The FY2018 Budget Request Cuts Health Assistance to Homeless People and People At-Risk of Homelessness by More Than $4 Billion

Health, Homelessness

The President’s Fiscal Year (FY) 2018 Budget Request for the Department of Health and Human Services proposes to cut health funding to assist homeless people and people at-risk of homelessness with health, mental health, and substance abuse treatment and prevention services by more than $4 billion compared to both the enacted FY2016 funding level and the enacted FY2017 funding level, the latter which was not enacted at the time the budget request was prepared.

Health Resources and Services Administration:

  • The Administration proposes a 71% decrease in funding of $3.602 billion for Primary Health Care for Health Centers and Free Clinics bringing the total to $1.488 billion compared to the enacted FY2016 level and enacted FY2017 level of $5.091 billion, including a decrease of $2.8 million in discretionary spending and a decrease of $3.6 billion in mandatory spending.  Funding for Health Centers is critical and life-saving and should be increased, instead of decreased, because more than 24 million patients and 1.1 million homeless patients were seen at Health Centers in the most recently reported year, millions of the patients and hundreds of thousands of the homeless patients have life-threatening and/or chronic conditions such as diabetes, hypertension, and heart disease, and 24% of total patients and 37% of the homeless patients have no health insurance.

Substance Abuse and Mental Health Services Administration:

  • The Administration proposes to cut Mental Health Programs by 20% or $237 million compared to the enacted FY2016 level and 26% or $251 million compared to the enacted FY2017 level, which may reduce funding for mental health programs for homeless people and to prevent homelessness, including the $97 million in funding for Grants to States for the Homeless (PATH), Homelessness Prevention Programs, and Science and Service: Homelessness activities.  Funding for mental health programs for homeless people are vital and should be increased because 44,000 persons with severe mental illness were homeless without shelter and 59,000 were in emergency shelters and transitional housing on a night in 2015.  Funding for mental health programs to prevent homelessness are important and should be increased because 19,950 individuals and adults in families who stayed in an emergency shelter or in transitional housing in 2015 came from a mental health facility, a decrease of only 288 people from the year before.
  • The Administration proposes a $1 million increase for Substance Abuse Treatment bringing the total to $2.196 billion compared to the enacted FY2016 level, which is a decrease of $16 million compared to the enacted FY2017 level.  Funding for Substance Abuse Treatment Systems for Homelessness should be increased, including a restoration of the $5 million that was cut in FY2017, because 43,000 homeless persons without shelter and 60,000 homeless persons in emergency shelters and transitional housing were battling chronic substance abuse on a given night in 2015.
  • The Administration proposes to cut Substance Abuse Prevention programs by 29% or $61 million compared to the enacted FY2016 level and 32% or $73 million compared to the enacted FY2017 level.  Funding for Substance Abuse Prevention should be increased, instead of decreased, because thousands of people and hundreds of homeless people from New York to Orange County, California have died in recent years before they were able to receive treatment.
  • The Administration proposes to cut Health Surveillance and Program Support by $35% or $73 million compared to the enacted FY2016 level and 10% or $15 million compared to 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.

Administration for Children and Families:

  • The Administration proposes to entirely eliminate the Social Services Block Grant Program, which is a decrease of $1.7 billion compared to both the enacted FY2016 and enacted FY2017 levels and would result in a decrease compared to the most recently reported funding levels of $24 million for Counseling Services to assist individuals in locating, obtaining, or retaining housing, $58 million for Residential Treatment, and $13 million for Substance Abuse Services.  In addition, the Administration proposes to reduce funding for the Temporary Assistance for Needy Families (TANF) Program by 10% or $1.268 billion and to entirely eliminate the TANF Contingency Fund of $608 million compared to the enacted FY2016 level, which could reduce the TANF Transfer Funds to the Social Services Block Grant of $4.2 million provided for Counseling Services, $33 million provided for Residential Treatment, and $297,000 provided for Substance Abuse Services as most recently reported.  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.

Centers for Medicare and Medicaid Services:

  • The Administration also proposes to reduce Medicaid State Grants and Demonstrations by 85% or $511 million compared to the enacted FY2016 level of $597 million, including entirely eliminating the Grants to Improve Outreach and Enrollment, Money Follows the Person Demonstration, and Demonstrations to Improve Mental Health.  In addition, the Administration also proposes to reduce Medicaid Program Management by 2% or $81 million compared to the enacted FY2016 level and enacted FY2017 level of $3.669 billion, which appears to include reductions in research, demonstrations, and evaluation projects.  Funding for these demonstrations and evaluations are important, life-saving, and cost-effective and should be maintained because they increase enrollment in Medicaid and the Children’s Health Insurance Program, increase the use of home and community-based services, improve access to high-quality behavioral health sciences, and increase access to health care services with evidence-based analysis.
  • Finally, the Administration proposes to reduce funding for the Children’s Health Insurance Fund by 63% or $12.2 billion compared to the enacted FY2016 level of $19.32 billion.  Funding for the Children’s Health Insurance Fund is critical and life-saving and should be increased, instead of decreased, because data indicate more than 8.3 million children and 1,100 homeless children are enrolled in the Children’s Health Insurance Program and more than 4.1 million children and 22,000 homeless children do not have any health insurance.

Overall, the President’s FY2018 Budget Request proposes to cut funding for programs that provide healthcare to homeless individuals and families and to those at risk of homelessness by more than $4 billion.  With hundreds of thousands of homeless adults with life-threatening or chronic conditions and with more than 100,000 adults and children with severe mental illness and/or chronic substance abuse who are homeless on a given night and almost half of them sleeping on the streets, Congress should increase, instead of decrease, funding for programs that provide critical and life-saving health, mental health, and substance abuse assistance to people who are homeless and who are at heightened risk of homelessness.