Obama Releases Proposed Budget, Includes Mental Health Funding

Wed April 10, 2013

(Washington, DC) — The President’s proposed $3.77 trillion fiscal 2014 budget, released this morning, would increase spending in 2014 by nearly $160 billion— a product both of canceling the previous sequester and implementing the president’s new spending initiatives. Many of the president’s plans to cut spending would phase in toward the end of the 10-year budget window, effectively trading the pain of sequestration now for cuts in entitlement spending later. Provisions included:

Mental Health Services

The Obama proposed budget includes a new $130 million initiative to expand mental health treatment and prevention services, including: $55 million for Project AWARE (Advancing Wellness and Resilience in Education) to provide Mental Health “First Aid” training in schools and communities and to help school districts and their communities work together to ensure that students with mental health issues are referred to the services they need; $50 million to train 5,000 new mental health professionals to serve students and young adults, including social workers, counselors, masters-level psychologists, and other mental health professionals; (Not Psychiatrists and other physicians, to which the APA and AAFP have objected) and $25 million for Healthy Transitions, a new competitive grant to help support transitioning youth (ages 16-25) and their families access and navigate behavioral health treatment systems. Additional information will be available following a SAMHSA budget briefing.

The President’s proposed SAMHSA “The Time is Now” initiatives in response to the Sandy Hook shootings at SAMHSA would be mostly be funded via existing SAMHSA dollars. As current grants sunset, the funding would be rolled over into the new programs.

Gun Violence Prevention Research

The president’s proposed budget includes an additional $20 million for the National Violent Death Reporting System to expand the surveillance system to all States in 2014 to improve our understanding of violence. The Budget also includes $10 million for the Centers for Disease Control and Prevention (CDC) to support research on the causes and prevention of gun violence. APA is a long-time supporter of funding for these issues.

For NIH, the President would add $470m to the overall budget of $31.3  billion in FY14. For NIDA, this would translate into an increase of $20m over FY12 $1.07 billion. For NIAAA, an increase of $5m to $468m and NIMH, at $1.46 billion. NIMH would actually receive a small downwards adjustment of $11.7million as the result of having $27m of its AIDS portfolio transferred to the National Institute for Allergy and Infectious Disease. Recall that the President announced a $100million BRAIN Initiative earlier this month which would leverage brain research across NIH, DARPA and the National Science Foundation, so on balance, more, not less funding is being directed to brain research.


Again, the focus is on primary care, and the president’s proposed budget provides” increased resources for primary care training programs” and support for health care providers who choose to train and practice in medically-underserved areas. The Budget includes funding that will support over 8,800 health care professionals practicing in underserved areas. In addition, the  proposed budget “initiates investments that will help train more than 2,800 additional primary care providers estimated to enter the workforce over the next five years.“

Medicare and Medicaid

The Obama administration supports a “period of payment stability lasting several years” to allow the development of “accountable payment models” that can replace the Sustainable Growth Rate formula.  After the period of stability, “practitioners will be encouraged to partner with Medicare by participating in an accountable payment model, and over time, the payment update for physician’s services would be linked to such participation,” the budget says, adding that higher payments will be tied to higher-quality care. Beneficiaries will “be encouraged” to “seek high-value and efficient care.”   

This is fully in keeping with current draft proposals under development by the House Ways and Means and Energy and Commerce Committees.   As you know, APA, AMA and a small group of medical specialties are working to influence the proposals.

The White House budget proposes a one-year delay of the ACA’s scheduled reductions in Disproportionate Share Hospital payments to safety-net hospitals. The reductions are scheduled to go into effect in 2014, as the law’s coverage expansions take effect and reduce the burden of uncompensated care. However, the administration wants to get a better sense of how much the ACA reduces the ranks of the uninsured.  The budget also proposes to reduce IGME payments by $11 billion over a 10-year period.

Department of Veterans Affairs

The president’s budget Provides $63.5 billion in discretionary funding for the Department of Veterans Affairs, an 8.5 percent increase over the 2012 enacted level, to provide needed care and other benefits to veterans and their families. In addition, the Budget includes $3.1 billion in estimated medical care collections, for a total budget authority of approximately $66.5 billion.

The budget as proposed  Includes $54.6 billion for veterans’ medical care, supporting continuing improvements in the delivery of mental health care, the development of tele-health technologies, specialized care for women veterans, and benefits for veterans’ caregivers.

The budget also requests $55.6 billion in 2015 advance appropriations for medical care programs, to ensure continuity of veterans’ health care services,  level funds for medical and prosthetic research efforts at $586 million, and provides $104 million through a new Transition Assistance Program called “Transition GPS” to help separating military service members better transition to civilian life


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