Domestic HIV Funding in the White House FY 2025 Budget Request
President Biden released his FY 2025 budget request on March 11, 2024. The President’s fourth and final budget request of his first term builds on past efforts to address the domestic HIV response, including by proposing slight funding increases for the “Ending the HIV Epidemic” (EHE) initiative and the Housing Opportunities for People with AIDS (HOPWA) Program. In addition, this is the third year the budget proposes a new mandatory HIV prevention program aimed at expanding the use of pre-exposure prophylaxis (PrEP), a medication that prevents HIV for those at higher risk.
The request also includes discretionary funding levels 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, Urban Development’s HOPWA Program, the Minority AIDS Initiative, and the Indian Health Service (IHS). It also marks the fifth year of budget requests for the EHE. (Not included here are funding levels through mandatory accounts, including Medicaid, Medicare, Social Security Insurance (SSI), and Social Security Disability Insurance (SSDI), which make up the majority of HIV spending by the federal government.)
As the FY 2024 budget has not yet been approved by Congress, comparisons are made to the FY 2023 level, when possible. An overall request total for discretionary HIV funding is not yet available as we await the domestic HIV funding level from NIH. The funding request for the EHE initiative totals $593.25 million, $20 million (3.5%) over the FY 2023 enacted level.
Key budget highlights are as follows.
CDC – HIV prevention
- The FY 2025 funding request for domestic HIV prevention at the CDC, which accounts for almost all federal funding for domestic HIV prevention, totals $1.0 billion which is the same level as the FY 2023 enacted amount.
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 $2.6 billion in the FY 2025 request, a $10 million (0.4%) increase over the FY 2023 enacted level. The small increase is attributed to EHE activities; the EHE receives $175 million in the request, an increase of $10 million (6.1%) over the FY 2023 enacted level.
- The FY 2025 budget request also includes $157.25 million in HIV funding for the Health Center Program at HRSA, all of which is for the EHE initiative, and is the same amount as the FY 2023 enacted level.
NIH – Domestic HIV Research
- The National Institutes of Health (NIH) carries out almost all federally funded HIV research activities. The domestic share of HIV funding is not yet known. The FY 2023 enacted level for domestic HIV research at NIH was $2.7 billion. (This line will be updated with FY 2025 request level, when possible.)
- Included in the overall HIV funding at NIH is funding for the EHE. The agency received $26 million in EHE funding in the request which is the same as the FY 2023 enacted level.
Indian Health Service (IHS)
- The FY 2024 budget request includes $15 million for EHE activities at the Indian Health Service (IHS). This is a $10 million, or 200% increase, over the FY 2023 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 $505 million, a $6 million (1%) increase over the FY 2023 enacted level.
PrEP Access through Medicaid and CHIP
- The budget creates a proposal which would require state Medicaid and CHIP programs to cover PrEP and associated laboratory services without cost-sharing for beneficiaries. It also “places guardrails on utilization management practices like prior authorization and step therapy.”
Mandatory PrEP Program
- For the third year in a row, the Budget proposes to repropose $9.8 billion over 10 years for a new mandatory Pre-Exposure Prophylaxis (PrEP) Delivery Program to End the HIV Epidemic in the United States (“PrEP Delivery Program”). The program would aim to “provide PrEP and associated services at no cost to uninsured and underinsured individuals and expand the number of providers serving underserved communities.”
The tables below compare federal funding levels for domestic HIV, where specified, in the FY 2025 request to the FY 2023 enacted levels. (As noted, FY24 funding levels are yet available for comparison.) Funding for the “Ending the HIV” Initiative is included in the overall table (Table 1) and in a dedicated table (Table 2). Funding for the new PrEP program is not included below as the following tables include discretionary funding only.