Tuesday, March 12, 2019

AUCD’s First Look at President's Budget

from AUCD:

March 12, 2019
As the old Washington saying goes, "The president proposes, Congress disposes." – Much of this week’s proposed presidential budget is not likely to translate to reality for Fiscal Year 2020. The Constitution gives Congress the ultimate power of the purse. Instead, it is a starting place and a chance to share with your congressional delegation your needs and priorities.

Monday’s 144-page document is just top line; details are expected next week.  A few big picture points:
    • Cuts spending by $2.7 trillion (the largest cut by any administration in American history).
      • What is listed as a 5% cut in domestic spending is really an 8.5-9% cut to non-defense discretionary spending with cuts to emergency disaster relief and wildfire suppression efforts not “counting” under ceilings calculated under the Budget Control Act, which sets federal spending caps.
      • Includes $22.1 billion in changes to welfare programs in fiscal 2020. This math doesn’t make sense, and the bullets below don’t seem to fit together. There is no definition of “welfare programs.”
          • $17.4 billion in cuts to the Supplemental Nutrition Assistance Program, or food stamps.
          • $456 billion in savings by cutting Medicare “waste, fraud and abuse” over the course of the decade.
          •  $143 billion is Medicaid cuts over the next decade, including converting it to a block grant program.
          • Cuts to SSI and SSDI from “Reform[ing] Federal disability programs and improv[ing] payment integrity.”
    • $750 billion increase in defense spending, using Overseas Contingency Operations and emergency funds to exceed the $576 billion cap of the Budget Control Act.
    • $8.6 billion for a barrier along the U.S.-Mexico border ($5 billion for the Department of Homeland Security and $3.6 billion for ongoing military construction).

Numbers of note:
U.S. Department of Health and Human Services (HHS): $87.1 billion in funding, a $14 billion or 12% cut.
  • $25 million in new funding to address the opioid epidemic and $2.1 billion in new funding for health center programs and public health research.
  • Assumes the repeal of the ACA and implementation of Medicaid Block Grants.

Administration for Community Living (ACL):
  • State Councils on Developmental Disabilities:  $56 million, a cut of $20M.
  • Developmental Disabilities Protection and Advocacy:  $39 million, a cut of $2M. 
  • Projects of National Significance:  $1 million, a cut of $11M. 
  • University Centers for Excellence in Developmental Disabilities:  $33 million, a cut of $8M. 
  • National Institute on Disability, Independent Living, & Rehabilitation Research:  $90 million, a cut of $19M. 
  • Independent Living:  $109 million, a cut of $8M. 
  • Family Caregiver Support Services:  $151 million, a cut of $31M.
  • Voting Access for People with Disabilities (HAVA):  $5 million, a cut of $2M.

Centers for Medicare & Medicaid Services (CMS):
  • Money Follows the Person: Eliminated. The entire budget of $112M is cut.

Health Resources and Services Administration (HRSA):
Maternal and Child Health
·       Autism and Other Developmental Disorders (which includes LENDs) is zeroed out, a cut of $52 million.
·       Block Grants proposed to be funded at $661 million, a cut of $17M.
·       Family-to-Family Health Information Centers are level funded at $6 million.
Ryan White HIV/AIDS Program
·       All existing projects are level funded.
·       New “Ending HIV Epidemic Initiative” funded at $70 million.

National Institutes of Health (NIH):
  • Proposes to fold the Agency for Healthcare Research and Quality (AHRQ) into the NIH and rename it the National Institute for Research on Safety and Quality.
    • Funding for research on ways to improve patient care and the health care system would be cut to $256 million from $338 million.
    • Congress has rejected this proposal in the past two budget negotiations.
  • Every existing NIH institute and center would see cuts (in millions).
    • Eunice K. Shriver Natl. Institute of Child Health & Human Development:  $1.297 billion, a cut of $210M.
    • National Institute of Mental Health:  $1.630 billion, a cut of $183M.
The Centers for Disease Control and Prevention (CDC):
  • Combating HIV transmission by dedicating $291 million for the CDC to work with local health agencies on “intensive testing and referral.”
  • Birth Defects, Developmental Disabilities, Disabilities and Health:  $112 million, a cut of $44M.
    • $2 million to support CDC’s work in understanding of neonatal abstinence syndrome.

Department of Education:  $37.1 million, a cut of 11%.
  • Programs of interest that are level funded:
    • Special Education
      • All birth and K-12 special education investments remain at FY19 levels.
    • Model Transition Programs for Students with Intellectual Disabilities into Higher Education (TPSID) remain at FY19 levels.
  • Programs of interest with increases:
    • Rehabilitation Services
      • Vocational Rehabilitation grants saw a small increase from $3,522 to $3,610 billion.
  • Programs of interest with cuts:
    • Hellen Keller National Center for Deaf Blind Youths and Adults cut from $13.5 to $10.3 million.
    • Special Institutions:  $216.7 million, a cut of $25.6M.
    • Supported Employment State Grants would be eliminated, a cut of $22.5 million.
    • Special Olympics Education Programs would be eliminated, a cut of $17.6 million.
  • School choice proposal:  a tax credit estimated to cost $50 billion over the next decade.
  • $200 million for school safety initiatives, such as developing safety plans, counseling, and emotional support and improving behaviors of students. Half the funding would be used for a new grant program for states and localities.

Department of Labor:  $10.9 billion, for a $1.2 billion or 9.7% decrease from the 2019 enacted level.
  • Office of Disability Employment Policy (ODEP) is cut by $11,203 million to $27 million.

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