Domestic HIV Funding in the White House FY 2023 Budget Request

President Biden released his full FY 2023 budget request on March 28, 2022. The President’s second budget request builds on past efforts to address the domestic HIV response, including by proposing funding increases for the “Ending the HIV Epidemic” (EHE) initiative. The EHE was launched by the Trump Administration in 2019, building on efforts made by the Obama Administration and has continued under the Biden Administration. In addition, the budget proposes a new mandatory HIV prevention program aimed at expanding use of pre-exposure prophylaxis (PrEP), a medication that prevents HIV acquisition and is recommended for those at higher risk.

The request also includes discretionary funding for key programs aimed at addressing the domestic HIV epidemic, including at the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS and Health Center Programs, the National Institutes of Health (NIH), the Dept. of Housing and Urban Development’s Housing Opportunities for People with AIDS (HOPWA) Program, and the Indian Health Service (IHS) and marks the fourth year of appropriations requests for the EHE.  Funding specifically targeted towards the EHE initiative totaled $850 million, $377 million (80%) over the FY 2022 enacted level. There are several other discretionary programs (e.g. Dept. of Veteran’s Affairs (VA), Substance Abuse Mental Health Services Administration (SAMHSA), etc.) for which funding information is not yet available and therefore those amounts are not included here. Also not included is HIV spending by mandatory programs (Medicaid, Medicare, SSDI and SSI), which is determined by eligibility rules and cost of services and not dependent on Congressional appropriations.

Key budget highlights are as follows.

CDC – HIV prevention

The FY 2023 funding request for domestic HIV prevention at the CDC, which accounts for almost all federal funding for domestic HIV prevention, totals $1.1 billion, an increase of $113 million (11%) over the FY 2022 enacted level. Of this, $310 million is allocated to EHE activities, an increase of $115 million over the FY 2022 enacted level.

HRSA – Ryan White and Health Center HIV Funding

  • The Ryan White HIV/AIDS Program, the nation’s safety net for HIV care and treatment, receives $2.7 billion in the FY 2023 request, a $160 million (6%) increase over the FY 2022 enacted level. Most of the increase is attributed to EHE activities; the EHE receives $290 million in the request, an increase of $165 million (132%) over the FY 2022 enacted level. Additionally, Ryan White Program Parts B (funding for states) and C (funding for clinical programs) also received small increases. Parts A (funding for urban areas), D (funding for clinical programs serving women and children), and F (funding for dental programs and training centers) saw small decreases compared to final enacted amounts in the FY22 final omnibus. The funding request for Part F Special Projects of National Significance (SPNS) was the same as the FY 2022 enacted level.
  • The FY 2023 budget request also includes HIV funding for the Health Center Program at HRSA, all of which is for the EHE initiative, totaling $172 million, a $49.8 million (41%) increase over the FY 2022 enacted level.
  • In past years, a small amount of EHE funding was also allocated to technical assistance within health centers for rural health. This amount totaled $1 million in FY 2020 and $1.5 million in FY 2021. Whether funding was allocated in FY 2022 or included in the FY 2023 request is not yet known.

NIH – Domestic HIV Research

  • The National Institutes of Health (NIH) carries out almost all federally funded HIV research activities. In the FY 2023 budget request, domestic HIV research funding at NIH totaled $2.49 billion, $81 million (3.2%) below the FY 2022 appropriated level.1  
  • Of that total, the agency received $26 million in EHE funding in the request which is the same as the FY 2022 enacted level.

Indian Health Service (IHS)

The FY 2023 budget request includes $52 million for EHE activities at the Indian Health Service (IHS), $47 million, or a nearly ten-fold increase, over the FY22 enacted level of $5 million.

Housing Opportunities for People with AIDS (HOPWA)

HOPWA is a program of the Department of Housing and Urban Development which provides housing assistance and supportive services to low-income people with HIV facing housing insecurity. The FY 2023 budget request includes $455 million, a $5 million (1%) increase over the FY 2022 enacted level.

Minority HIV/AIDS Fund

The request also includes $58 million for the Minority HIV/AIDS Fund which aims to reduce new HIV infections, improve HIV-related health outcomes, and reduce HIV disparities for racial and ethnic minority communities. This is $1.1 million (2%) higher than the FY 2022 appropriated level.

New Mandatory PrEP Program

In addition to funding proposals for discretionary programs (programs whose funding is dependent on Congressional appropriations), the budget also proposes to create a new mandatory program that would provide PrEP to uninsured and underinsured people without cost-sharing. The program would include “essential wrap-around services through States and localities, and establish a network of community providers to reach underserved areas and populations.” The proposed program would invest $237 million in FY 2023 and $9.8 billion in funding over 10 years into the effort.

Alongside the proposal for the new PrEP program, the budget calls on the Medicaid program, the largest payer for HIV care and treatment, to expand access to PrEP and associated services without cost sharing or utilization management for enrollees.

The tables below compare federal funding levels for domestic HIV, where specified, in the FY 2023 request to the FY 2022 enacted levels. Funding for the “Ending the HIV” Initiative is included in the overall table (Table 1) and in a dedicated table (Table 2). For a more detailed assessment of EHE funding see our EHE funding tracker. (Funding for the new PrEP program, or other existing mandatory programs, are not included below.)

Table 1: FY 2023 Key Discretionary Accounts in the Domestic HIV Budget Request (in Millions)
Agency/Program FY22 Omnibus FY23 Request Difference: FY23 Request– FY22 Enacted
CDC – HIV Prevention $986.71 $1,099.71 $113.00
(11%)
      Of which EHE $195.00 $310.00 $115.00
(59%)
HRSA
   Ryan White $2,494.78 $2,654.78 $160.00
(6%)
       Of which EHE $125.00 $290.00 $165.00
(132%)
   Community Health Centers (EHE Only) $122.25 $172.00 $49.75
(41%)
  Health Centers (EHE Rural Health TA) NA NA NA
NIH – Domestic HIV Research $2,565.87 $2,485.25 -$80.62
3.2%
      Of which EHE $26.00 $26.00 $0
(0%)
HUD – HOPWA $450.00 $455.00 $5.00
(1%)
IHS (EHE Only) $5.00 $52.00 $47.00
(940%)
Minority HIV/AIDS Fund $56.90 $58.00 $1.10
(2%)
Key Accounts Total $6,681.51 $6,976.74 $295.23
4.2%
Table 2: FY 2023 Ending the HIV Epidemic Budget Request (in Millions)
 Agency/Program FY22 Omnibus FY23 Request Difference: FY23 Request– FY22 Enacted
CDC $195.00 $310.00 $115.00
(59%)
HRSA
   Ryan White $125.00 $290.00 $165.00
(132%)
   Community Health Centers $122.25 $172.00 $49.75
(41%)
 Health Centers  (Rural Health TA) NA NA NA
NIH $26.00 $26.00 $0
(0%)
IHS $5.00 $52.00 $47.00
(940%)
Total $473.25 $850.00 $376.75
(80%)

Key Documents:

Endnotes
  1. Domestic funding level obtained via personal communication with NIH.

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