The COVID relief provisions include $69 billion in funding to purchase and distribute vaccines ($8.75b to the Centers for Disease Control to help states provide COVID testing, tracing, and mitigation, with $2.5 billion provided as grants to communities of color and rural communities for such purposes). The bill provides $4.5 billion in mental health funding related to the pandemic and $9 billion in support for health care providers.  The Indian Health Service receives $1 billion out of the total funds.  The NIH receives $1.25b beyond its regular appropriation for COVID research. 

Early in the pandemic, Congress increased the federal share of funding supporting Medicaid.  That temporary boost is scheduled to continue through March, 2021; the new bill does not extend this deadline.  Advocates had sought a bigger increase than what was provided.  As cases and hospitalizations are surging, states will be hard-pressed to keep up with care needs without increased federal help; if federal help declines when the temporary boost ends, states will be in a very difficult position.  Tribes and territories also need additional Medicaid help to cope with the pandemic. 

One new provision contained within the 5,500–page bill not directly connected to COVID relief would limit surprise medical billing starting in 2022.  The legislation will prevent patients from being billed large amounts from health care providers not in their insurance network whose services were used in the course of treatment.  For example, if a patient is hospitalized for emergency surgery and the anesthesiologist or ambulance service utilized are not in the patient’s insurance company network, patients can be charged tens of thousands of dollars for these services despite not providing approval for them (perhaps because they are unconscious and/or in urgent need of care).  The legislation would stop most of these bills from going to the patient, and would instead require insurance companies to negotiate payment with the health service providers billing for out-of-network care. 

In regular FY21 appropriations, the National Institutes of Health receives $42.9 billion for FY21 (plus another $1.25b for COVID purposes).  CDC’s regular funding is set at $7.9b, up $125m over the prior year.  Its COVID-related spending on vaccines more than doubles its total funding. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) gets regular FY21 appropriations of $6 billion, an increase of $133 million over FY20.  SAMHSA also has additional funding through the COVID relief package of $4.5 billion. There is new funding for a Crisis Care Initiative within the Mental Health Block Grant.  New funds also address a National Child Traumatic Stress Initiative and suicide prevention.  Substance use disorder prevention and treatment, still a critical problem and likely worsened by the pandemic, receives an additional $1.65 billion out of the total COVID funds allocated to SAMHSA.   

FY21 appropriations also include increases for Community Health Centers, to achieve a goal of decreasing new HIV infections by 90 percent over 10 years.  In addition, the Maternal and Child Health Block Grant rises by $32 million to $975 million. 

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