National Alliance on Mental Illness
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FY 2013 Spending Bills for Mental Illness Research, Services, Housing and Veterans Programs Move Forward
Against a backdrop of tight limits on federal discretionary spending and a possible across the board cut looming at the end the of the year, Congress has been moving forward in advancing spending bills to cover federal discretionary programs, including mental illness research and services, as well as veterans and housing programs. In theory, these discretionary appropriations bills are supposed to be enacted before FY 2013 begins on October 1. However, no one expects final FY 2013 spending levels to be resolved until a post-election “lame duck” session in November.
Possible Across the Board “Sequester” Looming
Under the Budget Control Act that Congress agreed to by the President and congressional leaders in August 2011, an automatic cut in discretionary spending of 8.4% is possible – unless an agreement to defer or cancel this “sequester” is reached at the end of the year. This possible sequester hangs over the current debate over FY 2013 funding levels for all discretionary programs, including mental illness research, services and housing programs. It is important to note that all veterans programs are exempt from this automatic sequester.
NAMI is participating in a large coalition of national organizations working to protect all categories of “non-defense discretionary” (NDD) spending from further reductions, including the sequester. More information on this coalition, including a sign-on letter that is open to all NAMI state and local organizations is available at
FY 2013 Appropriations Bills Advance
In recent weeks, both the House and Senate Appropriations Committees have been advancing bills to fund mental illness research, services, veterans and housing programs for FY 2013. As noted above, all of these bills are subject to tight limits on discretionary spending that were set by Congress and the President in August 2011. These limits on discretionary spending mean that nearly all federal agency budgets – with the notable exception of the Department of Veterans’ Affairs – will be frozen at their FY 2012 for the coming fiscal year. In most cases these bills are unlikely to advance further until after the fall election and the expected “lame duck” session in November and December.
Click here to view a detailed analysis of proposed FY 2013 funding levels for mental illness research, services, veterans and housing programs
Summary of Draft FY 2013 Spending Bills for Mental Illness Research, Services, Veterans and Housing Programs
Mental Illness Research at NIMH
A draft bill covering the FY 2013 budgets for the Departments of Labor, HHS and Education (S 3295) was reported by the Senate Appropriations Committee on June 14. This bill includes FY 2013 $30.731 billion in funding for the National Institutes of Health (NIH) -- $100 million more than the comparable FY 2012 level. This amounts a virtual freeze in funding for biomedical research at NIH. Within NIH, the National Institute of Mental Health (NIMH) would see a slight $4 million increase under the Senate bill – up to $1.483 billion. Like the overall NIH budget, this is essentially a freeze at the current FY 2012 level.
Under a freeze, the NIMH will continue to struggle to fund an adequate number of “new and competing” research in FY 2013. A flat budget for the NIMH means that the agency must operate at below “medical research inflation” – the annual escalation in research cost. In addition, NIMH still has significant “out-year” commitments, that is ongoing multi-year grants for ongoing basic research and clinical studies. Further, holding the NIMH budget at or near a freeze for FY 2013 also means that the Institute’s “pay-line” will continue to stay below 20% -- in other words, 80% of “new and competing” research grants (that get through peer review and are deemed meritorious science) will not receive funding.
On a positive note, the report accompanying the Senate bill contains language specifically directing NIMH to develop and coordinate a research program to examine early mortality and medical co-morbidities experienced by adults living with serious mental illness, a major priority for NAMI. This language directs NIMH to work with other NIH institutes responsible for diabetes and heart disease on focused research on individuals with serious mental illness:
Premature Mortality.—The Committee continues to be concerned about premature mortality and lower life expectancy experienced by adults living with serious mental illness as a result of treatable medical conditions such as cardiovascular, pulmonary, endocrine, and infectious diseases. The Committee urges NIMH to continue its collaborations with other Institutes, including NIDDK and NHLBI, to pursue research to better understand the causes and interventions needed to address this crisis. The Committee requests an update in the fiscal year 2014 congressional budget justification.
Mental Health Services at SAMHSA
For the second year in a row, the Senate Appropriations Committee has recommended an increase for the Mental Health Block Grant program. For FY 2013, the recommended increase is $21 million, boosting funding to $479.76 million. In report language accompanying the bill, the Committee specifically noted that these increases are in response to the deep cuts being imposed at the state and local level for publicly funded mental health services. NAMI strongly supports this 2nd year of increases for the MHBG – after more than a decade of flat funding – and is extremely grateful to Subcommittee Chairman Tom Harkin (D-IA) and Ranking Member Richard Shelby (R-AL) for including these increases in the bill.
Funding for most other Substance Abuse and Mental Health Services Administration (SAMHSA) and its Center for Mental Health Services (CMHS) is frozen in the Senate bill at current FY 2012 levels. This includes funding for the Childrens Mental Health program ($117.8 million) and the PATH program ($65 million – outreach and engagement for homeless individuals with mental illness). The draft Senate bill also continues the SAMHSA “primary-behavioral health integration” grant program at $65.7 million – rejecting a proposal from the Obama Administration to cut the program by $9 million. This is an important initiative designed, in part, to integrate primary medical care into specialty settings such as CMHCs to address chronic medical conditions experienced by people with serious mental illness.
The Senate bill also allows for a $45 million transfer to the CMHS Projects of Regional National Significance” (PRNS) account from the Public Health and Prevention Fund – funds set aside under the Affordable Care Act. This transfer will allow for the overall PRNS account to increase to $315.4 million.
FY 2013 funding for mental health services for the Department of Veterans Affairs is included in the Military Construction-VA Appropriations bill (HR 5854/S 3215). Overall, both the House and Senate bills fund the VA at the President’s request of $135.6 billion for FY 2013. This figure includes $52.54 billion in advanced funding VA medical care that was allocated last year for the FY 2013. Since 2010, Congress has been funding VA medical care through this advanced appropriations mechanism which places the agency on a more stable and predictable two year funding cycle.
As with the Senate bill, the House bill continues increases for mental illness treatment in the VA. This includes advanced funding for FY 2014 of $6.453 billion for mental health services – a 4.3% increase (a $269 million funding boost). The bill specifically allocates $443.3 million of this total for treatment for PTSD and $75.6 million for suicide prevention activities at the VA. The House bill also contains specific directives for the VA to follow through on recommendations of the Office of Inspector General for addressing delays in mental illness treatment with respect to timely initial evaluations, filling of clinical staff vacancies and data collection.
The Senate bill allocates $5.76 billion for health care and support services for homeless veterans. This includes $1.35 billion in direct programs to assist homeless veterans, including $244.6 million for the HUD-VASH program and $235 million for the Homeless Grant Per Diem Program.
Finally, both the House and Senate bills allocate $582.7 million – the same amount as the President’s request – for VA medical research, including research on PTSD and other mental health disorders.
Housing & Homelessness Programs
FY 2013 funding for housing and homelessness programs is included in the Transportation-HUD Appropriations bill (S 2322). Both the House and Senate Appropriations Committees have moved their versions of the “T-HUD” bill forward. The House bill rejects the President’s request to cut the HUD Section 811 program by $15 million, allowing for full funding at the FY 2012 level of $165 million. By contrast, the Senate bill funds Section 811 at the President’s request of $150 million. Within this total, both bills allocate a projected $85 million to renew (and make amendments to) existing project-based assistance contacts (PRACs) that cover the operating costs of current 811 units.
Both the House and Senate bills would continue funding in FY 2013 for the new Section 811 Project-Based Assistance (PRA) demonstration program, as authorized in the Frank Melville Supportive Housing Investment Act that passed Congress in 2010. This would allow Section 811 to develop as many 2,800 new units in FY 2012 – as opposed to fewer than 500 new units under the existing capital advance-PRAC model.
More information on the new 811 PRA option – including information about the recently published Notice of Funding Availability (NOFA) for the FY 2012 allocation of funding is available at:
For homeless programs under the McKinney-Vento Homeless Assistance Act, the Senate bill provides a $245 million increase over the FY 2012 level – boosting funding to $2.146 billion. By contrast, the House bill funds homeless programs at $2 billion. There is growing concern that the funding level in the House bill is insufficient to renew existing rent and operating subsidies under the permanent supportive housing programs funded under McKinney-Vento (programs such as Shelter Plus Care).
Both the House and Senate T-HUD Appropriations bills do fund the President’s request for an additional $75 million for rental vouchers for the joint HUD-VA VASH program – supportive housing and services for homeless veterans.
Social Security Administrative Funding
Monthly Social Security benefits (including SSI and SSDI cash assistance) are mandatory programs funded outside of annual discretionary appropriations bills. However, the Social Security Administration’s LAE (Limitation on Administrative Expenses) budget is funded annual as a discretionary program. This funds local SSA offices as well as state DDS (disability determination) offices that adjudicate claims and appeals for SSI and SSDI benefits. Adequate funding for the SSA LAE is therefore critical to ensuring that the agency and the DDS offices have the capacity to hear claims and appeals for eligibility and serve current beneficiaries in a timely fashion.
For FY 2013, the President proposed an LAE level of $11.755 billion. The draft Senate Labor-HHS bill includes an LAE of $11.735 billion.
June 20, 2012
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