CENTER FOR HEALTHCARE RESEARCH & TRANSFORMATION Issue Brief February 2016 Affordable Care Act Funding: An Analysis of Grant Programs under Health Care Reform FY2010-FY2015 Spending Provisions...2 Spending Extensions... 3 As part of the Patient Protection and Affordable Care Act (ACA), which was signed into law on March 23, 2010, Congress appropriated funds to expand access to care, implement private insurance reforms, and enhance public health infrastructure. The ACA provided for both annual appropriations and multiple-year appropriations. Many ACA funds ended in fiscal year (FY) 2014 or FY2015, including all market reform grants. However, several grants were extended for an additional year or more, including many of the maternal and child health programs. The ACA also includes a few permanent appropriations, including the Prevention and Public Health Fund (PPHF) and the Center for Medicare and Medicaid Innovation (CMMI). This issue brief updates a previous CHRT brief and examines how ACA grants were awarded to states and local organizations from the shortened FY2010 (March 23, 2010 to September 30, 2010) through the end of FY2015. This brief also contains specific analyses of ACA funding in Michigan. 1 1 The earlier CHRT brief examined ACA awards from March 23, 2010, through September 30, 2014 (FY2010-FY2014). K. Lausch, J. Fangmeier, M. Udow-Phillips. February 2015. Affordable Care Act Funding: An Analysis of Grant Programs under Health Care Reform FY2010-FY2014. (Ann Arbor, MI:CHRT). http://www.chrt.org/ publication/affordable-care-act-funding-analysis-grant-programs-health-carereform-fy2010-fy2014/ ACA Funding from March 2010 September 2015.......................... 4 ACA Grant Funding in Michigan.... 7 ACA Grant Funding in Michigan, Fiscal Year 2015...8 Appendix A: Funding of Select ACA Programs, by Year (millions of dollars)...11 Appendix B: ACA Grant Funding, Total and Per Capita, by State....12 The Center for Healthcare Research & Transformation (CHRT) illuminates best practices and opportunities for improving health policy and practice. Based at the University of Michigan, CHRT is a non-profit partnership between U-M and Blue Cross Blue Shield of Michigan to promote evidence-based care delivery, improve population health, and expand access to care. Visit CHRT on the Web at: www.chrt.org Suggested citation: Bondalapati, Kirsten; Fangmeier, Joshua; Udow-Phillips, Marianne. Affordable Care Act Funding: An Analysis of Grant Programs under Health Care Reform FY2010 FY2015. February 2016. Center for Healthcare Research & Transformation. Ann Arbor, MI.
Spending Provisions Many ACA initiatives were funded through mandatory spending and do not require further Congressional approval. In total, the ACA included more than $100 billion in mandatory spending over a ten-year period (FY2010- FY2019). This included $65.2 billion to the Children s Health Insurance Program (CHIP) between FY2014 and FY2017, and $10 billion to extend other funding programs, as required by subsequent legislation. 2, 3 In order to administer new grant programs, the ACA provisions included mandatory funding in several categories: 4 Community-based prevention: Includes a series of programs to improve public health infrastructure. The primary source of funding for these programs is the Prevention and Public Health Fund (PPHF). 5 Health Centers and the National Health Service Corps: Includes funding for federally qualified health centers (FQHCs), the National Health Service Corps (NHSC), and school-based health centers. Much of these grants focus on providing care in underserved areas. Health workforce: Includes a series of programs to enhance capacity of the primary care workforce. Long-term care: Includes grant programs to support coordinated longterm care services. Market reform: Includes a series of grants that helped states reform their private insurance markets and prepare for the October 2013 launch of health insurance marketplaces (sometimes called exchanges). Grants supported states in establishing online insurance marketplaces, reviewing health insurance premium rates, and providing consumers insurance information. Market reform grants were only appropriated for FY2010- FY2015. Maternal and child health: Includes several grant programs targeted to serve at-risk families and prevent teenage pregnancy. Medicaid & CHIP: Includes grant programs focused on the health of enrollees in Medicaid and the Children s Health Insurance Program (CHIP). Medicare: Includes a series of programs funded by the ACA to boost the effectiveness and efficiency of Medicare. 2 C.S. Redhead. March 6, 2015. Appropriations and Fund Transfers in the Affordable Care Act (ACA) (Washington, D.C.: Congressional Research Service). 3 The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 extended funding for CHIP through FY2016 and FY2017, totaling $25 billion over the two years. This is not included in the $100 billion estimated by the Congressional Research Service. 4 C.S. Redhead. March 6, 2015. 5 The community-based prevention grant programs included in this report do not capture all PPHF funding uses. PPHF funds have also been integrated into existing programs that do not mention PPHF. 2 Issue Brief: Affordable Care Act Funding: An Analysis of Grant Porgrams under Health Care Reform - FY2010-FY2015 February 2016
Spending Extensions Since the ACA s passage, three major pieces of legislation extended mandatory spending for certain ACA programs. 6 The American Taxpayer Relief Act (ATRA) of 2012 extended funding for Family-to-Family Health Information Centers, and for Outreach and Assistance for Low-Income Programs, including the Area Agency on Aging, State Health Insurance Program, National Center for Benefits and Outreach Enrollment, and Aging Disability Resource Centers. Funding for these programs expired at the end of FY2012 and was extended through FY2013. The Protecting Access to Medicare Act (PAMA) of 2014 extended several maternal and child health, health workforce, health center, and Medicare programs through FY2014 and FY2015. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law in April 2015, extended CHIP, the Community Health Center Fund (CHCF) that funds health centers and the National Health Service Corps (NHSC), several maternal and child health programs, and health workforce programs. Funding in these categories was set to expire at the end of FY2015 and was extended through either FY2016 or FY2017. CHIP programs vary from state to state and can operate as an expansion of Medicaid, as a stand-alone program, or a combination of both. Michigan operates as a combination. In January 2016, the CHIP-funded MIChild program became a Medicaid expansion program. 7 See Appendix A for a list of funding sources for select ACA programs by fiscal year. Select programs include those with permanent funding or funding extensions, and at least one program was included per funding category. 6 An earlier CHRT brief provided details about legislation that rescinded funding and the effects of budget sequestration on ACA funding. See: J. Fangmeier, P. Eller, M. Udow-Phillips. December 2013. Affordable Care Act Funding: An Analysis of Grant Programs under Health Care Reform - FY2010-FY2013 (Ann Arbor, MI:CHRT). http://www.chrt.org/publication/affordablecare-act-funding-analysis-grant-programs-health-care-reform-fy2010-fy2013/ 7 Michigan Department of Health and Human Services, Answers to Frequently Asked Questions about MIChild Converting to Medicaid: http://www.michigan.gov/ mdhhs/0,5885,7-339-71547_2943_4845_4931-20641--,00.html (accessed 12/29/15). 3 Issue Brief: Affordable Care Act Funding: An Analysis of Grant Porgrams under Health Care Reform - FY2010-FY2015 February 2016
ACA Funding From March 2010 through September 2015 By the end of FY2015, the U.S. Department of Health and Human Services (HHS) had awarded $28.5 billion in grants to agencies and organizations across the United States, including the District of Columbia. The ACA funded a total of 101 grant programs between March 2010 and the end of FY2015. States with large populations received the most funding, including California and New York, with approximately $3.6 billion and $2.0 billion, respectively. Figure 1 However, similar to CHRT s analysis of FY2010-FY2014 ACA funding, states that received funding to plan and establish state-based health insurance marketplaces had greater overall funding compared to states that chose federally facilitated marketplaces. For example, Kentucky and Oregon (ranked 26th and 27th in population, respectively) established state-based marketplaces and ranked in the top ten for total funding, with market reform grants totalling $292.1 million and $314.7 million, respectively. In contrast, Georgia and North Carolina, which have federally facilitated marketplaces, have larger populations (ranked 8th and 9th, respectively), but did not rank in the top ten in total funding. Georgia received $3.5 million in total funding and North Carolina received $23.9 million. The District of Columbia received the most per capita funding overall, averaging $600.13 per person. The District also had the most per capita funding in FY2011 and FY2014, and ranked second and fourth for per capita funding in FY2012 and FY2013, respectively. The District is home to numerous national health care organizations and established a state-based insurance marketplace. See Appendix B for full details of statelevel funding. Figure:1 FY2010-FY2015 ACA Funding, by State California Washington Oregon Nevada Idaho Utah Arizona Montana Wyoming Colorado New Mexico North Dakota Minnesota South Dakota Wisconsin Iowa Nebraska Illinois Kansas Missouri Oklahoma Arkansas Mississippi Texas Louisiana Indiana Michigan Tennessee Alabama Kentucky Ohio Georgia West Virginia Pennsylvania North Carolina South Carolina Florida Virginia Vermont New York Maine New Hampshire Massachusetts Rhode Island Connecticut New Jersey Delaware Maryland District of Columbia Alaska $700.0 million to $3.6 billion $480.0 million to $699.9 million $370.0 million to 479.9 million $250.0 million to 369.9 million Hawaii $66.5 million to 249.9 million 4 Issue Brief: Affordable Care Act Funding: An Analysis of Grant Porgrams under Health Care Reform - FY2010-FY2015 February 2016
ACA Funding From March 2010 through September 2015 (continued) The total amount of funding awarded under the ACA has increased every year except from FY2013 to FY2014. Funding increased by 6.0 percent between FY2013 and FY2015, and 14.2 percent between FY2014 and FY2015. Figure 2 The increase from FY2014 ($6.28 billion) to FY2015 ($7.17 billion) was largely due to an increase in funding for new and expanded services and capital improvements for health centers. Funding in this area increased from $3.3 billion (52.4 percent) of total ACA grant funding in FY2014, to $4.3 billion (60.5 percent) in FY2015. Most of the FY2015 funding in this area supported the Behavioral Health Integration Service Expansion, Health Center Controlled Networks, Health Center Expanded Services, and New Access Points programs ($4.2 billion combined). Market reform funding has decreased significantly since the launch of the health insurance marketplaces in October 2013. This area of funding fell from $2.2 billion in FY2013 to $679.1 million in FY2014, and to $410.2 million in FY2015. Grant funding for Medicare has also decreased, from $544.4 million in FY2014 to $390 million in FY2015, mainly due to a reduction in Health Care Innovation Awards to test new payment and delivery models. Between FY2010-FY2015, almost twothirds of all ACA funding went toward health centers and market reform, $12.5 billion and $5.5 billion, respectively. Community-based prevention and maternal and child health were other prominent categories, with $2.6 billion and $2.4 billion, respectively. Figure 2 Billions Figure:2 FY2010-2015 ACA Grant Funding, by Funding Category (in billions of dollars) $8 $7 $6 $5 $4 $3 $2 $1 $0 FY2010 Funding Category FY2011 FY2012 Health Centers and NHSC Market Reform Community-based Prevention Maternal and Child Health FY2015 FY2013 FY2014 FY2015 Health Workforce Medicare Long-Term Care Medicaid & CHIP Grand Total (FY2010-FY2015) Funding % Funding % Health Centers and NHSC $4,335,575,041 60.5% $12,523,545,339 43.9% Market Reform $410,184,831 5.7% $5,491,054,320 19.2% Community-based Prevention $646,315,400 9.0% $2,575,619,426 9.0% Maternal and Child Health $494,300,223 6.9% $2,355,231,083 8.3% Health Workforce $395,812,329 5.5% $2,127,993,740 7.5% Medicare $389,976,628 5.4% $1,759,082,022 6.2% Long-Term Care $484,576,242 6.8% $1,544,038,891 5.4% Medicaid & CHIP $14,860,304 0.2% $161,872,303 0.6% Total $7,171,600,998 100% $28,538,437,124 100% 5 Issue Brief: Affordable Care Act Funding: An Analysis of Grant Porgrams under Health Care Reform - FY2010-FY2015 February 2016
ACA Funding From March 2010 through September 2015 (continued) Health and community-based organizations were the leading recipients of ACA funding awards during the FY2010-FY2015 period, with $13.1 billion (46.0 percent) of total awarded funding. Figure 3 The majority of these funds, $10.7 billion, supported new and expanded services and capital development for health centers. The second largest share of funding was awarded to state agencies, with $11.5 billion (40.4 percent) of total funding. In FY2015, state agencies received $2.1 billion in funding, which was similar to the $2.2 billion they received in FY2014; however, it was a smaller portion of the overall ACA grant funding, at 28.6 percent in FY2015 compared to 34.9 percent in FY2014. Billions Figure:3 FY2010-FY2015 ACA Funding, by Recipient Type (in billions of dollars) $8 $7 $6 $5 $4 $3 $2 $1 $0 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 Health & Community-based Organizations State Agencies Local Agencies State Colleges & Universities Private Colleges & Universities Tribal Organizations Other Recipient Type Health & Community-based Organizations FY2015 Grand Total (FY2010-FY2015) Funding % Funding % $4,290,660,835 59.8% $13,115,758,359 46.0% State Agencies $2,054,259,251 28.6% $11,542,871,828 40.4% Local Agencies $389,092,408 5.4% $1,381,223,076 4.8% State Colleges & Universities $203,461,878 2.8% $1,370,501,121 4.8% Private Colleges & Universities $140,897,385 2.0% $838,845,276 2.9% Tribal Organizations $64,002,431 0.9% $199,857,977 0.7% Other $29,226,810 0.4% $89,379,487 0.3% Total $7,171,600,998 100% $28,538,437,124 100% 6 Issue Brief: Affordable Care Act Funding: An Analysis of Grant Porgrams under Health Care Reform - FY2010-FY2015 February 2016
ACA Grant Funding in Michigan In Michigan, several organizations have been active in applying for and receiving grant funding to implement insurance reforms, improve health care access, and invest in public health infrastructure. Since the ACA became law in March 2010 through the end of the most recent fiscal year in September 2015, Michigan was awarded $708.9 million in funding. The largest category of funding was for health centers ($329.1 million) and the second largest was for community-based prevention ($81.2 million). Direct funding to the state, including to the Michigan Department of Community Health (now the Michigan Department of Health and Human Services), accounted for the most funding over this period ($240.5 million); the second highest recipient was Cherry Health, an FQHC. Figure 4 Figure:4 Top 10 Michigan Institutions Receiving ACA Grant Funding (FY2010- FY2015) Recipient Funding Total State of Michigan $240,471,468 Cherry Health $29,547,838 University of Michigan $20,355,807 InterCare Community Health Network $18,886,089 Detroit Wayne County Health Authority $17,758,768 Health Delivery, Inc. $16,365,029 Wayne State University $15,625,107 Family Health Center, Inc. $14,903,876 Detroit Community Health Connection $14,726,423 Altarum Institute $14,709,822 7 Issue Brief: Affordable Care Act Funding: An Analysis of Grant Porgrams under Health Care Reform - FY2010-FY2015 February 2016
ACA Grant Funding in Michigan, Fiscal Year 2015 Michigan received $219.6 million in ACA grants in FY2015, ranking ninth among states in total state awards. This was an increase from the $183.9 million Michigan received in FY2014, when Michigan was also ranked ninth among all states. On a per capita basis, however, Michigan ranked 33rd in FY2015. Appendix B Similar to national trends, Michigan s largest funded grant category was health center programs, receiving over half of total funding in FY2015. Funding for ACA Medicare programs represented a larger percentage of total awarded funding in Michigan, at 15.1 percent, compared to the average 5.4 percent for Medicare program funding across other states. Figure 5 Health and community-based organizations were the largest recipient type followed by state agencies in FY2015, receiving $123.2 million and $63.3 million, respectively. 9 Figure 6 This is similar to FY2014, in which health and community-based organizations received $98.1 million and state agencies received $62.4 million. In FY2015, 43 community health center organizations received awards. Leading recipients included Cherry Health ($9.6 million), Health Delivery, Inc. ($7.5 million), and InterCare Community Health Network ($7.3 million). 8 The Michigan Office of Financial and Insurance Regulation (now the Department of Insurance and Financial Services) received a $442,863 grant for consumer assistance in health insurance enrollment in FY2014. In FY2015, $789 of the grant was returned, and no other market reform grants were awarded in Michigan, resulting in a negative total for market reform in FY2015. 9 In the Tracking Accountability in Government Grants System (TAGGS), the award recipient Vanguard Health Systems (VHS) of Michigan was categorized as a state agency for FY2015. VHS of Michigan is a private, for-profit health system, thus was re-categorized as a health and community-based organization for this analysis. This aligns with the FY2014 TAGGS designation of VHS of Michigan as a health and community-based organization. 10 The Michigan Office of Services to the Aging was awarded $7.4 million in FY2014 to integrate care for Medicare-Medicaid enrollees (also known as dual eligibles). The full amount was returned in FY2015, lowering the total awarded to state agencies from $70.7 million to $63.3 million. Figure:5 Michigan FY2015 Grant Funding, by Funding Category 3.2% 4.5% 0% 13.0% 10.4% 15.1% 53.8% Funding Category Funding Total Health Centers and NHSC $118,179,489 Medicare $33,059,291 Community-based Prevention $28,649,813 Health Workforce $22,793,778 Maternal and Child Health $9,892,565 Long-Term Care $7,006,724 Market Reform -$789 8 Total $219,580,871 28.8% 1.1% 1.7% 0.4% 3.9% 8.0% 56.1% Health Centers and NHSC Medicare Community-based Prevention Health Workforce Maternal and Child Health Long-Term Care Market Reform Figure:6 Michigan FY2015 Grant Funding, by Recipient Category Health & Community-based Organizations State Agencies Local Agencies State Colleges & Universities Tribal Organizations Other Organizations Private Colleges & Universities Recipient Type Funding Total Health & Community-based Organizations $123,225,348 State Agencies $63,261,686 10 Local Agencies $17,504,274 State Colleges & Universities $8,541,809 Tribal Organizations $3,707,569 Other Organizations $2,481,217 Private Colleges & Universities $858,968 Total $219,580,871 8 Issue Brief: Affordable Care Act Funding: An Analysis of Grant Porgrams under Health Care Reform - FY2010-FY2015 February 2016
ACA Grant Funding in Michigan, Fiscal Year 2015 (continued) Michigan award highlights in FY2015 included: Health Centers New and Expanded Services: Funding to support new and expanded services at health centers grew considerably in FY2015. In Michigan, 41 community health centers were awarded funding for a total of $109.3 million. Capital Development: Funding to support capital development also increased, from $1.4 million in FY2014 to $8.6 million in FY2015. Nine health centers in Michigan received awards under this program. Medicare and Medicaid State Innovation Model: The Michigan Department of Community Health (MDCH) was awarded $19.5 million to implement and test new delivery models. Integrated Care for those eligible for both Medicare and Medicaid: MDCH received $12.2 million for demonstration models to integrate care, financing, and/or administration for beneficiaries eligible for both Medicare and Medicaid. Community-based Prevention Cancer Prevention and Control Programs: MDCH received $6.9 million to develop comprehensive breast and cervical cancer early detection programs. Preventive Health and Health Services Block Grants (PPHF): MDCH was awarded $6 million in FY2015 to address broad preventive health issues across the state. This is similar to the $6.1 million received in FY2014. State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Factors and Promote School Health: MDCH was awarded $4.7 million to implement programs that promote health and prevent and control chronic disease. Primary and Behavioral Health Care Integration: Five community health centers received funding to integrate primary care into community-based behavioral health settings. Community Network Services received $1.6 million and the remaining recipients received $400,000 each, for a total of $3.2 million. Health Workforce Teaching Health Centers: Two community health organizations, the Detroit Wayne County Health Authority (now Authority Health) and the Hamilton Community Health Network, received $13.7 million in combined funding ($11.8 million and $1.9 million, respectively) for community-based graduate medical education programs. Maternal and Child Health Early Childhood Home Visitation: Funding for the MDCH s nurse visitation program decreased from $9.4 million in FY2014 to $3.5 million in FY2015. Since the ACA s passage, the MDCH has received a total of $36.9 million for the program. Long-Term Care Money Follows the Person (MFT): The MDCH was awarded $7 million to transition Medicaid beneficiaries from nursing homes to community-based care. The MDCH was awarded $12.1 million in FY2014 and $10.1 million in FY2013. 9 Issue Brief: Affordable Care Act Funding: An Analysis of Grant Porgrams under Health Care Reform - FY2010-FY2015 February 2016
ACA Grant Funding in Michigan, Fiscal Year 2015 (continued) Top 10 recipients of ACA grants in FY2015 were: 1. State of Michigan $63,261,686 (19 awards) a. Medicare $24,880,330 b. Community-based Prevention $21,956,121 c. Maternal and Child Health 8,673,300 d. Long-Term Care $7,006,724 e. Health Centers $764,000 2. Detroit Wayne County Health Authority (Authority Health) $11,796,268 (Health Workforce, 1 award) 3. Cherry Health $9,550,277 (Health Centers, 2 awards) 4. Health Delivery, Inc. $7,514,818 (Health Centers, 2 awards) 5. InterCare Community Health Network $7,259,847 (Health Centers, 1 award) 6. Hamilton Community Health Network, Inc. $6,604,110 (2 awards) a. Health Centers $4,719,503 b. Health Workforce $1,884,607 7. Baldwin Family Health Care, Inc. $5,503,846 (Health Centers, 2 awards) 8. Alcona Citizens for Health, Inc. $5,053,199 (Health Centers, 2 awards) 9. Detroit Community Health Connection $4,816,534 (Health Centers, 1 award) 10. Detroit Healthcare for the Homeless $4,655,664 (Health Centers, 1 award) 10 Issue Brief: Affordable Care Act Funding: An Analysis of Grant Porgrams under Health Care Reform - FY2010-FY2015 February 2016
Appendix A: Funding of Select ACA Programs, by Year (millions of dollars) Funding Category (Program) ACA Section FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 FY2016 FY2017 FY2018 FY2019 10-year total Market Reform Exchange planning and establishment 1311 Health Centers and NHSC HHS Secretary determined amounts to be appropriated as necessary from FY2010 until January 1, 2015. $5.2 billion has been obligated since March 4, 2015 11 Teaching health centers 5508(c) Not to exceed $230 million for FY2011 through FY2015 $60a $60a $350 NHSC (CHCF) 10503(b)(2) $290 $295 $300 $305 $310 $310a $310a $2,120 Family-to-family health information centers 5507(b) $5 $5 $5 $5b $5c $5a $5a $5a $40 Community health center services (CHCF) 10503(b)(1) $1,000 $1,200 $1,500 $2,200 $3,600 $3,600a $3,600a $16,700 Community-based Prevention Prevention and Public Health Fund 4002 $500 $750 $1,000 $1,000 $1,000 $1,000 $1,000 $1,000 $1,250 $1,250 $9,750 Maternal and Child Health Early childhood home visitation 2951 $100 $250 $350 $400 $400 $400d $400a $400a $2,700 Personal responsibility education 2953 $75 $75 $75 $75 $75 $75d $75a $75a $600 Abstinence education 2954 $50 $50 $50 $50 $50 $50d $75a $75a $450 Health Workforce Health workforce demonstration 5507(a) $85 $85 $85 $85 $85 $85d $85a $85a $680 Medicaid & CHIP Childhood obesity demonstration 4306 $25 million total for FY2010 through FY2014 $10a $10a $45 CHIP annual appropriations 10203(d) $19,147d $21,061d $19,300a $5,700a $65,208 Medicare Center for Medicare and Medicaid Innovation Environmental health screening and education Outreach and assistance for low-income programs Long-term Care 3021(a) $5 $10 billion total for FY2011 through FY2019, and $10 billion for each future decade. $10,005 10203(b) $23 million total for FY2010 through FY2014 $20 million total for FY2015 through FY2019, and for each 5-year period thereafter $43 3306 $45 million for FY2010 through FY2012 $25b $25d $37.5e $37.5a $37.5a $207.5 Money Follows the Person demonstration 2403 $450 $450 $450 $450 $450 $450 $2,700 $5,200 a. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 appropriated funding for teaching health centers, NHSC, family-to-family health information centers, community health center services, early childhood home visitation, personal responsibility education, abstinence education, health workforce demonstrations, childhood obesity demonstrations, CHIP annual appropriations, and outreach and assistance for low-income programs for the indicated fiscal years. 11 C.S. Redhead. March 6, 2015. b. The American Taxpayer Relief Act (ATRA) of 2012 appropriated funding for the family-to-family health information centers program and the outreach and assistance for low-income programs for FY2013. c. The Bipartisan Budget Control Act of 2013 appropriated $2.5 million for family-to-family health information centers for the first half of FY2014 and the Protecting Access to Medicare Act (PAMA) of 2014 appropriated $2.5 million to the family-to-family health information centers for the second half of FY2014, for a total of $5 million for FY2014. d. PAMA appropriated funding for family-to-family health information centers, outreach and assistance for low-income program, CHIP annual appropriations, the early childhood home visitation, personal responsibility education, and abstinence education for the indicated fiscal years. e. PAMA appropriated $12.5 million and MACRA appropriated $25 million, for a total of $37.5 million to the outreach and assistance for low-income programs in FY2015. 11 Issue Brief: Affordable Care Act Funding: An Analysis of Grant Porgrams under Health Care Reform - FY2010-FY2015 February 2016
Appendix B: ACA Grant Funding, Total and Per Capita, by State State FY2015 Total FY2015 Total Ranking FY2015 Per Capita FY2015 Per Capita Ranking FY2010-FY2015 Total FY2010-FY2015 Total Ranking FY2010-FY2015 Per Capita FY2010-FY2015 Per Capita Ranking Alabama $121,389,709 22 $25.03 25 $399,015,193 28 $82.28 33 Alaska $85,079,574 34 $115.48 1 $251,417,324 41 $341.26 3 Arizona $115,970,022 26 $17.23 44 $420,722,964 25 $62.50 42 Arkansas $183,991,666 11 $62.03 6 $482,695,637 21 $162.72 12 California $730,524,863 1 $18.83 40 $3,567,730,223 1 $91.95 29 Colorado $147,834,982 17 $27.60 22 $680,037,599 12 $126.97 20 Connecticut $147,952,187 16 $41.14 9 $598,378,041 16 $166.37 11 Delaware $34,838,157 47 $37.24 12 $140,117,881 48 $149.76 14 District of Columbia $68,344,219 40 $103.73 3 $395,420,836 29 $600.13 1 Florida $276,867,795 4 $13.92 48 $846,014,731 8 $42.53 51 Georgia $168,653,021 13 $16.70 45 $567,360,970 17 $56.19 47 Hawaii $53,988,630 43 $38.03 11 $407,430,342 27 $287.01 5 Idaho $104,215,435 29 $63.76 5 $305,731,783 38 $187.05 9 Illinois $271,808,964 5 $21.10 34 $1,018,462,888 4 $79.07 36 Indiana $109,299,669 27 $16.57 46 $373,808,785 30 $56.66 46 Iowa $77,005,616 35 $24.78 26 $323,163,785 37 $104.01 25 Kansas $71,380,636 37 $24.58 28 $277,715,034 40 $95.63 28 Kentucky $116,784,432 25 $26.46 23 $616,846,653 14 $139.76 18 Louisiana $131,558,608 19 $28.29 21 $418,161,986 26 $89.93 30 Maine $53,126,254 44 $39.94 10 $234,939,633 43 $176.63 10 Maryland $126,031,024 21 $21.09 35 $622,202,961 13 $104.11 24 Massachusetts $203,355,525 10 $30.15 20 $947,141,197 6 $140.41 17 Michigan $219,580,871 9 $22.16 33 $708,934,984 11 $71.54 40 Minnesota $121,326,446 23 $22.23 32 $558,211,448 18 $102.29 26 Mississippi $91,241,640 32 $30.47 19 $330,244,603 35 $110.30 23 Missouri $139,155,441 18 $22.95 30 $474,049,088 22 $78.18 37 Montana $57,864,266 41 $56.53 7 $236,589,525 42 $231.14 6 Nebraska $38,317,604 46 $20.37 37 $157,732,529 47 $83.83 32 Nevada $30,363,298 48 $10.69 51 $226,921,018 44 $79.93 35 New Hampshire $46,874,912 45 $35.33 15 $198,395,511 46 $149.53 15 New Jersey $116,956,070 24 $13.09 50 $461,352,642 24 $51.62 49 New Mexico $75,599,816 36 $36.25 14 $466,817,374 23 $223.83 7 New York $487,507,912 2 $24.69 27 $2,002,065,632 2 $101.39 27 North Carolina $174,970,072 12 $17.60 43 $609,091,348 15 $61.25 45 North Dakota $22,676,150 50 $30.66 18 $88,873,107 50 $120.18 21 Ohio $237,847,156 7 $20.51 36 $857,881,861 7 $73.99 39 Oklahoma $100,200,645 30 $25.84 24 $325,487,630 36 $83.93 31 Oregon $127,466,777 20 $32.11 17 $769,534,859 9 $193.83 8 Pennsylvania $227,635,699 8 $17.80 42 $717,929,486 10 $56.14 48 Rhode Island $70,493,742 38 $66.81 4 $337,339,628 33 $319.70 4 South Carolina $108,810,242 28 $22.52 31 $373,524,733 31 $77.29 38 South Dakota $28,231,727 49 $33.09 16 $114,295,194 49 $133.96 19 Tennessee $154,000,542 14 $23.51 29 $523,638,623 19 $79.95 34 Texas $364,528,464 3 $13.52 49 $1,319,956,026 3 $48.97 50 Utah $55,551,891 42 $18.88 39 $203,125,608 45 $69.02 41 Vermont $69,721,473 39 $111.28 2 $333,368,937 34 $532.06 2 Virginia $151,695,760 15 $18.22 41 $513,455,448 20 $61.67 44 Washington $258,203,771 6 $36.56 13 $1,016,474,696 5 $143.95 16 West Virginia $91,131,110 33 $49.25 8 $293,880,888 39 $158.83 13 Wisconsin $91,765,380 31 $15.94 47 $358,243,870 32 $62.22 43 Wyoming $11,881,133 51 $20.34 38 $66,504,382 51 $113.85 22 Total $7,171,600,998 $22.49 $28,538,437,124 $89.50 Center for Healthcare Research & Transformation 2929 Plymouth Road, Suite 245 Ann Arbor, MI 48105-3206 Phone: 734-998-7555 chrt-info@umich.edu www.chrt.org 12 Issue Brief: Affordable Care Act Funding: An Analysis of Grant Porgrams under Health Care Reform - FY2010-FY2015 February 2016