Source: http://www.chrt.org/publications/price-of-care/affordable-care-act-funding-an-analysis-of-grant-programs-under-health-care-reform/
Timestamp: 2014-08-21 21:57:42
Document Index: 526780236

Matched Legal Cases: ['§ 1003', '§ 1002', '§ 1311', '§1002', '§1003', '§1311', '§5601', '§10503', '§6301']

Affordable Care Act Funding: An Analysis of Grant Programs under Health Care Reform » Center for Healthcare Research & Transformation
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CHRT Issue Brief September 2012
MLive 09/17/2012
ACA Funding in Fiscal Year 2010
ACA Funding in Fiscal Year 2011
ACA Funding in the Future
The Patient Protection and Affordable Care Act (ACA) is a comprehensive law with the potential to affect the health of Americans in many ways. The ACA reduces the number of uninsured Americans by expanding eligibility for Medicaid and offering tax credits for the purchase of private insurance.i In addition, the ACA makes investments to expand access to care, reform the health care delivery system, implement broad private insurance reforms, and enhance the public health infrastructure.
i The ACA expands coverage in 2014 through tax credits for private insurance and increasing eligibility for Medicaid. The estimated gross cost of this coverage expansion is $975 from FY2011 to FY2019, according to the Congressional Budget Office Report “CBO’s Analysis of the Major Health Care Legislation Enacted in March 2010” from March 2011. Since these provisions are funded outside federal budget process, they are not included in non-discretionary appropriations.
The ACA includes both discretionary and mandatory spending to fund its programs, but many key ACA initiatives are funded through mandatory spending that does not require further Congressional approval. Appendix 1 In total, the ACA included $101.25 billion in mandatory spending from fiscal years 2010 through 2019.ii By the end of fiscal year 2011, the U.S. Department of Health and Human Services (HHS) had awarded nearly $3.6 billion in grants under the ACA.iii Most grant programs under the ACA have been funded through mandatory spending.
Market reform: Includes a series of grants to help states reform their private insurance markets. These grants were directly funded by the ACA to establish insurance exchanges, review health insurance premium rates, and provide insurance information to consumers. The rate review program was appropriated $250 million (§ 1003); the consumer information program was appropriated $30 million (§ 1002); and the secretary of HHS has discretion to appropriate the amount necessary for insurance exchange grants prior to 2015 (§ 1311). To date, approximately $1 billion has been awarded to states through insurance exchange grants.iv
For a list of funding sources for select ACA programs by implementation year, see Appendix 1.
ii Based on CHRT calculations from the Congressional Research Service report “Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act” from February 2011. Appropriations for state grants for health insurance exchange planning and implementation are not included, since the Secretary of HHS has discretion to spend amounts necessary for these grants. As of May 16, 2012, HHS had awarded nearly $1 billion in planning and implementation grants for health insurance exchanges. http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html
iii Tracking Accountability in Government Grants System (TAGGS) available at http://taggs.hhs.gov.
iv As of May 16, 2012, HHS has awarded approximately$ 849 million in Level One and Level Two funding, $117 million in Early Innovator grants, and $47 million in exchange planning grants. http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html
Awards were limited in FY2010 due to the shorter funding period (March 2010 to September 2010) and to allow time for HHS and other agencies to prepare for the increase in spending under the ACA. Of the ACA’s many grant programs, 36 were actively funded in FY2010.
Figure 1FY2010 ACA Grant Funding by State
The Prevention and Public Health Fund and the market reform provisions in the ACA funded most active grant programs. In anticipation of the need for expanded primary care capacity in 2014, HHS committed one-half of the FY2010 Prevention and Public Health Fund budget to health workforce development programs instead of traditional community-based public health programs. This investment in health workforce made workforce funding the largest category of grants ($503 million), more than twice as much as community-based prevention programs (approximately $209 million), the next largest category. Figure 2 Another prominent category of ACA funding was for maternal and child health programs, which received $116 million. Much of this funding was distributed to states for Maternal, Infant, and Early Childhood Home Visiting programs ($103 million).
Figure 2 FY2010 ACA Grant Funding by Funding Category
$208,585,809
$116,312,534
State agencies were the leading recipient of ACA funding awards in FY2010, with nearly $414 million. Figure 3 These funds were used to support a wide variety of programs and initiatives, including Maternal, Infant, and Early Childhood Home Visiting programs ($85 million); health insurance exchange planning ($48 million); insurance premium reviews ($46 million); and personal responsibility pregnancy prevention ($44 million). Community-based health organizations, along with public and private colleges and universities, also received significant amounts of ACA funding, particularly to support primary care training and residency programs.
Figure 3 FY2010 ACA Grant Funding by Recipient Type
$225,577,854
$4,887,603
Nationally, ACA funding more than doubled in FY2011 to more than $2.5 billion as FY2011 was the first full fiscal year of ACA implementation. The number of actively funded grant programs under the ACA increased from 36 in FY2010 to 47 in FY2011. As in FY2010, California again received the most funding in FY2011, with nearly $258 million in grants. Figure 4
Figure 4 FY2011 ACA Grant Funding by State
Funding for community health centers comprised the largest category of grant funding in FY2011 with more than $858 million. Figure 5 Much of this funding was awarded for capital expenditures, with $716 million awarded to community health centers and $94 million awarded to school-based health centers. The next largest category was for grants to states for programs to reform the private insurance industry ($595 million), including grants to continue planning and to begin establishing health insurance exchanges ($463 million). Community-based prevention programs were also awarded funding ($436 million) for a variety of programs, including nearly $108 million in Community Transformation Grants.
Figure 5 FY2011 ACA Grant Funding by Funding Category
$435,659,620
$250,486,728
$2,562,541,851
In FY2011, state agencies again received the most ACA grant funding with more than $1.1 billion. Figure 6 More than one-third of this funding was awarded for state planning and implementation of health insurance exchanges ($427 million). State agencies were also awarded funds to continue operating Maternal, Infant, and Early Childhood Home Visiting programs ($216 million) and insurance premium Rate Review programs ($102 million). Similar to FY2010, community health centers continued to receive significant funding ($840 million), with most of funding for capital development ($632 million). Public and private colleges and universities experienced modest increases in funding from their FY2010 levels as Prevention and Public Health Fund funding shifted away from workforce training and toward traditional public health programs.
Figure 6 FY2011 ACA Grant Funding by Recipient Type
$839,988,927
$123,335,806
$18,093,294
The ACA includes nearly $4 billion in non-discretionary funding explicitly for FY2012, not including funding allocated across multiple years.v Assuming that the ACA is implemented as planned, total spending is scheduled to increase over previous years as new grant programs are introduced and agencies are established. Of course, scheduled increases could change over time. For example, as part of the Middle Class Tax Relief and Job Creation Act of 2012, the Prevention and Public Health Fund was cut from $15 billion to $9.75 billion over its first 10 years to offset the costs of extending temporary tax cuts and preventing a large cut in Medicare payments to physicians.
Some states have also returned grant funding for ACA programs. Four states—Delaware, Florida, North Dakota, and Pennsylvania—experienced a drop in total ACA funding from FY2010 to FY2011 even though the ACA was in effect for all of FY2011. Oklahoma, Kansas, and Wisconsin were three of seven states to receive Early Innovator Grants to develop infrastructure for health insurance exchanges. Oklahoma returned its $54 million award, reducing its state total to $35.3 million.vi Kansas returned its grant, worth $31.5 million, dropping its total to $14.1 million.vii Wisconsin also returned its grant, worth $38 million, reducing its total to $41 million.viii These states cited a desire to maintain flexibility in the future as a primary reason for returning the awards. Although the return of these grants was announced in 2011, they will be reflected in the funding levels for FY2012.
Funding may also be affected by the sequestration process under the Budget Control Act of 2011, which was triggered by the failure of the Joint Select Committee on Deficit Reduction (also known as the “super committee”) to agree on a plan to decrease the federal deficit. The sequestration process aims to reduce the deficit by $1.2 trillion by cutting funding for certain domestic programs and defense spending from 2013 to 2021.ix The resulting cuts to non-defense spending will likely reduce funding for ACA programs. While ACA-funded initiatives are designed to influence the future delivery of health care, the size and nature of future ACA-funded programs remains uncertain.
v Based on CHRT calculations from the Congressional Research Service report “Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act” from February 2011.
vi Oklahoma Gov. Mary Falling announced on April 14, 2011 that Oklahoma would return its $54 million Early Innovator Grant. http://www.ok.gov/triton/modules/newsroom/newsroom_article.php?id=223&article_id=1601
vii Kansas Gov. Sam Brownback announced on August 9, 2011 that Kansas would return its $31.5 million Early Innovator grant. https://governor.ks.gov/media-room/media-releases/2011/08/09/kansas-to-opt-out-of-early-innovator-grant
viii Wisconsin Gov. Scott Walker announced on January 18, 2012 that Wisconsin would return its $38 million Early Innovator Grant. http://walker.wi.gov/Default.aspx?Page=84c6be7e-6bf7-47bb-949a-7330dd644579
ix The $1.2 trillion sequester includes $492 billion in defense cuts, $492 billion in non-defense discretionary funding cuts, and $216 billion in reduced debt serving costs, http://www.bipartisanpolicy.org/blog/2011/11/bca-sequester
Focus on Michigan: Analysis of ACA Funding Awarded to Michigan
For FY2010 and FY2011, Michigan received a total of $82.6 million in ACA grant awards. The largest category of funding was for health workforce training and development ($26.5 million) with funding for community health centers a close second ($26.1 million). The State of Michigan, including the Department of Community Health, received the most funding in this two-year period with $27.1 million; nearly triple the amount of the next highest recipient. Figure 7
Figure 7 Top 10 Michigan Institutions Receiving ACA Grant Funding (FY2010-FY2011)
$27,106,892
$9,670,241
$8,321,408
$6,318,432
$5,736,624
$3,823,980
$3,427,616
$2,341,318
Michigan received more than $29 million in ACA grants in FY2010, ranking 10th in total state awards. Per-person, however, Michigan ranked 39th. Appendix 2
Funding in Michigan followed a pattern similar to the national level, with grants for the health workforce as the largest category by a large margin with $18.1 million. Figure 8 Many of these workforce grants were funded by the Prevention and Public Health Fund, which prioritized workforce development in FY2010.
Figure 8 Michigan FY2010 Grant Funding by Funding Category
Funding Category Funding Total
$18,058,616
$3,280,678
$2,633,673
$29,454,478
Colleges and universities in Michigan received much of this health workforce grant funding, making this the largest recipient category. Figure 9 For example, funding was awarded to the University of Michigan ($4.5 million), Wayne State University ($3.1 million), and Michigan State University ($2.4 million) for health workforce development.
Figure 9 Michigan FY2010 Grant Funding by Recipient Category
Recipient Category Funding Total
$13,903,858
$8,683,415
$4,400,966
$1,463,377
Health Workforce Nursing Education and Training: Michigan received 35 grant awards for nursing workforce development, totaling about $9.8 million. Notable awards include $1.4 million to University of Michigan-Flint, $1.4 million to Michigan State University, and $1.3 million to Wayne State University to expand advanced nursing education. Since nursing schools received a large number of the nursing-related grants, public and private universities received over half of the FY2010 funding in this category. Figure 9
Community-based Prevention Public Health: Michigan received four awards from the Prevention and Public Health Fund for traditional public health programs. The Michigan Department of Community Health received $135,438 for HIV testing, $493,670 to expand laboratory capacity, and $400,000 for public health infrastructure improvements.
Health Centers and National Health Service Corps Nurse Managed Health Clinic: The University of Michigan received nearly $1.5 million for a nurse-managed health clinic to expand primary care access in medically-underserved areas.
Maternal and Child Health Early Childhood Home Visitation: The Michigan Department of Community Health received a $2.1 million award to implement a Maternal, Infant, and Early Childhood Home Visiting program.
Market Reform Health Insurance Exchange Planning: Along with 48 other states, the State of Michigan received about $1 million for planning activities related to a state health insurance exchange.
Other Notable Funding Money Follows the Person (MFP): The State of Michigan was awarded $400,000 to transition Medicaid beneficiaries from nursing homes to community-based care. The ACA did not directly appropriate this funding; rather it authorized the use of existing MFP appropriations to fund the grant program.
State of Michigan$8,683,415(10 awards)Community-based Prevention$2,783,816
Health Workforce$650,061
Maternal and Child Health$2,133,673
Medicare$616,093
University of Michigan$5,990,359(9 awards)Health Workforce$4,491,782
Health Centers$1,498,577
Spectrum Health$3,490,659(Health Workforce, 1 award)
Wayne State University$3,060,624(Health Workforce, 6 awards)
Michigan State University$2,402,683(Health Workforce, 6 awards)
Grand Valley State University$2,010,423(Health Workforce, 3 awards)
University of Detroit Mercy$1,153,781(Health Workforce, 5 awards)
Michigan Primary Care Association$861,069(Health Centers, 1 award)
Inter-Tribal Council of Michigan, Inc$501,000(2 awards)Maternal and Child Health$500,000
Medicare$1,000
Washtenaw Community Health Organization$496,862(Community-based Prevention, 1 award)
Michigan received $53 million in FY2011, nearly double the amount received in FY2010. However, Michigan’s grant totals fell relative to other states, from 10th to 14th. Appendix 2 Per capita grant funding also declined from 39th to 44th nationally.
Figure 10 Michigan FY2011 Grant Funding by Funding Category
$23,734,556
$9,703,329
$8,441,153
$6,109,549
$53,106,587
Figure 11 Michigan FY2011 Grant Funding by Recipient Category
$23,068,278
$18,423,477
$6,785,378
$1,849,599
Community-based Prevention Public Health: The Michigan Department of Community Health received five awards through the Prevention and Public Health Fund to support public health programs. Awards included nearly $2.5 million for new increased laboratory capacity and $1.2 million for immunization program improvements.
Health Centers Community Health Centers: Approximately 35 percent, or about $18.7 million, of its total ACA-related funding in Michigan went for capital development of community health centers (see Figure 2). These grants were awarded to Family Health Center, Inc. ($9.4 million), Cherry Street Services, Inc. ($5.9 million), and Center for Family Health, Inc. ($3.4 million).
Maternal and Child Health Maternal, Infant, and Early Childhood Home Visiting program: The Michigan Department of Community Health received $5.6 million for its nurse home visitation program.
Market Reform Consumer Assistance Program: The Michigan Office of Financial and Insurance Regulation received $1.1 million for its Consumer Assistance Program. This program helps health insurance beneficiaries address disputes with insurance plans regarding coverage and benefits.
Other Notable Funding State Demonstration to Integrate Care of Dual Eligible Individuals: Michigan was one of 15 states to receive $1 million from the Center for Medicare and Medicaid Innovation for a demonstration project to develop a person-centered care model for individuals enrolled in both Medicare and Medicaid (dual-eligibles).
Multi-Payer Advanced Primary Care Practice Demonstration: Michigan was one of eight states selected for the Centers for Medicare and Medicaid Services (CMS) Multi-Payer Advanced Primary Care Practice demonstration project. Although not technically a direct ACA budget appropriation, the three-year project is expected to result in budget neutrality for Medicare and provide approximately $23 million per year in additional Medicare funds, along with funds from other payers, for enhanced care coordination and integrated care.x The multi-payer project was originally created under the CMS, but is now run by the newly created Center for Medicare and Medicaid Innovation. The project focuses on how the patient-centered medical home model can improve care. In Michigan, the project is known as the Michigan Primary Care Transformation Project, or MiPCT.
State of Michigan$18,423,477(11 awards)Community-based Prevention$6,945,928
Health Workforce$750,061
Maternal and Child Health$5,609,549
Family Health Center, Inc.$9,670,241(Health Centers, 2 awards)
Cherry Street Services, Inc.$6,318,432(Health Centers, 2 awards)
Center for Family Health, Inc.$3,400,000(Health Centers, 1 award)
Wayne State University$2,676,000(Health Workforce, 5 awards)
University of Michigan$2,331,049(Health Workforce, 7 awards)
Inter-Tribal Council of Michigan, Inc.$1,574,080(3 awards)Community-based Prevention$1,074,080
Maternal and Child Health$500,000
Michigan Primary Care Association$1,034,673(Health Centers, 1 award)
Michigan State University$1,024,933(Health Workforce, 5 awards)
Genesee County Health Department $850,000(Community-based Prevention, 1 award)
x Medicare funding estimate provided by the staff of the Michigan Primary Care Transformation Project (MiPCT).
However, Michigan has received other funding for FY2012, including $183,000 in awards for school-based health centers. If the ACA remains in effect as planned, Michigan can expect to receive more funding before the end of FY2012, as the application process moves along for other ACA programs.
Funding Sources of Select ACA Programs by Year (in millions of dollars)
Section Title FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 Total
§1002, §1003, & §1311
Grants to states to help establish insurance exchanges, review health insurance policies, and provide consumers insurance information
(Plus sums for exchange grants for FY2010 through FY2014 as necessary)
CMI conducts research and demonstration projects to improve efficacy and quality in Medicare, Medicaid and CHIP
(Plus $10 billion total for FY2011 through FY2019)
§5601 & §10503
Planning and expansion grants to increase the number of FQHCs nationwide
(Plus $1.5 billion total for community health center construction and renovation for FY2011 through FY2015)
§6301(e)
The PCORI funds studies of clinical effectiveness of various treatments
(Plus the net revenue from a fee levied on insurance policies and health plans for FY2013 through FY2019)
ACA Grant Funding by State (FY2010–FY2011)xi
State 2010 Total 2010 Ranking 2011 Total 2011 Ranking 2010 Per Capita 2010 Per Capita Ranking 2011 Per Capita 2011 Per Capita Ranking 2010–2011 Total Change
$17,124,019
$23,422,283
$8,689,448
$18,561,650
$17,135,703
$45,214,557
$15,409,304
$25,230,596
$83,370,688
$257,867,386
$17,456,197
$39,514,689
$18,654,522
$43,815,938
$6,698,710
$23,019,161
$34,111,800
$45,952,823
$39,514,272
$19,833,921
$36,574,858
$10,311,441
$28,078,761
$7,681,281
$17,735,420
$37,582,055
$93,700,925
$15,494,842
$50,136,605
$8,796,283
$29,324,634
$8,958,468
$45,590,837
$12,370,887
$51,102,450
$18,973,037
$34,589,314
$9,568,503
$24,573,806
$14,972,958
$58,376,022
$39,250,733
$124,861,483
$15,152,159
$32,551,776
$9,381,451
$36,089,699
$20,147,011
$60,040,629
$11,907,318
$18,764,597
$10,936,216
$21,064,330
$10,567,395
$16,241,465
$8,702,591
$16,172,098
$30,719,358
$33,953,677
$8,874,018
$49,016,300
$66,564,073
$146,544,575
$35,413,508
$69,445,475
$7,387,093
$6,305,950
$29,040,673
$144,260,115
$17,594,093
$89,305,824
$13,200,876
$111,889,237
$43,412,258
$36,453,089
$7,234,007
$22,497,162
$16,891,657
$19,563,117
$5,663,123
$10,622,510
$28,247,825
$52,083,869
$43,668,584
$76,731,180
$9,258,626
$19,532,532
$6,219,274
$14,988,245
$25,320,795
$46,549,353
$24,126,106
$85,854,864
$8,128,526
$48,059,529
$24,054,802
$79,024,415
$3,709,338
$17,232,656
xi Tracking Accountability in Government Grants System (TAGGS).