Congress gave final approval to a massive $1.2 trillion “omnibus” appropriations bill for the current federal fiscal year that includes funding for a broad array of federal discretionary programs including mental illness research, services and veterans’ programs. The package has already been signed by President Obama. This ends the year-long partisan fight over FY 2012 spending priorities, nearly three months into the current fiscal year. This agreement keeps in place an overall limit on discretionary spending that congressional leaders and President Obama agreed to in August of 2011 and will stay in place for the coming decade. For mental illness research and mental health services programs there is a 0.189 percent reduction across the board. This very small cut was imposed on every program and account in the Labor-HHS-Education title of the omnibus appropriations bill.
For FY 2012, the agreement includes $1.483 billion for the National Institute of Mental Health (NIMH). This is approximately $8 million more than the FY 2011 funding level of $1.475 million. The 0.189 percent reduction will lower this $8 million increase by $2.8 million. This is far below the requested increase for FY 2012 that was in the President’s budget and the original House version of the Labor-HHS-Education Appropriations bill, a $40 million increase above the FY 2011 level. This is a major disappointment given the challenges facing NIMH and the tremendous need for new investments in basic scientific and clinical research on mental illness.
Holding the NIMH budget essentially to its current level will likely leave the agency struggling to fund an adequate number of “new and competing” research grants in FY 2012. The very small increase for NIMH for FY 2012 is well below “medical research inflation,” the annual escalation in research cost. In addition, NIMH has nearly $700 million in “out-year” commitments (more than 40 percent of the total NIMH budget) of ongoing multi-year grants for basic research and clinical studies. Holding the NIMH budget at or near a freeze for FY 2012 will likely lower the Institute’s “pay-line” to 15 percent. In other words, 85 percent of “new and competing” research grants (that get through peer review and are deemed to be meritorious science) will not receive funding.
The final Omnibus spending bill also includes an allocation of $576.6 million for the new National Center for Advancing Translational Sciences (NCATS). This new center was created earlier this year at NIH. It is intended to spur research designed speed up the delivery of new drugs, diagnostics and medical devices to patients. This is a critical new investment on the part of NIH to reach beyond basic scientific research and clinical trials toward higher risk research aimed at finding breakthrough cures and novel therapies. In addition, this $576.5 million appropriation, the final Omnibus bill with $10 million to help guide the new Cures Acceleration Network (CAN) authorized in the Affordable Care Act. While there is no guarantee that research on serious mental illness will be able to successfully compete for funds from NCATS or CAN, this will nonetheless create opportunities for breakthrough research that reaches beyond current medications and therapies. Earlier this week, NIH Director Dr. Francis Collins announced that NIMH Director Dr. Tom Insel will serve as the Acting Director of NCATS while the search for a permanent director is undertaken.
In an important victory for NAMI, the final Omnibus Appropriations bill includes a $41 million increase for the Mental Health Block Grant program, boosting funding up to $462 million. Of this increase, $14 million will be transferred to data infrastructure needs, funding efforts to develop improved systems to track spending and outcomes for public mental health services. This is the first increase in funding for the Mental Health Block Grant program since 1999. NAMI pushed hard for this increase as a critical federal response to the deep cuts that have been made in state funded mental health services during this prolonged economic downturn. This is a clear indication that these cuts in state and local programs are drawing attention in Congress.
Beyond the Mental Health Block Grant, other programs at the Substance Abuse and Mental Health Services Administration (SAMHSA) and its Center for Mental Health Services (CMHS) were either frozen at current levels or cut. This includes the Children’s Mental Health program ($117.8 million) and the PATH program ($65 million), which provides outreach and engagement for homeless individuals living with mental illness. A number of key priorities at CMHS focused on the emerging needs of children and adults living with serious mental illness will continue in FY 2012. These include:
It is important to note that funding for most discretionary programs at the Department of Veterans Affairs (VA) are not subject to the overall limit on discretionary spending that Congress and the President agreed to in August. This means that funding VA medical care will climb by more than 4.2 percent in FY 2013. The final Omnibus bill includes an “advance appropriation” of $52.5 billion for the Veterans Health Administration for FY 2013 and FY 2014. This includes an advance appropriation of $41.354 billion for direct medical care for FY 2013. Medical care in the VA is now funded under the advanced funding system whereby funding is locked in two years in advance to allow for more effective long-term planning and to avoid any disruption in funding if Congress fails to pass an appropriation for the VA at the beginning of the new federal fiscal year, a routine occurrence in recent years. This means that funding for the VA’s system of hospital and clinics is now secure and stable through Sep. 30, 2014.
The final omnibus bill also allocates $248 million for the caregivers program for FY 2013. While the VA does not segregate funding for psychiatric treatment and mental health services into a separate account, it is expected that mental health care in the VA will exceed $4 billion in FY 2012. The final Omnibus Appropriations bill does include language urging the VA to continue implementation of the Integrated Mental Health Strategy. Finally, the final bill includes resources to implement the VA’s homeless assistance programs including the grant and per diem programs, domiciliary care and the VASH supportive housing programs.
Beyond Veterans Health Administration, there are still a range of VA activities that depend on annual appropriations for the current fiscal year. These include the medical research budget at the VA, which is funded in the Omnibus bill at $581 million for FY 2012, $1.162 million more than the comparable FY 2011 level.
Funding for Social Security’s mandatory entitlement programs (including SSI and SSDI) are not included in the discretionary budget. However, SSA’s administrative functions are subject to the agency’s discretionary budget, known as the Limitation on Administrative Expenses (LAE). Providing sufficient funds to SSA through the LAE is critical to helping the agency keep pace with the large and growing backlog of administrative appeals that often leave claimants for SSI and SSDI eligibility waiting sometimes years for hearing decisions. For FY 2012, the Omnibus Appropriations bill includes $10.6 billion for the Social Security LAE. This is $74 million above the FY 2011 level, and $865 million below the President’s request.
Funding for programs at the Department of Housing and Urban Development (HUD) were included in a separate “minibus” appropriations bill for FY 2012 that was passed and signed into law in November. Further details can be read on housing programs targeted to people living with serious mental illness is available at.
Posted: Dec. 20, 2011
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