NCI's Fiscal Year 2024 Budget Challenges and Interim Paylines Explained

November 15, 2023, by NCI Acting Director, Dr. Douglas R. Lowy

For the National Institutes of Health and other federal agencies, the autumn season signals the end of one fiscal year (FY) and the start of the next. While a new fiscal year is, in principle, associated with a new budget designed to address updated priorities and opportunities, the National Institutes of Health rarely receives its final appropriation from Congress before the new fiscal year begins on October 1.

NCI FY24 budget outlook: Where we are now

Currently, NCI is operating under a continuing resolution that provides temporary, interim funding to federal agencies at fiscal year 2023 (FY23) levels through November 17, 2023. Congress typically enacts a series of short-term stopgap funding measures before final appropriations. This could be the case for FY24 if Congress does not pass a new appropriation before midnight on November 17.

To ensure that the cancer research enterprise remains strong and well supported, NCI needs sustained increases to its budget each year. Our current “flat” budget (i.e., no increase from previous funding levels) under the continuing resolution does not meet the level of resources that NCI needs in FY24 to deliver on the scientific opportunities before us. And the current interim funding does not include the $216 million NCI received in FY23 for the Cancer Moonshot℠ (more details in the next section).

Therefore, a “flat” budget is effectively a decreased budget because of the loss of the $216 million Cancer Moonshot funds, as well as inflation and other factors. When NCI’s annual appropriation increases only modestly, does not increase at all, or decreases, we face serious challenges in our efforts to support cancer research as strongly as we should.

NCI FY24 budget outlook: Recent trends and considerations

Conducting biomedical research has become more expensive over time. That results mainly from two factors: inflation and advances in technology, which have made it possible to conduct more sophisticated types of research and at larger scale. And the cost of doing research only continues to increase. The amount of research that NCI is able to “buy” has actually decreased over time, even though the actual dollar amount of NCI’s budget has increased in 8 of the last 10 years.

NCI Budget & Appropriations

Learn more about the federal budget process and how NCI allocates its budget.

For instance, compared with 20 years ago (FY03), NCI’s research buying power in FY23 fell by $1.1 billion (or 13%) in FY23 dollars, despite NCI having a much larger budget in FY23 compared to FY03: $7.3 billion versus $4.6 billion. (For details, view this recent presentation before the National Cancer Advisory Board.)

Additionally, NCI continues to prioritize making more funding awards each year, but this comes with increased costs as this infographic explains. For example, the number of competing (new and renewed) R01 grants NCI awarded, which are typically 5-year funding commitments, increased from 620 in FY12 to 805 in FY22.

During the same period, the dollar amount for a typical award has increased. Between FY12 and FY22, the percentage of larger “nonmodular” awards (those with more than $250,000 in direct costs) went from about 38% of NCI R01 awards to 83%. This means smaller “modular" awards (those with up to $250,000 in direct costs) decreased proportionally during that time. This shift makes sense, given the overall rising costs of biomedical research.

Another factor to consider with regard to NCI’s budget outlook is the end of 21st Century Cures Act funding that supported the first phase of the Cancer Moonshot ($1.8 billion over 7 years). FY23 was the final year of Cures Act funding for the initial Cancer Moonshot, which launched in FY17.

Thanks to this funding, researchers have made remarkable progress in scientific discovery, collaboration, and data sharing. NCI is committed to continuing to support the most promising ongoing Cancer Moonshot projects; however, to do so requires the necessary funding.

President Biden included $716 million in discretionary Cancer Moonshot funding in his FY24 proposed budget for NCI: $216 million for FY24 to account for the end of Cures Act funding plus a $500 million increase from FY23 that would help to enable even greater progress in cancer research.

When “flat” isn’t flat

Unless the final FY24 appropriation we receive includes funding for the amount that NCI would have been given had Cures Act funding continued this fiscal year, plus adjustments for inflation, we will not be able to support cancer research at even the previous year’s levels. In other words, a “flat” budget in FY24 is not flat—it is a reduction.

The implications of a “flat” budget are that NCI must spend conservatively and make judicious cuts in all areas of our work, including research project grants, intramural research programs, investments in critical cancer data and infrastructure, training and workforce development, resources for researchers, cancer centers and clinical trials, and operating expenses. Making cuts in even one of these areas will reduce our ability to support cancer research, so the consequences will be amplified if we have to reduce spending across all aspects of our budget. This point is important to stress, because all components of the cancer research enterprise are interconnected and are critical to delivering progress.

Interim paylines for FY24 NCI competing grants

The uncertainty of the FY24 budget outlook has important implications not only for NCI, but also for our grantee recipients. Until we have clarity about our FY24 budget, we must be conservative in making grant funding decisions.

While we have been able to increase paylines in recent years, a flat budget will reverse this promising upward trend, despite NCI’s continuing desire to prioritize new awards and increase paylines. When under an interim budget, we must apply interim paylines and proceed with caution.

Interim paylines for FY24 for competing R01 and R21 grants are shown in the table below. NCI will generally fund noncompeting grants at 90% of the committed level.

Once we receive a final FY24 budget, we will update our grant funding policies and share the details with our grant recipients. Whatever level of funding NCI receives in FY24, we will work creatively and collaboratively to continue to make progress against cancer for all people.

The bottom line: NCI faces significant challenges while operating under short-term stopgap funding at FY23 levels, which is, in effect, a reduced budget. We have set conservative interim paylines for FY24 during this time of uncertainty, but we hope to be able to increase them in the future when we have our final annual appropriation. There are incredible opportunities before us to make meaningful progress against cancer, but the current resources do not match the opportunities.