Federal Support for Domestic COVID-19 Test Availability

Federal Support for Domestic COVID-19 Test Availability

February 18, 2022
Federal Support for Domestic COVID-19 Test Availability
In January 2022, the White House launched several actions
law also directed a $790 million transfer to the Indian
to boost the availability of Coronavirus Disease 2019
Health Service for testing.
(COVID-19) tests to the general public, including the
distribution of rapid antigen tests to individuals free of cost,
American Rescue Plan Act of 2021 (ARPA, P.L. 117-2,
enhanced testing initiatives in K-12 schools, and expansion
Title II, Section 2401), enacted March 2021, provided a
of community testing options.
total of $47.8 billion to the HHS Secretary, to remain
available until expended, for COVID-19 testing, contact
This In Focus covers the federal funding sources, activities,
tracing, and mitigation activities. The law directed the HHS
and mechanisms that support domestic COVID-19 test
Secretary to implement a national, evidence-based strategy
availability as of the date of publication. As defined here,
for testing; award grants for and support SLTT testing
activities to support COVID-19 test availability include (1)
programs; and support the development, manufacture,
the purchase, manufacture, and distribution of tests and
purchase, distribution, and administration of COVID-19
related supplies, and (2) support for community and
tests, among other actions.
institution-based (e.g., school) testing programs. This In
Focus does not address funding or financing for testing-
In addition to these appropriations, other HHS COVID-19
related research and development, regulation, provider
relief appropriations (such as certain funding made
reimbursement, health service delivery, or health insurance.
available to CDC and the HHS Secretary), can also be used
to support COVID-19 test availability. According to GAO,
Appropriations
HHS allocated a total of $58.3 billion for testing as of
The list below provides a general overview of major
November 30, 2021 (GAO-22-105291; total does not reflect
COVID-19 relief appropriations that support domestic
all HHS SLTT testing-related grants). This allocation
COVID-19 test availability, but it is not exhaustive. The
supports test purchase and distribution, community-based
following Department of Health and Human Services
testing programs, testing among high-risk populations,
(HHS) appropriations (greater than $20 billion dollars each)
screening in schools, and other activities. As of November
have been specifically directed to aid in expanding COVID-
30, 2021, $34.9 billion of the total funds has been obligated
19 testing, including increasing test availability:
and $15.5 billion has been expended.
Paycheck Protection Program and Health Care
COVID-19 relief appropriations have also funded non-HHS
Enhancement Act (P.L. 116-139, Division B, Title
federal support for COVID-19 test availability. For
I), enacted April 2020, provided $25 billion total, available
example, relevant FEMA activities draw from the Disaster
until expended, to the Public Health and Social Services
Relief Fund (DRF), a no-year account that supports all
Emergency Fund (PHSSEF) account for a variety of
assistance provided under the Robert T. Stafford
COVID-19 testing- and contact tracing-related purposes.
Emergency Assistance and Disaster Relief Act (the Stafford
The law directed HHS to reserve or transfer some of these
Act, P.L. 93-288, as amended).
funds. For example, not less than $11 billion was specified
for grants to states, localities, territories, tribes, and other
Test Manufacturing and Supply
tribal entities (SLTTs). In addition, the law specified
HHS funding has supported test and testing supply
several transfers to other HHS agencies for specific
manufacturing throughout the pandemic. In February 2021,
purposes (e.g., the Food and Drug Administration was to
the Biden Administration launched a partnership between
receive $22 million for its testing-related activities). The
HHS and Department of Defense (DOD) to boost such
remaining funds were appropriated for broader activities to
manufacturing through federal contracts. The Trump and
boost testing infrastructure, manufacture, capacity, and
Biden Administrations also invoked authorities under the
administration, including the purchase of testing supplies.
Defense Production Act of 1950 (DPA, P.L. 81-774, as
amended) to redress certain COVID-19 test supply
Coronavirus Response and Relief Supplemental
shortages. The Trump Administration’s actions included
Appropriations Act, 2021 (CRRSA, P.L. 116-260;
DOD contracts to expand manufacturing capacity for test
Division M), enacted December 2020, provided a total of
swabs. The Biden Administration’s National Strategy for
$22.4 billion, available until September 30, 2022, to the
the COVID-19 Pandemic and several subsequent executive
PHSSEF account for a variety of COVID-19 testing- and
orders announced that the federal government would invoke
contact tracing-related purposes. The law specified that
DPA authorities to expand private-sector manufacturing
these funds were intended for SLTT governmental entities
capacity and federal purchase of tests. ARPA appropriated
(at least $21 billion has since been awarded as Centers for
$10 billion, provided to a new HHS account, to support
Disease Control and Prevention [CDC] SLTT grants). The
DPA actions for the purchase, manufacture, and distribution
of medical supplies, to include COVID-19 tests. The full
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Federal Support for Domestic COVID-19 Test Availability
scope of DPA actions under either Administration is
this fund under the CARES Act (P.L. 116-136), CRRSA,
unknown due to reporting limitations.
and ARPA. SEAs are required to award at least 90% of
these funds to local educational agencies (LEAs) by
Purchase and Distribution of Tests
formula, who in turn can use the funds for various purposes,
The federal government has purchased and distributed tests
including testing initiatives. Furthermore, funds available
to governmental entities, health centers and clinics, and
from the Governor’s Emergency Education Relief (GEER)
community-based organizations. Recent initiatives, many
Fund, provided by the CARES Act and CRRSA, could
supported by ARPA, include the following:
potentially be used for K-12 school-based testing programs,

as governors have broad discretion in how to use such
Purchase of 1 billion at-home, rapid COVID-19 tests
funding. A total of $4.3 billion was made available directly
with the intent to distribute to households free of cost.
to governors through the GEER Fund (this amount does not
The first 500 million became available for home
include a $2.75 billion reservation of funds from the GEER
delivery on January 19, 2022. Each household is eligible
Fund authorized by CRRSA to provide support to
to receive up to four tests.
nonpublic schools).
 Distribution of millions of free, at-home COVID tests to
community health centers and rural health clinics, which
FEMA: Under the Stafford Act declarations for the
then distribute to patients.
pandemic, FEMA’s Public Assistance (PA) program may

reimburse eligible applicants (subfederal governments and
Establishment of Operation Expanded Testing program
certain nonprofit entities, including health care providers)
by CDC, which provides no-cost testing to childcare
for certain COVID-19 testing costs. FEMA may reimburse
centers, K-12 schools, historically Black colleges and
applicants for the costs of surge staff to administer tests, the
universities (HBCUs), and other congregate living
purchase and delivery of test kits and other medical
facilities and qualified sites. This is an HHS and DOD
supplies, and contracts for third-party testing, among others.
partnership, and can perform up to 1 million tests total
A state, tribe, or territory may also request Direct Federal
through July 1, 2022.
Assistance (e.g., supplies, federal personnel) required to
Federal Community-Based Testing Sites
execute eligible COVID-19 testing (44 C.F.R. §206.208).
FEMA will cover 100% of eligible testing costs incurred
Since March 2020, FEMA and HHS have supported several
from January 20, 2020, through at least April 1, 2022.
iterations of federally supported community-based testing
sites in partnership with pharmacies and public health
Treasury: Department of Treasury COVID-19 relief grant
agencies. In December 2021, FEMA and HHS established
programs for general assistance to state and local
new federal surge testing sites in partnership with state,
governments either can be or have been used to support
tribal, and territorial governments, provided through the
testing programs. These include the $150 billion
Stafford Act declarations for the pandemic and
Coronavirus Relief Fund (CRF) established by the CARES
administered through HHS’s Increasing Community Access
Act, which expired on December 31, 2021, and the $350
to Testing program.
billion ARPA State and Local Fiscal Recovery programs
Grant Support for Testing
(§9001), which are available until December 31, 2024, with
funded projects completed no later than December 31,
This section summarizes selected federal grant programs
2026. These grants support myriad health, economic, and
for SLTT governments or other organizations that can be
other purposes. Many states used a portion of CRF funding
used to support COVID-19 test availability. In general,
for testing programs, according to National Conference of
grantees have discretion over the amount spent on testing
State Legislatures (NCSL) data. The ARPA programs can
within the scope of specific award guidance and
also support testing, as indicated by the Treasury final rule
requirements.
(31 C.F.R. Part 35).
CDC: CDC has primarily used its existing Epidemiology
Table 1. Related CRS Products
and Laboratory Capacity (ELC) grant mechanism to award
SLTT grants that can be used, in part, to support testing.
CRS Report R46481, COVID-19 Testing: Frequently Asked
Typically, the ELC program awards annual funding to 64
Questions
state, local, and territorial health departments to facilitate
CRS Report R46711, U.S. Public Health Service: COVID-19
capacity for infectious disease control and prevention.
Supplemental Appropriations in the 116th Congress
According to CDC data (as of December 2021), the agency
CRS Report R46834, American Rescue Plan Act of 2021 (P.L.
has granted a total of $42.3 billion in ELC awards to the 64
117-2): Public Health, Medical Supply Chain, Health Services, and
jurisdictions that can be used, in part, to support COVID-19
Related Provisions
testing. The allowable uses of funds vary by grant
allocation. These allocations include $10 billion for school-
CRS Report R46990, General State and Local Fiscal Assistance
based testing programs funded by ARPA. Other CDC
and COVID-19: Eligible Purposes, Allocations, and Use Data
COVID-19 grant awards can also support testing.

Department of Education: Funds provided to state
Kavya Sekar, Analyst in Health Policy
educational agencies (SEAs) from the Elementary and
Taylor R. Wyatt, Analyst in Public Health Emergency
Secondary School Emergency Relief (ESSER) Fund may
Management
be used to establish COVID-19 testing programs in K-12
schools. A total of $190 billion has been appropriated to
https://crsreports.congress.gov

Federal Support for Domestic COVID-19 Test Availability

IF12050
Erica A. Lee, Analyst in Emergency Management and
Disaster Recovery

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