrease, funding for programs that provide critical and life-saving health, mental health, substance abuse, and support services to people who are currently homeless and who are at heightened risk of homelessness.