Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

Overview of COVID-19 LHHS Supplemental
April 23, 2021
Appropriations: FY2020 and FY2021
Jessica Tollestrup
The legislative response to the global pandemic of Coronavirus Disease 2019 (COVID-
Specialist in Social Policy
19) has included the enactment of laws to provide authorities and supplemental funding

to prevent, prepare for, and respond to the pandemic. This report focuses on
Karen E. Lynch
supplemental FY2020 and FY2021 discretionary appropriations provided to programs
Specialist in Social Policy
and activities traditional y funded by the Departments of Labor, Health and Human

Services, and Education, and Related Agencies (LHHS) appropriations bil . For a
discussion of those appropriations for FY2020 only, see CRS Report R46353, COVID-

19: Overview of FY2020 LHHS Supplemental Appropriations.
As of the date of this report, LHHS supplemental discretionary appropriations for COVID-19 response have been
provided in five separate supplemental appropriations measures (four for FY2020 and one for FY2021):
 Title III, Division A, of the Coronavirus Preparedness and Response Supplemental Appropriations
Act, 2020 (P.L. 116-123), enacted on March 6, 2020, provided approximately $6.4 bil ion in
supplemental LHHS funds.
 Title V, Division A, of the Families First Coronavirus Response Act (FFCRA, P.L. 116-127),
enacted on March 18, 2020, provided $1.25 bil ion in supplemental LHHS funds.
 Title VIII, Division B, of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act,
P.L. 116-136), enacted on March 27, 2020, provided $172.1 bil ion in supplemental LHHS funds.
 Title I, Division B, of the Paycheck Protection Program and Health Care Enhancement Act
(PPPHCEA, P.L. 116-139), enacted on April 24, 2020, provided $100 bil ion in supplemental
LHHS funds.
 Title III, Division M, of the Consolidated Appropriations Act, 2021 (FY2021 CAA, P.L. 116-
260), enacted on December 27, 2020, provided $154.9 bil ion in supplemental LHHS funds.
In total, LHHS received roughly $435 bil ion in supplemental discretionary appropriations from these COVID-19
response measures. These supplemental funds are in addition to roughly $195 bil ion in regular FY2020 LHHS
discretionary appropriations enacted in P.L. 116-94 prior to these supplemental appropriations measures, and $200
bil ion in regular FY2021 LHHS discretionary appropriations enacted in Division H of the FY2021 CAA. Unlike
the annual discretionary appropriations, however, these additional funds were designated as an “emergency
requirement” and thus were effectively exempted from otherwise applicable budget enforcement requirements
(such as the statutory discretionary spending limits). Overal , the COVID-19 supplemental funds increased
FY2020 LHHS discretionary appropriations by approximately 143%, and FY2021 LHHS discretionary
appropriations by approximately 77%.
The Department of Health and Human Services (HHS) received funding in al five COVID-19 supplemental
appropriations acts. The Department of Education (ED) received funding in the third and fifth supplementals,
while the Department of Labor (DOL) and entities funded under the “Related Agencies” heading received funding
in the third supplemental only. In total, HHS received $321 bil ion, or 73.8% of al COVID-19 LHHS
supplemental appropriations. ED received the second-largest share at $113 bil ion, or 26.0%. DOL and Related
Agencies (as a whole) received approximately 0.1% apiece of the LHHS COVID-19 supplemental funds.


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Contents
Introduction ................................................................................................................... 1
Legislative History .......................................................................................................... 3
FY2020.................................................................................................................... 3
P.L. 116-123 (H.R. 6074), Coronavirus Preparedness and Response Supplemental
Appropriations Act, 2020 .................................................................................... 3
P.L. 116-127 (H.R. 6201), Families First Coronavirus Response Act (FFCRA) .............. 4
P.L. 116-136 (H.R. 748), Coronavirus Aid, Relief, and Economic Security Act
(CARES Act) .................................................................................................... 5
P.L. 116-139 (H.R. 266), Paycheck Protection Program and Health Care
Enhancement Act (PPPHCEA) ............................................................................ 6
FY2021.................................................................................................................... 6
P.L. 116-260 (H.R. 133), Consolidated Appropriations Act, 2021 (FY2021 CAA) .......... 6
Funding Overview........................................................................................................... 7
Department of Labor .................................................................................................. 8
Department of Health and Human Services.................................................................... 8

Public Health and Social Services Emergency Fund (PHSSEF) ................................... 9
Other HHS Funding............................................................................................ 10
Department of Education .......................................................................................... 12
Related Agencies ..................................................................................................... 13
Detailed LHHS Programs and Activities Supplemental Amounts .................................... 13


Tables
Table 1. Summary of FY2020 and FY2021 LHHS Supplemental Appropriations for
COVID-19 Response .................................................................................................... 7
Table 2. FY2020 and FY2021 LHHS Supplemental Appropriations for COVID-19
Response .................................................................................................................. 14

Contacts
Author Information ....................................................................................................... 21

Congressional Research Service

Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

Introduction
The pandemic of Coronavirus Disease
Scope of the LHHS Appropriations Act
2019 (COVID-19), the worst U.S. public

the Department of Labor;
health emergency in more than a century,

most agencies at the Department of Health and Human
has elicited extraordinary effort across al
Services, except for the Food and Drug Administration
levels of government and sectors of
(FDA, funded through the Agriculture appropriations
society. Federal response efforts have
bil ), the Indian Health Service (IHS, funded through the
included the enactment of laws to provide
Interior-Environment appropriations bil ), and the
Agency for Toxic Substances and Disease Registry
authorities and supplemental funding to
(ATSDR, funded through the Interior-Environment
prevent, prepare for, and respond to the
appropriations bil );1
pandemic. This report focuses on

the Department of Education; and
supplemental FY2020 and FY2021

more than a dozen related agencies, including the
discretionary appropriations provided to
Social Security Administration, the Corporation for
programs and activities traditional y
National and Community Service, the Corporation for
funded by the Departments of Labor,
Public Broadcasting, the Institute of Museum and
Health and Human Services, and
Library Services, the National Labor Relations Board,
and the Railroad Retirement Board.2
Education, and Related Agencies (LHHS)
appropriations bil .3 For a discussion of
those appropriations for FY2020 only, see CRS Report R46353, COVID-19: Overview of FY2020
LHHS Supplemental Appropriations.
As of the date of this report, LHHS supplemental discretionary appropriations for COVID-19
response have been provided in five separate supplemental appropriations measures (four for
FY2020 and one for FY2021):
 Title III, Division A, of the Coronavirus Preparedness and Response
Supplemental Appropriations Act, 2020 (P.L. 116-123), enacted on March 6,
2020, provided $6.4 bil ion in supplemental LHHS funds.
 Title V, Division A, of the Families First Coronavirus Response Act (FFCRA,
P.L. 116-127), enacted on March 18, 2020, provided $1.25 bil ion in
supplemental LHHS funds.
 Title VIII, Division B, of the Coronavirus Aid, Relief, and Economic Security
Act (CARES Act, P.L. 116-136), enacted on March 27, 2020, provided $172.1
bil ion in supplemental LHHS funds.
 Title I, Division B, of the Paycheck Protection Program and Health Care
Enhancement Act (PPPHCEA, P.L. 116-139), enacted on April 24, 2020,
provided $100 bil ion in supplemental LHHS funds.

1 COVID-19-related supplemental funding appropriated to the FDA and IHS is not discussed in this report. For
information on the IHS supplemental funding, see CRS Insight IN11333, COVID-19 and the Indian Health Service.
2 For a detailed description of the scope of the LHHS appropriations act and a summary of FY2020 appropriations, see
CRS Report R46492, Labor, Health and Hum an Services, and Education: FY2020 Appropriations. For a summary of
FY2021 appropriations, see CRS Report R46457, Status of FY2021 Labor, Health and Hum an Services, and Education
Appropriations: In Brief
.
3 Appropriations acts both provide and control discretionary spending. While appropriations acts may also provide
some mandatory spending (often referred to as appropriated m andatory spending), this spending generally is not the
focus of appropriations decision-making because it is controlled elsewhere (in authorizing laws). Consequently, the
focus of this report is only the discretionary spending provided by the COVID-19 supplemental appropriations acts.
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Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

 Title III, Division M, of the Consolidated Appropriations Act, 2021 (FY2021
CAA, P.L. 116-260), enacted on December 27, 2020, provided $154.9 bil ion in
supplemental LHHS funds.
In total, LHHS has received roughly $435
bil ion in supplemental discretionary
COVID-19-Related Funding Elsewhere
appropriations from these COVID-19
Several of the laws noted above include divisions that
response measures.4 These funds are in
provided regular annual appropriations (both
addition to roughly $195 bil ion in regular
mandatory and discretionary) for LHHS accounts and
FY2020 LHHS discretionary appropriations
activities. These regular annual funds are not included
in this report, as they were not appropriated to
enacted in P.L. 116-94 prior to these
prevent, prepare for, or respond to COVID-19. In
supplemental appropriations measures, and
addition, several of these laws contained mandatory
$200 bil ion in regular FY2021 LHHS
appropriations to certain LHHS-related accounts for
discretionary appropriations enacted in
COVID-19 response. These mandatory appropriations
Division H of the FY2021 CAA.
were provided in divisions of law considered to be
5 Unlike the
authorizing legislation, not appropriations acts. As such,
regular discretionary appropriations, however,
these mandatory funds are beyond the scope of this
these additional supplemental funds were
report. Mandatory funds provided for COVID-19-
designated as an “emergency requirement”
related activities in the American Rescue Plan Act (P.L.
and thus were effectively exempted from
117-2) are excluded from this report for the same
reason.
otherwise applicable budget enforcement
requirements (such as the statutory
discretionary spending limits).6 Overal , the COVID-19 supplemental funds have increased
FY2020 LHHS discretionary appropriations by approximately 143%, and FY2021 LHHS
discretionary appropriations by approximately 77%.7

4 T his total was calculated by the Congressional Research Service based on amounts specified for supplemental
appropriations in the applicable division of each COVID-19 response measure listed above. T his total excludes funds
provided to LHHS agencies and activities in other divisions of these laws, including emergency -designated funds
provided in regular appropriations acts and mandatory appropriations. In addition, this total also excludes a
supplemental appropriation of $210 million for the Department of Labor that was provided in T itle IX of the United
States-Mexico-Canada Agreement (USMCA) Supplemental Appropriations Act, 2019 ( P.L. 116-113). These are
excluded because they were not provided to prevent, prepare for, or respond to the COVID -19 pandemic.
5 For consistency, these amounts (like the amount shown for COVID-19 supplemental appropriations) are based on
total funds provided in the acts, not total funds available for the fiscal year. In addition, these amounts have not been
adjusted for certain scorekeeping conventions of the Congressional Budget Office. For FY2020, this amount is drawn
from the explanatory statement accompanying the FY2020 LHHS omnibus (P.L. 116-94), available in the
Congressional Record, daily edition, vol. 165, no. 204, Book III (December 17, 2019), p. H11159. For FY2021, this
amount is drawn from the explanatory statement accompanying the FY2021 CAA ( P.L. 116-260), available in the
Congressional Record, daily edition, vol. 166, no. 218, Book IV (December 21, 2020 ), p. H8710. Note that in addition
to annual discretionary appropriations, the vast majority of LHHS funding in both of these appropriations laws is
mandatory spending for certain programs and activities. As previously noted, mandatory appropriations are generally
beyond the scope of this report.
6 For further information about the emergency requirements designation, see CRS Report R45778, Exceptions to the
Budget Control Act’s Discretionary Spending Limits
.
7 For further information on FY2020 and FY2021 regular LHHS appropriations, see CRS Report R46492, Labor,
Health and Hum an Services, and Education: FY2020 Appropriations
, and CRS Report R46457, Status of FY2021
Labor, Health and Hum an Services, and Education Appropriations: In Brief
.
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Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

Legislative History
The relevant legislative history of each of the five enacted laws containing LHHS supplemental
appropriations is detailed below.
FY2020
P.L. 116-123 (H.R. 6074), Coronavirus Preparedness and Response
Supplemental Appropriations Act, 2020

In the weeks leading up to the supplemental appropriations action in Congress, Alex Azar, the
Secretary of the U.S. Department of Health and Human Services (HHS), took administrative steps
to al ocate existing funding to COVID-19 response efforts. These included issuing a
determination on January 25, 2020, al owing the al otment of $105 mil ion from the Infectious
Diseases Rapid Response Reserve Fund (IDRRRF).8 He also reportedly informed Congress on
February 2 that he would potential y exercise his authority to transfer $136 mil ion in existing
funds within HHS to increase the budgetary resources of several operating divisions and offices
that were tasked with COVID-19 response.9 In response, the Chair of the House Appropriations
Committee, Representative Nita Lowey, and the Chair of the LHHS Subcommittee,
Representative Rosa DeLauro, sent the Secretary a letter expressing concern that budgetary
resources available to HHS at that time would not be sufficient.10
On February 24, 2020, the Trump Administration sent Congress a request for supplemental
appropriations of $1.25 bil ion for the Public Health and Social Services Emergency Fund
(PHSSEF) at HHS.11 The request letter included a number of other proposals, largely but not
exclusively related to re-purposing existing funds toward response efforts. Al told, the
Administration estimated needing to al ocate approximately $2.5 bil ion toward COVID-19
response efforts. (For the most part, amounts for other LHHS aspects of the request general y
were unspecified in the publicly released request letter.)12

8 CQ Newsmaker T ranscripts, “Health and Human Services Secretary Azar Holds News Conference on Coronavirus,”
January 28, 2020, https://plus.cq.com/doc/newsmakertranscripts-5822133?8&searchId=XGVQS7c5. Authority for the
IDRRRF, administered by the Director of the Centers for Disease Control and Prevention (CDC), is codified at 42
U.S.C. 247d-4a.
9 Yasmeen Abutaleb and Erica Werner, “HHS Notifies Congress that It May T ap Millions of Additional Dollars for
Coronavirus Response,” Washington Post, February 3, 2020, https://www.washingtonpost.com/health/2020/02/03/hhs-
notifies-congress-it-may-tap-millions-additional-dollars-coronavirus-response/. For additional background on early
funding steps taken by the Administration, see CRS Insight IN11212, Another Coronavirus Em erges: U.S. Dom estic
Response to 2019-nCoV
; and CRS Report R46219, Overview of U.S. Dom estic Response to Coronavirus Disease 2019
(COVID-19)
.
10 Letter from Representative Nita M. Lowey, Chair, House Appropriations Committee, and Representative Rosa
DeLauro, Chair, LHHS Subcommittee, to Alex Azar, HHS Secretary, February 4, 2020,
https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/Lowey-DeLauro%20Ltr%20-
%20Azar%20-%202.4.20.pdf).
11 T he PHSSEF is an account used by the HHS Secretary for one-time or short-term funding such as emergency
supplemental appropriations, and for some ongoing public health prep aredness activities.
12 Letter from Russell T . Vought, Acting Director, Office of Management and Budget (OMB), to Vice President
Michael Pence, February 24, 2020, https://www.whitehouse.gov/wp-content/uploads/2020/02/Coronavirus-
Supplemental-Request -Letter-Final.pdf.
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Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

Several days after the Administration’s request, the Chair of the House Appropriations Committee
introduced H.R. 6074 on March 4, 2020. The measure passed the House that same day by a vote
of 415-2, passed the Senate on March 5 by a vote of 96-1, and was signed into law (P.L. 116-123)
on March 6.13
According to the Congressional Budget Office (CBO), P.L. 116-123 provided a total of $7.8
bil ion in supplemental appropriations in Division A, of which roughly $6.4 bil ion (about 83%)
was for LHHS accounts and activities.14 (Division B contained authorization provisions related to
certain LHHS programs and activities—providing the HHS Secretary authority to temporarily
waive or modify the application of certain Medicare requirements with respect to telehealth
services.15 The mandatory spending budgetary effects of these provisions are outside the scope of
this report.)
P.L. 116-127 (H.R. 6201), Families First Coronavirus Response Act (FFCRA)
A second COVID-19 response measure was developed by Congress and the Administration soon
after the first was enacted. Initial y, H.R. 6201 was introduced by the Chair of the House
Appropriations Committee on March 11, 2020.16 The House amended and passed the measure by
a vote of 363-40 on March 14, but further alterations to the final legislative package were
negotiated over the next two days.17 On March 16, the House (by unanimous consent) considered
and agreed to a resolution (H.Res. 904) that directed the Clerk to make changes to the legislation
when preparing the final, official version of the House-passed bil (engrossment). The engrossed
version was sent to the Senate and ultimately passed without amendment by a vote of 90-8 on
March 18. President Trump signed the bil into law (P.L. 116-127) the same day.18
Division A of P.L. 116-127 was estimated by CBO to provide a total of $2.5 bil ion in
supplemental appropriations, of which $1.25 bil ion (approximately 51%) was for LHHS
accounts and activities.19 (Other divisions of the act contained authorization provisions that in
some cases relate to LHHS programs and activities—for instance, provisions providing a 6.2%
increase to the federal matching assistance percentage for Medicaid and certain other programs.20
The mandatory spending budgetary effects of such provisions are outside scope of this report.)

13 A summary of provisions is provided in CRS Report R46285, Coronavirus Preparedness and Response
Supplem ental Appropriations Act, 2020 (P.L. 116 -123): First Coronavirus Supplem ental
.
14 Congressional Budget Office (CBO), Discretionary Spending Under Division A, the Coronavirus Preparedness and
Response Supplem ental Appropriations Act, 2020
, March 4, 2020, https://www.cbo.gov/system/files/2020-03/
hr6074.pdf.
15 For further information, see CRS Report R46239, Telehealth and Telemedicine: Frequently Asked Questions.
16 For a summary of the measure, see House Appropriations Committee, H.R. 6201, FAMILIES FIRST
CORONAVIRUS RESPONSE ACT, Title-By-Title Sum m ary
, March 11, 2020, https://appropriations.house.gov/sites/
democrats.appropriations.house.gov/files/Families%20First%20Summary%20FINAL.pdf.
17 For background, see John Bresnahan and Marianne Levine, “Senate to take up coronavirus package after House
passes revised bill,” Politico, March 16, 2020, https://www.politico.com/news/2020/03/16/senate-coronavirus-
emergency-package-131465. See also “ DIRECT ING T HE CLERK OF T HE HOUSE OF REPRESENT AT IVES T O
MAKE CORRECT IONS IN T HE ENGROSSMENT OF H.R. 6201,” Congressional Record, daily edition, vol. 166,
no. 50 (March 16, 2020), pp. H1698 -H1707.
18 CRS Reports on FFCRA are available on Congress.gov at https://www.congress.gov/bill/116th-congress/house-bill/
6201.
19 CBO, Preliminary Estimate of the Effects of H.R. 6201, the Families First Coronavirus Response Act, April 2, 2020,
p. 18, https://www.cbo.gov/system/files/2020-04/HR6201.pdf.
20 See Division F, Section 6008 of the Families First Coronavirus Response Act (P.L. 116-127). For background on the
federal matching assistance percentage for Medicaid, see CRS Report R43847, Medicaid’s Federal Medical Assistance
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Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

P.L. 116-136 (H.R. 748), Coronavirus Aid, Relief, and Economic Security Act
(CARES Act)

On March 17, 2020, the Administration released a second request for FY2020 supplemental
appropriations of $45.8 bil ion for COVID-19 response, of which $11.1 bil ion was for LHHS
accounts and activities.21
Over the next several days, Congress and the Administration negotiated the scope and scale of
this legislative response, which was expected to involve authorities and additional funding for
numerous programs across the federal government. The legislative vehicle that was ultimately
chosen for this package was H.R. 748, an unrelated measure that had been passed previously by
the House.22 Prior to when a deal was reached between Congress and the Administration, the
Senate voted on March 22 (47-47) and March 23 (49-46) not to invoke cloture on the motion to
proceed to H.R. 748.23 The measure was ultimately laid before the Senate by unanimous consent
and passed with a substitute amendment by a vote of 96-0 on March 25. The House subsequently
took up the Senate amendment on March 27, and agreed to it by a voice vote. The bil was signed
into law (P.L. 116-136) by President Trump that same day.24
According to CBO, P.L. 116-136 provided about $330 bil ion in supplemental appropriations in
Division B, of which $172.1 bil ion (approximately 57%) was for LHHS accounts and
activities.25 (Division A contained authorization provisions that in some cases relate to LHHS
programs and activities—for instance, $1.320 bil ion in mandatory funds for the HRSA health
centers program.26 The mandatory spending budgetary effects of such provisions are outside the
scope of this report.)

Percentage (FMAP). For information on FMAP increases, see CRS Report R46346, Medicaid Recession-Related
FMAP Increases
. See also CRS Insight IN11297, Federal Medical Assistance Percentage (FMAP) Increase for Title
IV-E Foster Care and Perm anency Paym ents
.
21 With regard to LHHS, the letter also explained that the Administration was seeking to amend its FY2021 budge t
request for CDC and NIH to provide them additional budgetary resources and authorities. Letter from Russell T .
Vought, Acting Director, Office of Management and Budget (OMB), to Vice President Michael Pence, March 17,
2020, https://www.whitehouse.gov/wp-content/uploads/2020/03/Letter-regarding-additional-funding-to-support-the-
United-States-response-to-COVID-19-3.17.2020.pdf.
22 Prior to when H.R. 748 was determined to be the vehicle for the third COVID-19 response measure, the Senate
Majority Leader, Senator McConnell, introduced a proposal on March 19, 2020, that did not include supplemental
appropriations (S. 3548). Four days later, on March 23, 2020, the House Appropriations Committee Ch air introduced a
proposal (H.R. 6379) that did include supplemental appropriations (including for LHHS).
23 T he Senate Appropriations Committee released a summary of the supplemental appropriations in the measure
(Senate Appropriations Committee, $340 Billion Surge in Em ergency Funding to Com bat Coronavirus Outbreak ,
March 25, 2020, https://www.appropriations.senate.gov/imo/media/doc/
Coronavirus%20Supplemental%20Appropriations%20Summary_FINAL.pdf .)
24 CRS reports on the CARES Act are available on Congress.gov at https://www.congress.gov/bill/116th-congress/
house-bill/748 and https://www.congress.gov/bill/116th-congress/senate-bill/3548.
25 T he total amount of supplemental appropriations in Division B is from CBO, Preliminary Estimate of the Effects of
H.R. 748, the CARES Act, P.L. 116-136, April 16, 2020, p. 35, https://www.cbo.gov/system/files/2020-04/hr748.pdf.
T he total amount of LHHS supplemental appropriations in Division B was calculated by CRS (see T able 2 of this
report).
26 See T itle III, Division A, Section 3211 of the CARES Act (P.L. 116-136). For background on the HRSA health
centers program, see CRS Report R43937, Federal Health Centers: An Overview.
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Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

P.L. 116-139 (H.R. 266), Paycheck Protection Program and Health Care
Enhancement Act (PPPHCEA)

About three weeks after the enactment of the CARES Act, Congress and President Trump came to
an agreement that, among other provisions, provided additional supplemental appropriations to
HHS for the Provider Relief Fund and to support COVID-19 testing. The legislative vehicle that
was used for the agreement was H.R. 266, an unrelated appropriations bil that had been passed
previously by the House. On April 21, 2020, the measure was laid before the Senate by
unanimous consent and passed with a substitute amendment by voice vote. The House adopted
the Senate version of the proposal on April 23 by a vote of 388-5.27 President Trump signed the
bil into law (P.L. 116-139) the following day.28
According to CBO, P.L. 116-139 provided $162.1 bil ion in supplemental appropriations in
Division B, of which $100 bil ion (approximately 62%) was for LHHS.29 (Division A contained
no provisions related to LHHS programs and activities. The mandatory spending budgetary
effects of the authorization provisions in Division A are outside the scope of this report.)
FY2021
P.L. 116-260 (H.R. 133), Consolidated Appropriations Act, 2021 (FY2021 CAA)
While annual appropriations for FY2021 were under discussion during the summer and fal of
2020, Congress and President Trump considered whether any additional COVID-19 response
funding should be enacted in separate supplemental appropriations measures or packaged with the
FY2021 annual funding. In addition, policymakers had the option of making further COVID-19
response funding subject to the limit on FY2021 nondefense discretionary spending, or providing
that funding instead as emergency appropriations (effectively exempt from that limit).30
Ultimately, additional FY2021 appropriations for COVID-19 relief were enacted as part of the
FY2021 CAA. (Regular FY2021 LHHS annual appropriations were provided in Division H;
emergency supplemental funding was provided in Division M.) On December 21, 2020, the final
version of the FY2021 CAA was approved by the House. (The vote to approve the portion that
contained Division M was 359-53.31) The measure was approved by the Senate (92-6) later that
same day, and signed into law (P.L. 116-260) by President Trump on December 27.

27 House Committee on Appropriations, H.R. 622, Paycheck Protection Program and Health Care Enhancement Act
Division B – Additional Emergency Appropriations for Coronavirus Response, April 21, 2020,
https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/
Interim%20Emergency%20Package%20Funds%20Hospitals%2C%20Health%20Workers%20and%20Testing.pdf .
28 See CRS Report R46325, Fourth COVID-19 Relief Package (P.L. 116-139): In Brief.
29 CBO, CBO Estimate for H.R. 266, the Paycheck Protection Program and Health Care Enhancement Act as Passed by
the Senate on April 21, 2020, April 22, 2020, https://www.cbo.gov/system/files/2020-04/hr266.pdf.
30 Prior to the enactment of full-year FY2021 LHHS funding, COVID-19-related LHHS provisions were proposed in
several different appropriations measures for FY2021, including the House-passed full-year LHHS bill (Division E,
H.R. 7617), a supplemental appropriations package (Division A, H.R. 925), and the FY2021 continuing resolution
(Division A, P.L. 116-159). While in some cases the budgetary effects of the COVID-19-related provisions were
designated as an emergency requirement, that was not the case universally.
31 T he special rule, H.Res. 1271, provided for the consideration of an amendment consisting of the FY2021 CAA (as
contained in House Rules Committee Print 116-68) to the Senate amendment to H.R. 133. H.Res. 1271 also provided
for the House to adopt the amendment in two votes: the first on Divisions B, C, E, and F; and the second on the
remaining divisions. T he House adopted Divisions B, C, E, and F by a vote of 327-85, and adopted the remaining
divisions by a vote of 359-53. T he subsequent motion that the House agree to the Senate amendment with an
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link to page 10 link to page 17 link to page 11 Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

According to CBO, P.L. 116-260 provided about $184.3 bil ion in supplemental appropriations in
Division M, of which $155 bil ion (approximately 84%) was for LHHS accounts and activities.32
The discretionary and mandatory funding in the other divisions of the FY2021 CAA is outside the
scope of this report. (Divisions A-L contained full-year appropriations for al 12 annual
appropriations acts.33 Additional COVID-19 response provisions were enacted in Division N—for
instance, $175 mil ion for nutrition services under the Older Americans Act [Sec. 731]—but
Division N is considered to be authorizing legislation and, thus, the funding in that division was
classified as mandatory spending.34 Divisions O-FF of the FY2021 CAA contained miscel aneous
authorizing provisions that are also beyond the scope of this report.35)
Funding Overview
As previously mentioned, LHHS has received in total roughly $435 bil ion in supplemental
discretionary appropriations from the COVID-19 response measures (Table 1). HHS received
funding in al five supplemental appropriations acts, whereas the Department of Education (ED)
received funding in only the third and fifth supplementals. The Department of Labor (DOL) and
entities funded under the Related Agencies (RAs) heading received funding in only the third
supplemental.
HHS received the vast majority of al LHHS COVID-19 supplemental funds—$321 bil ion, or
73.8%. ED received the second-largest share—$113 bil ion, or 26.0%. DOL and RAs (as a whole)
received approximately 0.1% apiece.
The remainder of this report provides highlights for HHS, DOL, ED, and RAs, and includes a
detailed table (Table 2) organized by department or agency and by account, program, or activity.
Table 1. Summary of FY2020 and FY2021 LHHS Supplemental Appropriations for
COVID-19 Response
(Budget authority in mil ions of dol ars)

FY2020
FY2021

P.L. 116-123
P.L. 116-127
P.L. 116-136
P.L. 116-139
P.L. 116-260

(Div. A)
(Div. A)
(Div. B)
(Div. B)
(Div. M)
Total
DOL


360


360
HHS
6,436a
1,250
140,389
100,000
72,945
321,020
ED


30,925

82,000
112,925

amendment was agreed to without objection.
32 T he total amount of supplemental appropriations in Division M is from CBO, Discretionary Spending Under
Division M, the Coronavirus Response and Relief Supplem ental Appropriations Act, 2021
, December 22, 2020, p. 1,
https://www.cbo.gov/publication/56916. T he total amount of LHHS supplemental appropriations in T itle III of
Division M was calculated by CRS (see T able 2 of this report), and does not include funding appropriated in T itle III to
the Food and Drug Administration (FDA) Salaries and Expenses account, as this funding is generally not under the
purview of the LHHS appropriations act.
33 Full-year LHHS appropriations were enacted in Division H.
34 For further information, see CBO, H.R. 133, Estimate for Division N—Additional Coronavirus Response and Relief
Consolidated Appropriations Act, 2021, January 14, 2021, https://www.cbo.gov/publication/56961.
35 For further information, see CBO, H.R. 133, Estimate for Divisions O-FF, Consolidated Appropriations Act, 2021,
January 14, 2021, https://www.cbo.gov/publication/56962.
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FY2020
FY2021

P.L. 116-123
P.L. 116-127
P.L. 116-136
P.L. 116-139
P.L. 116-260

(Div. A)
(Div. A)
(Div. B)
(Div. B)
(Div. M)
Total
Related


430


430
Total:
6,436
1,250
172,104
100,000
154,945
434,735
Source: Compiled by CRS from amounts specified in P.L. 116-123 (Title III, Division A), P.L. 116-127 (Title V,
Division A), P.L. 116-136 (Title VIII, Division B), P.L. 116-139 (Title I, Division B), and P.L. 116-260 (Title III,
Division M). This report does not include funding appropriated in Title III (P.L. 116-260, Division M) to the Food
and Drug Administration (FDA) Salaries and Expenses account, as this funding is general y not under the purview
of the LHHS appropriations act. Funds provided in other titles and divisions of these laws are beyond the scope
of this report and are excluded from the table. (For instance, the table does not include the $1.320 bil ion in
mandatory funds for the HRSA health centers program provided in Title III, Division A, Section 3211 of P.L. 116-
136.)
Note: Al funds are designated as an emergency requirement.
a. $300 mil ion of these funds (appropriated to the Public Health and Social Services Emergency Fund at HHS)
are contingent upon future HHS actions.
Department of Labor
The majority of DOL funds ($345 mil ion)—al provided in the third measure—were for
dislocated worker assistance through activities authorized by the Workforce Innovation and
Opportunity Act (WIOA). Specifical y, the DOL funds were for the WIOA National Reserve,
which provides National Dislocated Worker Grants (NDWGs) to states and localities to assist
with worker dislocation resulting from natural disasters and mass layoffs. These funds were
general y expected to address workforce-related effects of the COVID-19 pandemic.36
Department of Health and Human Services
The majority of HHS funds (87%) in the supplemental appropriations measures have been
appropriated to the Public Health and Social Services Emergency Fund (PHSSEF). The PHSSEF
account is used by the HHS Secretary for one-time or short-term funding, such as emergency
supplemental appropriations, and for some ongoing public health preparedness activities
including those of the Office of the HHS Assistant Secretary for Preparedness and Response
(ASPR).
Accounts at the Centers for Disease Control and Prevention (CDC) and the Administration for
Children and Families (ACF) each received approximately 5% of the supplemental HHS
appropriations provided in the COVID-19 response measures. Remaining funds were provided in
smal er amounts to the National Institutes of Health (NIH), the Administration for Community
Living (ACL), the Substance Abuse and Mental Health Services Administration (SAMHSA), and
the Centers for Medicare and Medicaid Services (CMS).
Although the funds in Table 2 are displayed as appropriated, readers should note that the first,
third, fourth, and fifth COVID-19 supplemental appropriations acts authorized HHS to transfer
funds made available in these acts, provided the transfers are made to prevent, prepare for, and
respond to the pandemic. (This broad authority giving HHS discretion over certain transfers is in
addition to provisions in these three measures that direct HHS to make specific transfers.) The

36 For additional information on programs and activities authorized by WIOA, see CRS Report R44252, The Workforce
Innovation and Opportunity Act and the One-Stop Delivery System
.
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Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

first measure broadly al owed for HHS to transfer funds among accounts at CDC, NIH, and
PHSSEF. The third measure al owed for transfers among amounts at CDC, PHSSEF, ACF, ACL,
and NIH. The fourth measure al owed for transfers among accounts at CDC, NIH, PHSSEF, and
the FDA, but limited the amounts available for such transfers (e.g., it excluded from this authority
$75 bil ion provided to the PHSSEF for the “Provider Relief Fund”). The fifth measure al owed
for transfers among accounts at CDC, NIH, PHSSEF, ACF, and SAMHSA, but also limited the
amounts available for such transfers (e.g., it excluded from this authority $22.4 bil ion provided
to the PHSSEF for COVID-19 testing, contact tracing, surveil ance, containment, and mitigation).
The acts require HHS to notify the House and the Senate appropriations committees 10 days in
advance of such transfers.
Public Health and Social Services Emergency Fund (PHSSEF)
The PHSSEF received about $280 bil ion in funding across the five measures. This accounts for
64% of al LHHS funds provided in the acts and 87% of the HHS funds in the LHHS titles of the
bil s.37 These PHSSEF funds may support various activities, including health care surge capacity
and the development and purchase of medical countermeasures, including vaccines. In general,
PHSSEF supplemental funding has been provided for four main sets of activities.
Medical Countermeasures and Surge Capacity: The first, third, and fifth measures each
provided funding to support (1) the development, manufacturing, and in some cases federal
purchase of COVID-19 medical countermeasures, such as diagnostic tests, treatments, vaccines,
and medical supplies, and (2) other response activities such as for healthcare workforce and surge
capacity. In total, approximately $53.4 bil ion has been provided for these activities. Note that the
bil s also specify that some of these funds are to be transferred elsewhere (e.g., to other federal
agencies for the care of persons under federal quarantine) or reserved for specific purposes or
activities (e.g., provided to grantees of the Hospital Preparedness Program). These activities may
be carried out by various ASPR components, especial y the Biomedical Advanced Research and
Development Authority (BARDA) for countermeasure development and procurement.38
COVID-19 Testing for the Uninsured: The second supplemental measure included $1 bil ion to
provide reimbursements for COVID-19 testing and related services for persons who are
uninsured. In addition, the fourth measure specified that up to $1 bil ion out of the amounts
appropriated for broader COVID-19 testing purposes (discussed below) may be used to cover the
costs of testing for the uninsured. The program is administered by HRSA.39
Provider Relief Fund: The third, fourth, and fifth supplemental measures each provided funding
for a “Provider Relief Fund” to assist health care providers and facilities affected by the COVID-
19 pandemic.40 These funds are intended to reimburse eligible health care providers for health
care-related expenses or lost revenues that are attributable to the pandemic. The measures define

37 For further information on PHSSEF funds in the supplemental measures, see CRS Report R46285, Coronavirus
Preparedness and Response Supplem ental Appropriations Act, 2020 (P.L. 1 16-123): First Coronavirus Supplem ental
;
CRS Report R46316, Health Care Provisions in the Fam ilies First Coronavirus Response Act, P.L. 116 -127; CRS
Report R46325, Fourth COVID-19 Relief Package (P.L. 116-139): In Brief; and CRS Report R46711, U.S. Public
Health Service: COVID-19 Supplem ental Appropriations in the 116th Congress
.
38 For information on the ASPR activities, see HHS, ASPR, “COVID-19: 2019 Novel Coronavirus Disease,”
https://www.phe.gov/emergency/events/COVID19/Pages/default.aspx.
39 HRSA, “ COVID-19 Claims Reimbursement to Health Care Providers and Facilities for T esting, T reatment, and
Vaccine Administration for the Uninsured,” https://www.hrsa.gov/CovidUninsuredClaim.
40 For more information on the PRF, see HHS, “CARES Act Provider Relief Fund,” April 22, 2020,
https://www.hhs.gov/provider-relief/index.html.
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eligible providers broadly as any that provide “diagnoses, testing, or care for individuals with
possible or actual cases of COVID-19.” In total, $178 bil ion has been appropriated for the
Provider Relief Fund.41 This program also is administered by HRSA.
COVID-19 Testing, Surveillance, and Contact Tracing: The fourth and fifth supplemental
measures provided $47.4 bil ion to augment national capacity for COVID-19 containment,
including expanded testing capacity, and workforce and technical capacity for disease
surveil ance and contact tracing. The fourth measure directed HHS to reserve some of these funds
for specific purposes (e.g., not less than $11 bil ion is for states, localities, territories, tribes, tribal
organizations, urban Indian health organizations, or health service providers to tribes). In
addition, the bil specified that certain funds are to be transferred to other agencies and accounts
(e.g., $22 mil ion is to be transferred to the FDA for diagnostic, serological, antigen, and other
tests). The fifth measure provided a total of $22.4 bil ion and provided that funds shal be for
states, localities, territories, and tribal entities.42
In addition to the activities specified above, PHSSEF appropriations in the first, third, fourth, and
fifth supplemental measures cal ed for some portion of the funds to be transferred to other
agencies or accounts for particular activities. For instance, some PHSSEF funds are required to be
transferred to the HRSA for health centers, rural health, the Ryan White HIV/AIDS program, and
health care systems.43
Other HHS Funding
Further public health-related funding for preparedness and response was appropriated to the CDC
($15.3 bil ion) and NIH ($3.0 bil ion) in the first, third, and fifth supplemental measures. In
addition, the fourth measure explicitly directed certain PHSSEF appropriations to be transferred
to CDC and NIH for COVID-19 response activities. When accounting for these transfers, total
funding directed to the CDC would come to not less than $16.3 bil ion and total funding directed
to NIH would come to not less than $4.8 bil ion.44 Much of the CDC funding in the first, third,
and fourth measures was intended, among other things, to support grants, or cooperative
agreements to states, localities, tribes and other entities, for public health activities (e.g.,
surveil ance, infection control, diagnostics, laboratory support, and epidemiology), as wel as for
global disease detection and modernization of public health data collection. The funds may also

41 For further information about these appropriations, see CRS Report R46325, Fourth COVID-19 Relief Package (P.L.
116-139): In Brief
, and HHS news releases at https://www.hhs.gov/about/news/index.html.
42 Of the total, $790 million is designated to be transferred to IHS, and a separate amount of not less than $2.5 billion is
for “strategies for improving testing capabilities and other purposes ... in high -risk and underserved populations,
including racial and ethnic minority populations and rural communities as well as identifying best practices for states
and public health officials to use for contact tracing in high -risk and underserved populations, including racial and
ethnic minority populations and rural communities.”
43 For further background on HRSA and these activities, see, for example, CRS Report R44054, Health Resources and
Services Adm inistration (HRSA) Funding: Fact Sheet
; CRS Report R46239, Telehealth and Telem edicine: Frequently
Asked Questions
; and CRS Insight IN11238, Coronavirus Disease 2019 (COVID-19) Poses Challenges for the U.S.
Blood Supply
. For further background on other transfers that were directed from the PHSSEF, see CRS Report R46711,
U.S. Public Health Service: COVID-19 Supplem ental Appropriations in the 116th Congress.
44 P.L. 116-139 directed HHS to transfer $1 billion to the CDC-Wide Activities and Program Support account for
various activities including workforce supports necessary to expand and improve COVID-19 testing. In addition, P.L.
116-139 directed HHS to transfer not less than $1.8 billion to NIH to support activities related to COVID -19 testing.
T his includes at least $306 million for the National Cancer Institute, at least $500 million for the National Institute of
Biomedical Imaging and Bioengineering, and at least $1 billion for the Office of the Director, for specified activities.
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Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

be used to support public outreach campaigns, and provide guidance to physicians, health care
workers, and others. The $8.75 bil ion for CDC in the fifth measure was specifical y designated
for activities related to the national vaccine distribution program. Most of the NIH funding was
provided to several institutes to support basic scientific research as wel as research on potential
vaccines, therapeutics, and diagnostics related to COVID-19.45 In the fourth and fifth measures, a
total of not less than $1.9 bil ion of funding directed to NIH was designated specifical y for
research and development related to diagnostic tests.
SAMHSA received a total of $4.7 bil ion in the third and fifth measures.46 The bulk of this
funding was for SAMHSA’s two main block grants ($1.65 bil ion apiece): the Substance Abuse
Prevention and Treatment Block Grant (SABG) and the Community Mental Health Services
Block Grant (MHBG).47 Other funding was al ocated to the Certified Community Behavioral
Health Clinic (CCBHC) grant program (not less than $850 mil ion), emergency substance abuse
or mental health needs (not less than $340 mil ion), and suicide prevention (not less than $100
mil ion).
CMS received $200 mil ion in the third measure. At least half of this appropriation was to be
spent on additional infection control surveys for federal y certified facilities with populations
vulnerable to severe il ness from COVID-19.48
ACF received $16.5 bil ion in the third and fifth measures. These funds were directed to a number
of human services programs. This funding was largely for the Child Care and Development Block
Grant, which received $13.5 bil ion to provide continued assistance to child care providers in the
event of decreased enrollment or program closures. These funds may also be used to support child
care facilities that are open and operating, including those providing care for the children of
essential workers.49 Several other ACF programs received funding, including the Community
Services Block Grant ($1 bil ion), Head Start ($1 bil ion), and the Low Income Home Energy
Assistance Program (LIHEAP, $900 mil ion).50

45 For background on NIH funding, see CRS Report R43341, National Institutes of Health (NIH) Funding: FY1995-
FY2021
. For further information on the NIH, see CRS Report R41705, The National Institutes of Health (NIH):
Background and Congressional Issues
.
46 Of this amount, not less than $140 million was to be allocated to tribes, tribal organizations, urban Indian health
organizations, or health or behavioral health service providers to tribes.
47 T he SABG and MHBG are SAMHSA’s two largest grant programs and distribute funds to states, the District of
Columbia, and territories according to a statutory formula (see PHSA T itle XIX). For more information, see CRS
Report R46426, Substance Abuse and Mental Health Services Adm inistration (SAMHSA): Overview of the Agency and
Major Program s
.
48 For background, see CMS, “Coronavirus: Updates for State Surveyors and Accrediting Organizat ions,”
https://www.cms.gov/medicare/quality-safety-oversight -general-information/coronavirus.
49 For further information, see CRS Report R46324, COVID-19: Child Care and Development Block Grant (CCDBG)
Supplem ental Appropriations in the CARES Act
.
50 For background on these programs, see CRS Report RL32872, Community Services Block Grants (CSBG):
Background and Funding
; CRS In Focus IF11008, Head Start: Overview and Current Issues; and CRS Report
RL31865, LIHEAP: Program and Funding.
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Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

ACL received a total of $1.3 bil ion in the second and third response measures.51 The majority of
this funding ($720 mil ion) was spread across a variety of activities that the agency undertakes to
provide meals to seniors.52
Department of Education
Almost al of the $112.9 bil ion in supplemental ED appropriations—which was provided in the
third53 and fifth measures—was for the Education Stabilization Fund (ESF). The ESF is
composed of three emergency relief funds: (1) a Governor’s Emergency Education Relief
(GEER) Fund (§18002), (2) an Elementary and Secondary School Emergency Relief (ESSER)
Fund (§18003),54 and (3) a Higher Education Emergency Relief Fund (HEERF) (§18004).55 The
third measure provided a total of $30.750 bil ion for the ESF.56 The fifth measure provided a total
of $81.9 bil ion for the ESF.57
The GEER Fund may be used to provide emergency support through grants to local educational
agencies (LEAs) that the state educational agency (SEA) or governor determines to have been the
most significantly impacted by COVID-19. Emergency support may also be provided through
grants to institutions of higher education (IHEs) serving students within the state that the
governor determines to have been the most significantly impacted by COVID-19. A governor
may also choose to provide emergency support to any other IHE, LEA, or education-related entity
within the state that he or she deems “essential for carrying out emergency educational services”
to students for a broad array of purposes ranging from any activity authorized under various
federal education laws to the provision of child care and early childhood education, social and
emotional support, and the protection of education-related jobs.
Funds from the ESSER Fund are to be awarded to states based on their relative shares of grants
awarded under Title I-A of the Elementary and Secondary Education Act (ESEA), as amended.
SEAs are required to provide at least 90% of the funds to LEAs to be used for myriad purposes
such as any activity authorized under various federal education laws (e.g., ESEA), coordination
of preparedness and response to the COVID-19 pandemic, technology acquisition, mental health,
and activities related to summer learning. Funds retained by the SEA must be used for emergency
needs, as determined by the SEA, to address issues in response to the COVID-19 pandemic and
for program administration.
The HEERF is to distribute funds to IHEs to address needs directly related to the COVID-19
pandemic, including, but not limited to, transitioning courses to distance education and grant aid

51 In T itle VII of Division N, P.L. 116-260 also provided $175.0 million to Aging and Disability Services Programs in
mandatory supplement al funding for nutrition services. Of this total, $168 million is for congregate and home-delivered
nutrition services and $7 million is for nutrition services to Native Americans. Because it was provided as mandatory
spending, this funding is not included in the budgetary figures in this report.
52 For more information, see CRS Report R43414, Older Americans Act: Overview and Funding.
53 For further information about ED appropriations provided in the third measure, see CRS Report R46378, CARES Act
Education Stabilization Fund: Background and Analysis
.
54 For more information about emergency assistance for elementary and secondary education related to COVID -19, see
CRS In Focus IF11509, CARES Act Elem entary and Secondary Education Provisions.
55 For more information about emergency assistance related to COVID-19 for IHEs, see CRS In Focus IF11497,
CARES Act Higher Education Provisions.
56 T he bill specified that these funds are to remain available through September 30, 2021.
57 T he bill specified that these funds are to remain available through September 30, 2022.
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link to page 17 Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021

to students for their educational costs such as food, housing, course materials, health care, and
child care.58
Related Agencies
The Social Security Administration (SSA) received the largest amount of COVID-19
supplemental funding ($300 mil ion) among the related agencies. These funds were provided to
the SSA Limitation on Administrative Expenses account to support the salaries and benefits of al
SSA employees affected as a result of office closures. The funds are also to be used for costs
associated with telework, phone, and communication services for employees; for overtime costs
and supplies; and for processing disability and retirement benefit workloads and backlogs.
Detailed LHHS Programs and Activities Supplemental Amounts
Table 2
displays funding directed to LHHS programs and activities, as enacted, across the five
COVID-19 supplemental appropriations acts. It is organized by department or agency and by
account, program, or activity. The table also indicates a number of cases in which appropriations
language reserved funds within a particular account for specific programs or activities, or directed
that funds be transferred to other accounts. It makes note of instances in which these reservations
are for not less than (NLT) or not more than (NMT) a certain dollar amount. In cases where the
bill text calls for transfers, funds are shown in the account to which they were appropriated, not

in the account to which they are to be transferred.


58 T he fifth supplemental shifted $100 million appropriated for Safe Schools and Citizenship in the CARES Act to
HEERF.
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Table 2. FY2020 and FY2021 LHHS Supplemental Appropriations for COVID-19 Response
(Budget authority in mil ions of dol ars)

FY2020
FY2021
P.L. 116-
P.L. 116-
P.L. 116-
P.L. 116-
P.L. 116-
Department and
123
127
136
139
260
Agency, Account, or Program
(Div. A)a
(Div. A)
(Div. B)
(Div. B)b
(Div. M)
Total
DOL Subtotal


360


360
Training and Employment Services: Dislocated Worker Assistance National Reserve


345


345
Departmental Management


15c


15
Transfer to OIG


(1)


(1)
HHS Subtotal
6,436d
1,250
140,389e
100,000f
72,945g
321,020
Centers for Disease Control and Prevention (CDC)
2,200

4,300

8,750
15,250
CDC-Wide Program Activities and Support
2,200

4,300

8,750
15,250
NLT for states, territories, localities, or tribal entitiesh
(950)i

(1,500)j

(4,500)k
(6,590)
Transfer to Infectious Disease Rapid Response Reserve Fund (IDRRRF)
(300)

(300)


(600)
NLT for global disease detection and response
(300)

(500)


(800)
NLT for health data surveil ance modernization


(500)


(500)
National Institutes of Health (NIH)
836

945

1,250
3,031
National Heart, Lung, and Blood Institute


103


103
National Institute of Al ergy and Infectious Diseases
836

706


1,542
NLT transfer to National Institute of Environmental Sciences
(10)




(10)
NLT for vaccine and infectious disease research facilities


(156)


(156)
National Institute of Biomedical Imaging and Bioengineering


60


60
National Library of Medicine


10


10
National Center for Advancing Translational Sciences


36


36
Office of the Director


30

1,250
1,280
CRS-14

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FY2020
FY2021
P.L. 116-
P.L. 116-
P.L. 116-
P.L. 116-
P.L. 116-
Department and
123
127
136
139
260
Agency, Account, or Program
(Div. A)a
(Div. A)
(Div. B)
(Div. B)b
(Div. M)
Total
Research and clinical trials related to long-term studies of COVID-19




(1,150)
(1,150)
NLT Rapid Acceleration of Diagnostics




(100)
(100)
Substance Abuse and Mental Health Services Administration (SAMHSA)


425

4,250
4,675
Health Surveil ance and Program Support


425l

4,250m
4,675
NLT for Certified Community Behavioral Health Clinics


(250)

(600)
(850)
NLT for suicide prevention


(50)

(50)
(100)
NLT for emergency response grants for substance abuse and mental health


(100)n

(240)
(340)
Substance Abuse and Prevention Treatment Block Grant




1,650
1,650
Project AWARE




50
50
National Child Traumatic Stress Network




10
10
Community Mental Health Services Block Grant




1,650
1,650
Centers for Medicare & Medicaid Services (CMS)


200


200
Program Management


200


200
NLT for survey and certification for infection control


(100)


(100)
Administration for Children and Families (ACF)


6,274

10,250
16,524
Low Income Home Energy Assistance Program


900


900
Child Care and Development Block Grant


3,500

10,000
13,500
NMT reservation for federal administrative expenses




(15)
(15)
Children and Families Services Programs


1,874

250
2,124
Community Services Block Grant


(1,000)


(1,000)
Head Start


(750)

(250)
(1,000)
Domestic Violence Hotline


(2)


(2)
CRS-15

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FY2020
FY2021
P.L. 116-
P.L. 116-
P.L. 116-
P.L. 116-
P.L. 116-
Department and
123
127
136
139
260
Agency, Account, or Program
(Div. A)a
(Div. A)
(Div. B)
(Div. B)b
(Div. M)
Total
Family Violence Prevention and Services Grants


(45)


(45)
Runaway and Homeless Youth


(25)


(25)
Child Welfare Services


(45)


(45)
Federal Administration


(7)


(7)
Administration for Community Living (ACL)

250
955

100o
1,305
Aging and Disabilities Services

250
955

100
1,205
Supportive Services


(200)


(200)
Congregate and Home-Delivered Nutrition Services

(240)p
(480)


(720)
Nutrition Services to Native Americans

(10)
(20)


(30)
Family Caregivers


(100)


(100)
Elder Rights Protection Activities


(20)


(20)
Aging and Disability Resource Centers


(50)


(50)
Centers for Independent Living


(85)


(85)
Elder Justice




(100)q
(100)
Office of the Secretary
3,400r
1,000s
127,290t
100,000u
48,345v
280,035
Public Health and Social Services Emergency Fund (PHSSEF)
3,400r
1,000s
127,290t
100,000u
48,345v
280,035
NMT transfer to HHS OIG
(2)w

(4)w
(6)w
(2)w
(14)
Testing for the Uninsured

(1,000)

—x

(1,000)
Transfers to HRSA (Ryan White, Rural Health, and Health Care Systems)


(275)y


(275)
Provider Relief Fund


(100,000)
(75,000)
(3,000)
(178,000)
Medical Countermeasures and Surge Capacity
(3,400)r

(27,015)

(22,945)
(53,360)
Transfer to HRSA (Health Centers)
(100)




(100)
CRS-16

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FY2020
FY2021
P.L. 116-
P.L. 116-
P.L. 116-
P.L. 116-
P.L. 116-
Department and
123
127
136
139
260
Agency, Account, or Program
(Div. A)a
(Div. A)
(Div. B)
(Div. B)b
(Div. M)
Total
NMT for Strategic National Stockpile


(16,000)

(3,250)
(19,250)
NLT for Hospital Preparedness Program grantees or subgrantees


(250)


(250)
NLT for Biomedical Advanced Research & Development Authority (BARDA)


(3,500)


(3,500)
BARDA




(19,695)
(19,695)
NMT transfer to other federal agencies for care of persons under federal quarantine


(289)


(289)
National Academies Study


(2)


(2)
COVID-19 Testing, Surveil ance, and Contact Tracing


z
(25,000)
(22,400)
(47,400)
NLT for grants to states, localities, territories, and tribal entities



(11,000)aa
bb
(11,000)
NLT transfer to CDC-Wide Activities and Program Support



(1,000)

(1,000)
NLT transfer to NIH National Cancer Institute



(306)

(306)
NLT transfer to NIH National Institute of Biomedical Imaging and Bioengineering



(500)

(500)
NLT transfer to NIH Office of the Director



(1,000)

(1,000)
NLT for BARDA



(1,000)

(1,000)
Transfer to FDA (Salaries and Expenses)



(22)

(22)
Transfer to HRSA (Health Centers)



(600)cc

(600)
Rural Health Clinics



(225)

(225)
NMT Testing for the Uninsured



(1,000)x

(1,000)
IHS Transfer




(790)
(790)
NLT improving testing and contract tracing high-risk and underserved populations




(2,500)
(2,500)
ED Subtotal


30,925

82,000
112,925
Education Stabilization Fund


30,750dd

81,880ee
112,630
Safe Schools and Citizenship


100ff


100
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link to page 21 link to page 21

FY2020
FY2021
P.L. 116-
P.L. 116-
P.L. 116-
P.L. 116-
P.L. 116-
Department and
123
127
136
139
260
Agency, Account, or Program
(Div. A)a
(Div. A)
(Div. B)
(Div. B)b
(Div. M)
Total
Gal audet University


7

11
18
Student Aid Administration


40

30
70
Howard University


13

20
33
National Technical Institute for the Deaf




11
11
Institute of Education Sciences




28
28
Program Administration


8

15
23
OIG


7

5
12
Related Agencies Subtotal


430


430
Corporation for Public Broadcasting


75


75
Institute of Museum and Library Services


50


50
Railroad Retirement Board


5


5
Social Security Administration


300


300
LHHS Total
6,436
1,250
172,104
100,000
154,945
434,735
Source: Compiled by CRS from amounts specified in P.L. 116-123 (Title III, Division A), P.L. 116-127 (Title V, Division A), P.L. 116-136 (Title VIII, Division B), P.L. 116-
139 (Title I, Division B), and P.L. 116-260 (Title III, Division M). This report does not include funding appropriated in Title III (P.L. 116-260, Division M) to the Food and
Drug Administration (FDA) Salaries and Expenses account, as this funding is general y not under the purview of the LHHS appropriations act. Funds provided in other
titles and divisions of these laws are beyond the scope of this report and are excluded from the table. (For instance, the table does not include the $1.320 bil ion in
mandatory funds for the HRSA health centers program provided in Title III, Division A, Section 3211 of P.L. 116-136).
Notes: OIG = Office of the Inspector General. NLT = Not Less Than. NMT = Not More Than. Al funds are designated as an emergency req uirement. Amounts in
parenthesis and italics are non-adds. The table displays funds in the accounts in which they were appropriated. The table makes note of a number of cases in which the
appropriations language reserved funds within a particular account for specific programs or activities, or directed that fund s be transferred to other accounts. When the
bil text cal s for transfers, funds are shown in the account to which they were appropriated, not in the account to which they are to be transferred.

a. For further information, see CRS Report R46285, Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116-123): First Coronavirus
Supplemental.
b. For further information, see CRS Report R46325, Fourth COVID-19 Relief Package (P.L. 116-139): In Brief.
CRS-18


c. DOL may transfer funds from this appropriation to the accounts for Employee Benefits Security Administration, Wage and Hour Division, Occupational Safety and
Health Administration, and Employment and Training Administration—Program Administration.
d. HHS may transfer nearly al the funds appropriated to it in Title III, Division A of P.L. 116-123 among accounts at CDC, NIH, or PHSSEF, provided the transfers are
made to prevent, prepare for, and respond to the COVID-19 pandemic, domestical y or international y (see §304). HHS is to notify the House and the Senate
appropriations committees 10 days in advance of such a transfer.
e. HHS may transfer nearly al the funds appropriated to it in Title VIII, Division B of P.L. 116-136 among accounts at CDC, PHSSEF, ACF, ACL, and NIH, provided the
transfers are made to prevent, prepare for, and respond to the COVID-19 pandemic, domestical y or international y (see §18111). HHS is to notify the House and
the Senate appropriations committees 10 days in advance of such a transfer.
f.
HHS may transfer certain funds appropriated to it in Title I, Division B of P.L. 116-139 among accounts at CDC, NIH, PHSSEF, and the FDA, provided the transfers
are made to prevent, prepare for, and respond to the COVID-19 pandemic (see §102). (This transfer authority does not apply to the $75 bil ion for the Provider
Relief Fund or to the $11 bil ion in COVID-19 testing capabilities funds for grants to states, localities, territories, tribes, tribal organizations, urban Indian health
organizations, or related providers.) HHS is to notify the House and the Senate appropriations committees 10 days in advance of such a transfer.
g. HHS may transfer certain funds appropriated to it in Title III, Division M of P.L. 116-260 among accounts at CDC, NIH, PHSSEF, ACF, and SAMHSA. (This transfer
authority does not apply to the $22.4 bil ion provided to the PHSSEF for COVID-19 testing, contact tracing, surveil ance, containment, and mitigation.) HHS is to
notify the House and the Senate appropriations committees 10 days in advance of such a transfer.
h. This appropriation was directed for vaccine-related activities, specifical y for “activities to plan, prepare for, promote, distribute, administer, monitor, and track
coronavirus vaccines to ensure broad-based distribution, access, and vaccine coverage.”
i.
Of the total appropriated, not less than $40 mil ion shal be al ocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to
tribes.
j.
Of the total appropriated, not less than $125 mil ion shal be al ocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to
tribes.
k. Of the total appropriated, not less than $300 mil ion shal be al ocated to serving high-risk and underserved populations, including racial and ethnic minority
populations and rural communities. In addition, $210 mil ion was to be transferred to the Indian Health Service.
l.
Of the total appropriated, not less than $15 mil ion shal be al ocated to tribes, tribal organizations, urban Indian health organizations, or health or behavioral health
service providers to tribes.
m. Of the total appropriated, not less $125 mil ion shal be al ocated to tribes, tribal organizations, urban Indian health organizations, or health or behavioral health
service providers to tribes.
n. SAMHSA ultimately al ocated $110 mil ion for these emergency response grants. HHS, SAMHSA, Grants/Grant Announcements/Emergency Grants to Address
Mental and Substance Use Disorders During COVID-19, April 1, 2020, https://www.samhsa.gov/grants/grant-announcements/fg-20-006.
o. P.L. 116-260 (Title VII, Division N) also provided $175.0 mil ion to Aging and Disability Services Programs in mandatory supplemental fund ing for nutrition services.
Of this total, $168 mil ion is for congregate and home-delivered nutrition services and $7 mil ion is for nutrition services to Native Americans.
p. Of this total, $80 mil ion is for congregate nutrition and $160 mil ion is for home-delivered nutrition.
q. This funding is for authorized activities under Title XX, Subtitle B—Elder Justice of the Social Security Act. Of this total, not less than $50 mil ion is for grants to
states to enhance Adult Protective Services.
r. The total shown in this table includes $300 mil ion in appropriations contingent upon future HHS actions. Of the total appropriated to the PHSSEF, up to $2 mil ion
is to be transferred to the HHS OIG.
CRS-19


s. To provide reimbursements for COVID-19 testing and related services for persons who are uninsured.
t.
Provided in distinct appropriations broadly focused on medical countermeasures and surge capacity ($27 bil ion), health care provider reimbursement (the Provider
Relief Fund, $100 bil ion), and HRSA transfers ($275 mil ion). Of the total appropriated to the PHSSEF, up to $4 mil ion is to be transferred to the HHS OIG.
u. Provided in distinct appropriations broadly focused on health care provider reimbursement (the Provider Relief Fund, $75 bil ion) and COVID-19 testing,
surveil ance, and contact tracing ($25 bil ion). Of the total appropriated to the PHSSEF, up to $6 mil ion is to be transferred to the HHS OIG.
v. Provided in distinct appropriations broadly focused on health care provider reimbursement (the Provider Relief Fund, $3 bil ion), medical countermeasures and
surge capacity ($23 bil ion), COVID-19 testing, surveil ance, and contact tracing ($22 bil ion). Of the total appropriated to the PHSSEF, up to $2 mil ion is to be
transferred to the HHS OIG.
w. The transfers to the HHS OIG are specified in general provisions (not more than $2 mil ion per Title III, Division A, Section 306 of P.L. 116-123, not more than $4
mil ion per Title VIII, Division B, Section 8113 of P.L. 116-136, not more than $6 mil ion per Title I, Division B, Section 103 of P.L. 116-139), and not more than $2
mil ion per Title III, Division M, Section 305 of P.L. 116-260. The amounts transferred to the HHS OIG may come from any funds appropriated to the PHSSEF in the
respective appropriations acts. The HHS OIG funds are for oversight of al activities supported with funds appropriated to HHS to prevent, prepare for, and
respond to the COVID-19 pandemic (not just funds appropriated to the PHSSEF).
x. P.L. 116-123 did not provide a distinct appropriation for testing for the uninsured, but it specified that up to $1 bil ion out of the $25 bil ion appropriated for
COVID-19 testing, surveil ance, and contact tracing may be used for this purpose.
y. Of the total to be transferred to HRSA, $90 mil ion is for the Ryan White HIV/AIDS program, $180 mil ion is for rural health programs (of which not less than $15
mil ion is for tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes), and $5 mil ion is for health care systems.
z. P.L. 116-136 did not provide a distinct appropriation for these activities, but it did al ow for PHSSEF appropriations to be used for “other prepa redness and
response activities.” At the HHS Secretary’s discretion, this may include testing, surveil ance, and/or contact tracing, among other things.
aa. From this total, not less than $750 mil ion shal be al ocated, in coordination with the Director of the Indian Health Service (IHS), to tribes, tribal organizations,
urban Indian health organizations, or related entities.
bb. P.L. 116-260 directed that these funds shal be for “states, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service
providers to tribes” and may be awarded as grants or cooperative agreements.
cc. P.L. 116-139 specified that these funds may be awarded to Federal y Qualified Health Centers under Section 330 of the Public Health Service Act and to entities that
are eligible for but not currently receiving such funds (i.e., Federal y Qualified Health Center “look-alikes”).
dd. P.L. 116-136 specified that the bulk of this funding was to be distributed between three different funds: Governor’s Emergency Education R elief (GEER) Fund ($3.0
bil ion), Elementary and Secondary Education Emergency Relief (ESEER) Fund ($13.2 bil ion), and Higher Education Emergency Relief (HEER) Fund ($14.0 bil ion)
(amounts distributed to each fund as calculated by CRS).
ee. P.L. 116-260 specified that the bulk of this funding was to be distributed between three different funds: GEER Fund ($4.1 bil ion), ESSER Fund ($54.3 bil ion), and
HEERF ($22.7 bil ion) (amounts distributed to each fund as calculated by CRS).
ff. The fifth supplemental shifted the $100 mil ion appropriated for Safe Schools and Citizenship in the CARES Act to HEERF.


CRS-20

Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021



Author Information

Jessica Tollestrup
Karen E. Lynch
Specialist in Social Policy
Specialist in Social Policy




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Congressional Research Service
R46775 · VERSION 1 · NEW
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