This section discusses the extent to which these circumstances affected the FY2018 and FY2019 funding levels published in the Office of Management and Budget (OMB) budget request materials and the HHS Budget in Brief (BIB), which are the primary data sources for this report. For the FY2019 budget submission, OMB and HHS materials dealt with this increase to the spending limits differently. Overview of the FY2019 HHS Budget Request

Under the budget request, HHS would spend an estimated $1.216 trillion in outlays in FY2019 (see Table 1 ). This is $48 billion more than the FY2018 estimate (based on the annualized CR and current services mandatory spending) and about $113 billion (+10%) more than FY2017 actual. Historical estimates by OMB indicate that HHS has accounted for at least 20% of all federal outlays in each year since FY1995. Most recently, HHS is estimated to have accounted for 28% of all federal outlays in FY2017. As this figure shows, mandatory spending typically accounts for the vast majority of the HHS budget. In fact, two programs—Medicare and Medicaid—are expected to account for 86% of all estimated HHS spending in FY2019. Medicare and Medicaid are "entitlement" programs, meaning the federal government is required to make mandatory payments to individuals, states, or other entities based on criteria established in authorizing law. This figure also shows that discretionary spending accounts for about 8% of FY2019 HHS outlays in the President's request. Although discretionary spending represents a relatively small share of total HHS spending, the department nevertheless receives more discretionary money than most federal departments. According to OMB data, HHS accounted for 7.2% of all discretionary budget authority in FY2017. Budgetary Resources versus Appropriations

Readers should be aware that the HHS budget includes a broader set of budgetary resources than the amounts provided to HHS through the annual appropriations process. A table of relevant CRS key policy staff is included at the end of the report. Following the conventions of the FY2019 HHS BIB, ATSDR's budget request is included in the CDC totals shown in this report.
This report provides information about the FY2019 budget request for the Department of Health and Human Services (HHS). The report begins by reviewing the department's mission and structure. Next, the report offers a brief explanation of the conventions used for the FY2018 estimates and FY2019 request levels in the budget documents released by the HHS and the Office of Management and Budget (OMB). The report also discusses the concept of the HHS budget as a whole, in comparison to how funding is provided to HHS through the annual appropriations process. The report concludes with a breakdown of the HHS request by agency, along with additional HHS resources that provide further information on the request. A table of CRS key policy staff is included at the end of the report.
Historically, HHS has been one of the larger federal departments in terms of budgetary resources. Estimates by OMB indicate that HHS has accounted for at least 20% of all federal outlays in each year since FY1995. Most recently, HHS is estimated to have accounted for 28% of all federal outlays in FY2017.
Under the FY2019 President's budget proposal, HHS would spend an estimated $1.2 trillion in FY2019. This is $48 billion more than FY2018 estimated spending levels and about $113 billion (+10%) more than FY2017 actual spending levels. Final FY2018 appropriations were not enacted prior to the release of the FY2019 President's budget request. As a result, the FY2018 estimates in FY2019 President's budget materials (and this report) are based on annualized amounts provided in an FY2018 continuing resolution, plus current services estimates for mandatory spending.
Mandatory spending typically accounts for the majority of the HHS budget. Two programs—Medicare and Medicaid—are expected to account for 86% of all estimated HHS spending in FY2019, according to the President's request. Medicare and Medicaid are "entitlement" programs, meaning the federal government is required to make mandatory payments to individuals, states, or other entities based on criteria established in authorizing law.
Discretionary spending accounts for about 8% of HHS outlays in the FY2019 President's request. Although discretionary spending represents a relatively small share of total HHS spending, the department nevertheless receives more discretionary money than most federal departments. According to OMB data, HHS accounted for 7% of all discretionary budget authority in FY2017.