Labor, Health and Human Services, and Education: FY2021 Appropriations

July 26, 2021 – January 10, 2022 R46859

Labor, Health and Human Services, and
January 10, 2022
Education: FY2021 Appropriations
Karen E. Lynch,
This report offers an overview of actions taken by Congress and the President to provide FY2021
Coordinator
appropriations for accounts funded by the Departments of Labor, Health and Human Services,
Specialist in Social Policy
and Education, and Related Agencies (LHHS) appropriations bill. This bill includes all accounts

funded through the annual appropriations process at the Department of Labor (DOL) and
Jessica Tollestrup,
Department of Education (ED). It also provides annual appropriations for most agencies within
Coordinator
the Department of Health and Human Services (HHS), with certain exceptions (e.g., the Food
Specialist in Social Policy
and Drug Administration is funded via the Agriculture bill). The LHHS bill also provides funds

for more than a dozen related agencies, including the Social Security Administration (SSA).
Kyle D. Shohfi
This report primarily focuses on regular FY2021 LHHS discretionary funding enacted during the
Analyst in Education Policy
annual appropriations process. The emergency-designated discretionary funding that was

subsequently enacted for FY2021 is generally not included in the budgetary figures discussed in
David H. Bradley
the main body of the report. (The FY2021 emergency supplemental discretionary appropriations
Specialist in Labor
enacted for COVID-19 pandemic response are addressed in the context of the FY2021 annual
Economics
cycle in Appendix C.)

Angela Napili
Regular Appropriations
Senior Research Librarian

FY2021 LHHS Omnibus: On December 27, 2020, the Consolidated Appropriations Act, 2021
(FY2021 LHHS omnibus; H.R. 133) was signed into law by President Trump as P.L. 116-260.
William R. Morton
The FY2021 LHHS omnibus provided full-year appropriations for all 12 annual appropriations
Analyst in Income Security
acts in Divisions A-L. Annual discretionary LHHS appropriations totaled $198.5 billion. This

amount is 1.6% more than FY2020 enacted and 11.0% more than the FY2021 President’s budget
request. The omnibus also provided $980.0 billion in mandatory funding, for a combined LHHS

total of $1.178 trillion. The distribution of discretionary funding was as follows:
 DOL: $12.5 billion, 1.0% more than FY2020.
 HHS: $97.0 billion, 2.2% more than FY2020.
 ED: $73.54 billion, 1.1% more than FY2020.
 Related Agencies: $15.5 billion, 0.6% more than FY2020.
FY2021 LHHS Senate Action: The FY2021 LHHS bill did not receive subcommittee, full committee, or initial floor action
in the Senate prior to its enactment. The chair of the Senate Committee on Appropriations, Senator Richard Shelby, released
drafts of all 12 annual appropriations bills along with draft accompanying committee reports on November 10, 2020, which
was intended to further negotiations on annual appropriations between the House and the Senate. These draft numbers are not
presented in this report.
FY2021 LHHS House Action: On July 13, 2020, the House Appropriations Committee voted to report the FY2021 LHHS
appropriations bill, 30-22; the measure was subsequently reported to the House on July 15 (H.R. 7614; H.Rept. 116-450).
This was preceded by subcommittee approval of the draft bill on July 7, by a vote of 9-6.
As reported by the full committee, the bill would have provided $198.1 billion in discretionary LHHS funds, a 1.3% increase
from FY2020 enacted levels. This amount would have been 10.8% more than the FY2021 President’s request. In addition,
the House committee bill would have provided an estimated $980.0 billion in mandatory funding, for a combined total of
$1.178 trillion for LHHS as a whole. The distribution of discretionary funding was as follows:
 DOL: $12.7 billion, 2.0% more than FY2020.
 HHS: $96.4 billion, 1.5% more than FY2020.
 ED: $73.47 billion, 1.0% more than FY2020.
 Related Agencies: $15.6 billion, 1.4% more than FY2020.
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The House version of LHHS appropriations was initially considered on the floor as part of a consolidated appropriations
package and passed the House (217-197), as amended, on July 31, 2020 (Division E of H.R. 7617). Of the amendments
offered, 84 were adopted and 8 were rejected. Because there is no publicly available source that estimates the account-level
budgetary effects of the amendments adopted to Division E, this report provides analysis of the House Committee-reported
version of the LHHS bill. For information on the LHHS amendments offered during floor consideration, see Appendix B.
FY2021 President’s Budget Request: The President’s FY2021 budget request was submitted to Congress on February 10,
2020. On March 17, 2020, President Trump submitted a letter to Congress about FY2021 budget amendments (along with a
supplemental appropriations request for FY2020) related to the response to the COVID-19 pandemic. These budget
amendments affected the FY2021 President’s requested levels for Centers for Disease Control and Prevention (CDC) and
National Institutes of Health (NIH) accounts at HHS. Amounts shown for the President’s request in the source materials
consulted for this report generally appear to reflect these budget amendments.
The President requested $178.8 billion in discretionary funding for accounts funded by the LHHS bill, which would have
been a decrease of 8.5% from FY2020 levels. In addition, the President requested $978.3 billion in annually appropriated
mandatory funding, for a total of $1.157 trillion for LHHS as a whole. The distribution of discretionary funding was as
follows:
 DOL: $11.1 billion, 10.5% less than FY2020.
 HHS: $87.0 billion, 8.3% less than FY2020.
 ED: $66.6 billion, 8.5% less than FY2020.
 Related Agencies: $14.1 billion, 8.2% less than FY2020.
Supplemental Appropriations
Several acts have been signed into law providing FY2020 and FY2021 supplemental discretionary appropriations for LHHS
programs and activities related to the COVID-19 pandemic. For FY2021, the same law that provided “regular” annual LHHS
appropriations for FY2021 in Division H also provided supplemental discretionary appropriations in a separate division
(Coronavirus Response and Relief Supplemental Appropriations Act, 2021; CRRSA). This law, which was enacted on
December 27, 2020, provided a total of $154.9 billion in supplemental LHHS funds (Title III, Division M, of P.L. 116-260).
In addition, prior to the end of FY2021, a second supplemental appropriations act containing LHHS appropriations was
enacted (P.L. 117-31) on July 30, 2021. This law provided $25 million in supplemental appropriations for the Refugee and
Entrant Assistance account at HHS for specified purposes related to Afghan special immigrants.
In total, FY2021 supplemental appropriations increased regular discretionary FY2021 LHHS enacted funding by about
78.1%. This funding was split roughly equally between HHS (48.1%) and ED (52.9%). (None was enacted for DOL or RA.)
The ED budgetary increase due to its supplemental funding was 111.5% (+82.0 billion) more than its FY2021 regular
discretionary appropriations. HHS regular discretionary appropriations were increased by 75.2% (+$72.9 billion).
See Appendix C of this report for an analysis of the supplemental discretionary LHHS appropriations provided in these acts.
For a detailed discussion of the LHHS COVID-19 pandemic response funding, see CRS Report R46775, Overview of
COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021.
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Introduction
This report provides an overview of FY2021
Scope of the Report:
appropriations actions for accounts traditionally funded
Emergency and Mandatory
in the appropriations bill for the Departments of Labor,
Funding Related to COVID-19
Health and Human Services, and Education, and Related
This report primarily focuses on regular
Agencies (LHHS). This bill provides discretionary and
FY2021 LHHS discretionary funding
mandatory appropriations to three federal departments:
enacted during the annual appropriations
the Department of Labor (DOL), the Department of
process. The emergency discretionary
funding that was enacted for FY2020, or
Health and Human Services (HHS), and the Department
proposed and enacted for FY2021, is
of Education (ED). In addition, the bill provides annual
generally not included in the budgetary
appropriations for more than a dozen related agencies,
figures discussed or table totals presented
including the Social Security Administration (SSA).
in the main body of the report. (Note that
while emergency-designated spending,
Discretionary funds represent less than one-fifth of the
including that proposed and enacted in the
total funds appropriated in the annual LHHS bill.
context of annual LHHS appropriations, is
Nevertheless, the LHHS bill is typically the largest
presented below the table totals, it is not
included in them. Also, the FY2021
single source of discretionary funds for domestic
emergency supplemental appropriations
nondefense federal programs among the various
enacted for COVID-19 pandemic response
appropriations bills. (The Department of Defense bill is
and other purposes are addressed in the
the largest source of discretionary funds among all
context of the FY2021 annual cycle in
federal programs.) Because the appropriations process
Appendix C.) In addition, during FY2020
and FY2021, mandatory appropriations
both provides and controls discretionary funding
were enacted to certain LHHS-related
(concepts discussed further in “Mandatory vs.
accounts for COVID-19 pandemic
Discretionary Budget Authority”), the bulk of this report
response, including in the American Rescue
is focused on these funds.
Plan Act of 2021 (P.L. 117-2). These

mandatory funds are beyond the scope of
The LHHS bill typically is one of the more controversial
this report.
of the regular appropriations bills because of the size of
its funding and the scope of its programs, as well as various related social policy issues addressed
in the bill, such as restrictions on the use of federal funds for abortion and for research on human
embryos, stem cells, and gun violence.
Congressional clients may consult the LHHS experts list in CRS Report R42638, Appropriations:
CRS Experts, for information on which analysts to contact at the Congressional Research Service
(CRS) with questions on specific agencies and programs funded in the LHHS bill.
Report Roadmap and Useful Terminology
This report is divided into several sections. The opening section provides an explanation of the
scope of the LHHS bill (and hence, the scope of this report) and an introduction to important
terminology and concepts that carry throughout the report. Next is a series of sections describing
major congressional actions on FY2021 appropriations and (for context) a review of the
conclusion of the FY2020 appropriations process. This is followed by a high-level summary and
analysis of enacted and proposed appropriations for FY2021, compared to FY2020 funding
levels. The body of the report concludes with overview sections for each of the major titles of the
bill: DOL, HHS, ED, and Related Agencies (RA). These sections provide selected highlights
from FY2021 enacted and proposed funding levels compared to FY2020. (Note that the
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distribution of funds is sometimes illustrated by figures, which in all cases are based on the
FY2021 enacted version of the LHHS bill.1)
Appendix A provides a summary of budget enforcement activities for FY2021. This includes
information on the Budget Control Act of 2011 (BCA; P.L. 112-25) and sequestration, budget
enforcement in the absence of an FY2021 budget resolution, the House LHHS subcommittee
spending allocation, and current-year spending levels. This is followed by Appendix B, which
provides an overview of the LHHS-related floor amendments that were offered in the House
during its consideration of H.R. 7617. Appendix C provides an analysis of the supplemental
discretionary LHHS appropriations enacted for FY2021. For a detailed discussion of the FY2021
supplemental LHHS COVID-19 pandemic response funding, see CRS Report R46775, Overview
of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021.
Scope of the Report
This report focuses on appropriations to agencies and accounts that are subject to the jurisdiction
of the Labor, Health and Human Services, Education, and Related Agencies subcommittees of the
House and Senate appropriations committees (i.e., accounts traditionally funded via the LHHS
bill). Department “totals” provided in this report do not include funding for accounts or agencies
that are traditionally funded by appropriations bills under the jurisdiction of other subcommittees.
The LHHS bill provides appropriations for the following federal departments and agencies:
 the Department of Labor;
 most agencies at the Department of Health and Human Services, except for the
Food and Drug Administration (funded through the Agriculture appropriations
bill), the Indian Health Service (funded through the Interior-Environment
appropriations bill), and the Agency for Toxic Substances and Disease Registry
(also funded through the Interior-Environment appropriations bill);
 the Department of Education; and
 more than a dozen related agencies, including the Social Security Administration,
the Corporation for National and Community Service, the Corporation for Public
Broadcasting, the Institute of Museum and Library Services, the National Labor
Relations Board, and the Railroad Retirement Board.
Note also that funding totals displayed in this report do not reflect amounts provided outside of
the annual appropriations process. Certain direct spending programs, such as Social Security and
parts of Medicare, receive funding directly from their authorizing statutes; such funds are not
reflected in the totals provided in this report because they are not provided through the annual
appropriations process (see related discussion in the “Important Budget Concepts” section).

1 The dollars and percentages in each figure also are generally illustrative, except as noted, of the parallel distribution
of funds enacted in FY2020 and proposed by the FY2021 President’s budget and the House committee bill.
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Important Budget Concepts
Mandatory vs. Discretionary Budget Authority2
The LHHS bill includes both discretionary and mandatory budget authority. While all
discretionary spending is subject to the annual appropriations process, only a portion of
mandatory spending is provided in appropriations measures.
Mandatory programs funded through the annual appropriations process are commonly referred to
as appropriated entitlements. In general, appropriators have little control over the amounts
provided for appropriated entitlements; rather, the authorizing statute controls the program
parameters (e.g., eligibility rules, benefit levels) that entitle certain recipients to payments. If
Congress does not appropriate the money necessary to meet these commitments, entitled
recipients (e.g., individuals, states, or other entities) may have legal recourse.3
Most mandatory spending is not provided through the annual appropriations process, but rather
through budget authority provided by the program’s authorizing statute (e.g., Social Security
benefits payments). The funding amounts in this report do not include budget authority provided
outside of the appropriations process. Instead, the amounts reflect only those funds, discretionary
and mandatory, that are provided through appropriations acts.
As displayed in this report, mandatory amounts for the FY2021 President’s budget submission
reflect current-law (or current services) estimates; they generally do not include the President’s
proposed changes to a mandatory spending program’s authorizing statute that might affect total
spending. (In general, such proposals are excluded from this report, as they typically would be
enacted in authorizing legislation.)
The report focuses most closely on discretionary funding because discretionary funding receives
the bulk of attention during the appropriations process. (While the LHHS bill includes more
mandatory funding than discretionary funding, the appropriators generally have less flexibility in
adjusting mandatory funding levels than discretionary funding levels.)
Mandatory and discretionary spending is subject to budget enforcement processes that include
sequestration. In general, sequestration involves largely across-the-board reductions that are made
to certain categories of discretionary or mandatory spending. However, the conditions that trigger
sequestration, and how it is carried out, differ for each type of spending. This is discussed further
in Appendix A.

2 For definitions of these and other budget terms, see U.S. Government Accountability Office (GAO), A Glossary of
Terms Used in the Federal Budget Process, GAO-05-734SP, September 1, 2005, http://www.gao.gov/products/GAO-
05-734SP. (Terms of interest may include appropriated entitlement, direct spending, discretionary, entitlement
authority, and mandatory.)
3 Sometimes appropriations measures include amendments to laws authorizing mandatory spending programs and
thereby change the amount of mandatory appropriations needed. Because such amendments are legislative in nature,
they may violate parliamentary rules separating authorizations and appropriations. For more information, see CRS
Report R42388, The Congressional Appropriations Process: An Introduction.
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Total Budget Authority Provided in the Bill vs. Total Budget Authority
Available in the Fiscal Year
Budget authority is the amount of money a federal agency is legally authorized to commit or
spend. Appropriations bills may include budget authority that becomes available in the current
fiscal year, in future fiscal years, or some combination. Amounts that become available in future
fiscal years are typically referred to as advance appropriations.
Unless otherwise specified, appropriations levels displayed in this report refer to the total amount
of budget authority provided in an appropriations bill (i.e., “total in the bill”), regardless of the
year in which the funding becomes available.4 In some cases, the report breaks out current-year
appropriations (i.e., the amount of budget authority available for obligation in a given fiscal year,
regardless of the year in which it was first appropriated).5
As the annual appropriations process unfolds, the amount of current-year budget authority is
measured against 302(b) allocation ceilings (budget enforcement caps for appropriations
subcommittees that traditionally emerge following the budget resolution process). The process of
measuring appropriations against these spending ceilings takes into account scorekeeping
adjustments, which are made by the Congressional Budget Office (CBO) to reflect conventions
and special instructions of Congress.6 Unless otherwise specified, appropriations levels displayed
in this report do not reflect additional scorekeeping adjustments. (Those scorekeeping
adjustments are displayed at the bottom of Table 2.)
Status of FY2021 LHHS Appropriations
FY2021 Supplemental Appropriations
The legislative response to the global COVID-19 pandemic has included the enactment of laws to
provide authorities and supplemental funding to prevent, prepare for, and respond to the
pandemic. LHHS supplemental appropriations for COVID-19 pandemic response were enacted in
four FY2020 measures, and one FY2021 measure. All five of these supplementals are discussed
in detail in CRS Report R46775, Overview of COVID-19 LHHS Supplemental Appropriations:
FY2020 and FY2021.
In addition, prior to the end of FY2021, a second supplemental appropriations act containing
LHHS appropriations was enacted (P.L. 117-31) on July 30, 2021. This law provided $25 million
in supplemental appropriations for the Refugee and Entrant Assistance account at HHS for
specified purposes related to Afghan special immigrants.
See Appendix C for an analysis of the regular and supplemental discretionary LHHS
appropriations enacted for FY2021.

4 Such figures include advance appropriations provided in the bill for future fiscal years, but do not include advance
appropriations provided in prior years’ appropriations bills that become available in the current year.
5 Such figures exclude advance appropriations for future years, but include advance appropriations from prior years that
become available in the given fiscal year.
6 For more information on scorekeeping, see CRS Report 98-560, Baselines and Scorekeeping in the Federal Budget
Process. See also a discussion of key scorekeeping guidelines included in the joint explanatory statement
accompanying the conference report to the Balanced Budget Act of 1997 (H.Rept. 105-217, pp. 1007-1014).
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Emergency Security Supplemental Appropriations Act, 2021 (H.R. 3237; P.L.
117-31)
H.R. 3237 was introduced as a supplemental appropriations bill by the chair of the House
Appropriations Committee, Representative DeLauro, on May 14, 2021. Both as introduced and as
passed by the House (213-212, 3 present) on May 20, 2021, the bill did not contain LHHS
funding. Subsequently, the Senate added $25 million in supplemental appropriations for the
Refugee and Entrant Assistance account at HHS for specified purposes related to Afghan special
immigrants, among other changes. The bill passed the Senate, as amended (98-0), on July 29,
2021. The House agreed to the Senate-passed version (416-11) on July 30, 2021, and the bill was
signed into law (P.L. 117-31) by President Biden that same day.
According to CBO, the $25 million in supplemental LHHS appropriations provided by P.L. 117-
31 was about 1% of the $2.1 billion in FY2021 discretionary appropriations provided by the law. 7
The Coronavirus Response and Relief Supplemental Appropriations (CRRSA)
Act, 2021 (Division M of H.R. 133; P.L. 116-260, “5th COVID”)
While annual appropriations for FY2021 were under discussion during the summer and fall of
2020, Congress and President Trump considered whether any additional COVID-19 pandemic
response funding should be enacted in separate supplemental appropriations measures or
packaged with the FY2021 annual funding. (Four COVID-19 pandemic response FY2020
supplemental appropriations acts had previously been enacted; see discussion in “Conclusion of
the FY2020 Appropriations Process and FY2020 Supplemental Appropriations”.) In addition,
policymakers had the option of making further COVID-19 pandemic response funding subject to
the limit on FY2021 nondefense discretionary spending, or providing that funding instead as
emergency appropriations (effectively exempt from that limit).8 Ultimately, additional FY2021
appropriations for COVID-19 pandemic relief were enacted as part of H.R. 133. (Regular
FY2021 LHHS annual appropriations were provided in Division H, referred to in this report as
“the FY2021 LHHS omnibus”; emergency supplemental funding for COVID-19 pandemic
response was provided in Division M.) On December 21, 2020, the final version of H.R. 133 was
approved by the House. (The vote to approve the portion that contained Division M was 359-53.9)
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.

7 CBO, Discretionary Spending: Senate Amendment 2123, July 29, 2021, https://www.cbo.gov/system/files/2021-07/
EmergencySecuritySupplementalAppropriationsAct2021.pdf.
8 Prior to the enactment of full year FY2021 LHHS funding, COVID-19 pandemic-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 pandemic-related
provisions were designated as an emergency requirement, that was not the case universally.
9 The special rule, H.Res. 1271, provided for the consideration of an amendment consisting of the final text for
enactment (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. The 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. The subsequent motion that the House agree to the Senate amendment with an
amendment was agreed to without objection.
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According to CBO, P.L. 116-260 provided about $184.3 billion in supplemental appropriations in
Division M, of which $155 billion (approximately 84%) was for LHHS accounts and activities.10
Funding was provided for various programs and activities at HHS and ED.
FY2021 Annual LHHS Appropriations
Table 1 provides a timeline of major legislative actions for full-year LHHS proposals, which are
discussed in greater detail below.
Table 1. Status of Full-Year LHHS Appropriations Legislation, FY2021
Subcommittee
Full Committee
Resolution of House and
Approval
Approval

Senate Differences

House
Senate
House
Senate
Initial
Initial
Conf.
Final
Final
Public
House
Senate
House
Senate Passage
Passage
Report
Passage
Passage
Law

7/7/2020
H.R. 7614
H.R. 7617,

H.R. 133,
H.R. 133,
P.L. 116-
9-6
H.Rept.
Division E
Division H Division H
260
116-450
7/31/20
12/21/20
12/21/20
12/27/20
7/13/20
217-197
359-53
96-2
30-22
Source: CRS Appropriations Status Table.
FY2021 LHHS Omnibus (Division H, Consolidated Appropriations Act, 2021,
H.R. 133; P.L. 116-260)
On December 27, 2020, the Consolidated Appropriations Act, 2021 was signed into law by the
President (H.R. 133, P.L. 116-260). P.L. 116-260 provided full-year appropriations for all 12
annual appropriations acts in Divisions A-L, and supplemental appropriations for COVID-19
pandemic relief in Division M.11 (Full-year LHHS appropriations were enacted in Division H,
referred to as “the FY2021 LHHS omnibus.”) Prior to its enactment, the final version of the
measure was approved by the House on December 21. (The vote to approve the portion that
contained LHHS appropriations was 359-53.12) It was approved by the Senate (92-6) later that
same day.

10 The total amount of supplemental appropriations in Division M is from CBO, Discretionary Spending Under
Division M, the Coronavirus Response and Relief Supplemental Appropriations Act, 2021, December 22, 2020, p. 1,
https://www.cbo.gov/publication/56916. The total amount of LHHS supplemental appropriations in Title III of
Division M was calculated by CRS (see Table 2 of this report), and does not include funding appropriated in Title 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.
11 P.L. 116-260 also contained additional COVID-19 pandemic response provisions in Division N, but this division is
considered authorizing legislation, rather than appropriations legislation, and is thus beyond the scope of this report.
For further discussion, see the Congressional Budget Office cost estimate for Division N, released on January 14, 2021,
https://www.cbo.gov/system/files/2021-01/PL_116-260_div_N.pdf. In addition, Divisions O-FF of P.L. 116-260
contained miscellaneous authorizing provisions that are also beyond the scope of this report.
12 The special rule, H.Res. 1271, provided for the consideration of an amendment consisting of the final text for
enactment (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. The 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. The subsequent motion that the House agree to the Senate amendment with an
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Labor, Health and Human Services, and Education: FY2021 Appropriations

LHHS discretionary appropriations in the FY2021 LHHS omnibus totaled $198.5 billion. This
amount is 1.6% more than FY2020 enacted and 11.0% more than the FY2021 President’s budget
request. The omnibus also provided $980.0 billion in mandatory funding, for a combined LHHS
total of $1.178 trillion. (Note that these totals are based only on amounts of non-emergency
appropriations provided by the FY2021 LHHS omnibus and do not include emergency-
designated or supplemental funds, which were provided in addition to the annual appropriations.
Division H also enacted $1.6 billion in emergency-designated budget authority, of which $925
million was for DOL in Title I, and $638 million was for HHS in Title II, which is not reflected in
the above figures.)
See Figure 1 for a breakdown of FY2021 discretionary and mandatory LHHS appropriations.13
Figure 1. FY2021 Enacted LHHS Appropriations

Source: Amounts in this figure are generally drawn from or calculated based on data contained in the
explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional
Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. Enacted totals (“Total BA in the Bil ”)
for FY2021 do not include emergency-designated appropriations provided in Division H or M of P.L. 116-260, or
P.L. 117-31. For consistency with source materials, amounts in this figure generally do not reflect mandatory
spending sequestration. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the
21st Century Cures Act (P.L. 114-255), as amended.
Notes: Details may not add to totals due to rounding. Amounts in this figure (1) reflect all budget authority
appropriated in the bil , regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bil ); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided for agencies
and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations
committees; and (4) do not include appropriations that occur outside of appropriations bil s.

amendment was agreed to without objection.
13 While the percentages in this figure were calculated based on amounts in the FY2021 LHHS omnibus, they are
generally also illustrative—within a few percentage points—of the share of mandatory and discretionary funds in
FY2020 and under the various FY2021 proposals (e.g., President’s budget and the House-committee bill).
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Labor, Health and Human Services, and Education: FY2021 Appropriations

FY2021 Continuing Resolutions (Division A of H.R. 8337; P.L. 116-159)
Between the start of the fiscal year on October 1, 2020, and the enactment of the annual LHHS
appropriations on December 27, 2020, LHHS programs and activities were provided temporary
FY2021 funding via a series of continuing resolutions (CRs).
The first CR providing temporary funding for LHHS programs and activities was signed into law
on October 1 (Division A of H.R. 8337; P.L. 116-159). The measure had previously been
introduced by the House Appropriations Committee chair, Representative Lowey, on September
22, and had passed the House that same day, 359-57.14 The Senate subsequently took up and
passed the measure without amendment, 84-10, on September 30.
The CR provided continuing appropriations for all 12 annual appropriations acts (including
LHHS) through December 11, 2020. In general, the CR funded discretionary programs at the
same rate and under the same conditions as in FY2020 (§101) and annually appropriated
entitlements at their current law levels (§111).15 It also included several anomalies that are
specific to LHHS accounts or related activities (§§149-156).
This first CR was extended by four subsequent CRs:
 P.L. 116-215 (Division A), which extended LHHS funding through December 18;
 P.L. 116-225, which extended LHHS funding through December 20;
 P.L. 116-226, which extended LHHS funding through December 21; and
 P.L. 116-246, which extended LHHS funding through December 28.
Earlier Congressional Action on an LHHS Bill
FY2021 LHHS Action in the Senate
Senate Appropriations Committee action on the FY2021 LHHS bill did not occur during the
FY2021 cycle. The chair of the Senate Committee on Appropriations, Senator Richard Shelby,
released drafts of all 12 annual appropriations bills along with draft accompanying committee
reports on November 10, 2020, which was intended to further negotiations on annual
appropriations between the House and the Senate.16 These draft numbers are not presented in this
report.

14 For further information about the continuing appropriations in H.R. 8337, see House Appropriations Committee,
“House Democrats File Bipartisan Continuing Resolution,” press release, September 22, 2020,
https://appropriations.house.gov/news/press-releases/house-democrats-file-bipartisan-continuing-resolution.
Previously, the chairwoman had introduced H.R. 8319, which included a similar CR in Division A, but that measure
did not receive House floor consideration. For further information about the continuing appropriations in H.R. 8319,
see House Appropriations Committee, “House Democrats Introduce Continuing Resolution,” press release, September
21, 2020, https://appropriations.house.gov/news/press-releases/house-democrats-introduce-continuing-resolution-1.
15 For an estimate of the discretionary appropriations contained in Division A of H.R. 8337, see CBO, “CBO’s Estimate
for H.R. 8337, the Continuing Appropriations Act, 2021 and Other Extensions Act, as Passed by the House of
Representatives on September 22, 2020,” September 23, 2020, https://www.cbo.gov/system/files/2020-09/hr8337.pdf.
16 See linked draft bill and report language text in the Senate Appropriations Committee majority press release,
“Committee Releases FY21 Bills in Effort to Advance Process, Produce Bipartisan Results,” November 10, 2020,
https://www.appropriations.senate.gov/news/committee-releases-fy21-bills-in-effort-to-advance-process-produce-
bipartisan-results. See also the statement from the Senate Appropriations Committee Vice Chair, Senator Patrick
Leahy, at https://www.appropriations.senate.gov/news/minority/senate-approps-vice-chair-leahy-statement-on-the-
release-of-the-fy-2021-senate-appropriations-bills-.
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FY2021 LHHS Action in the House (Division A, H.R. 2740)
The House LHHS subcommittee approved the draft LHHS bill on July 7, by a vote of 9-6. On
July 13, 2020, the House Appropriations Committee voted to report the FY2021 LHHS
appropriations bill, 30-22; the measure was subsequently reported to the House on July 15 (H.R.
7614; H.Rept. 116-450).
As reported by the full committee, the bill would have provided $198.1 billion in discretionary
LHHS funds, a 1.3% increase from FY2020 enacted levels. This amount would have been 10.8%
more than the FY2021 President’s request. In addition, the House committee bill would have
provided an estimated $980.0 billion in mandatory funding, for a combined total of $1.178 trillion
for LHHS as a whole. (Note that these totals are based only on amounts of non-emergency
appropriations that would have been provided by the House committee bill and do not include
emergency-designated or supplemental funds, which were provided in addition to the annual
appropriations. The House committee bill included a total of $19.4 billion in emergency-
designated budget authority in Title VI, of which $925 million was for DOL and $18.5 billion
was for HHS, which is not reflected in the above figures.)
Later in July, LHHS appropriations were initially considered on the House floor as part of a
consolidated appropriations package and passed the House (217-197), as amended, on July 31,
2020 (Division E of H.R. 7617). This package would have provided appropriations for five other
appropriations acts in addition to LHHS: Department of Defense; Commerce, Justice, Science;
Energy and Water Development; Financial Services and General Government; and
Transportation, Housing, and Urban Development.17 Floor action on H.R. 7617 was regulated by
the terms of a special rule (H.Res. 1067) that made in order 92 amendments to the LHHS title of
the bill.18 That rule also provided the authority for the chair of the Appropriations Committee or
her designee to offer any of the amendments made in order en bloc (i.e., in groups of amendments
to be disposed of together). All but three LHHS amendments were considered in this manner.19
When counted as 92 separate amendments, 84 were adopted and 8 were rejected.
Because there is no publicly available source that estimates the account-level budgetary effects of
the amendments adopted to Division E, this report provides analysis of the House Committee-
reported version of the LHHS bill. For information on the LHHS amendments offered during
floor consideration, see Appendix B.
FY2021 President’s Budget Request
The President’s FY2021 budget request was submitted to Congress on February 10, 2020.20 On
March 17, 2020, President Trump submitted a letter to Congress about FY2021 budget

17 H.R. 7617 was initially expected to provide appropriations for the act funding the Department of Homeland Security,
but that division was ultimately omitted under the terms of the special rule that regulated floor consideration (H.Res.
1067).
18 For a list of these LHHS amendments (numbered 218-309) and the text of each that was made in order, see H.Rept.
116-461, pp. 23-32 and 89-108. Readers should note that LHHS amendments were keyed to Division F of what was to
be the base text for amendment (Rules Committee Print 116–60). The LHHS division was redesignated as Division E
after House passage due to the omission of the Department of Homeland Security division from the bill.
19 For the en bloc amendments proposing changes to the LHHS division of the bill, see consideration of amendments en
bloc nos. 3, 4, and 5 in Congressional Record, daily edition, Vol. 166, No. 135 (July 30, 2020), pp. H4134-H4139,
H4143-H4169.
20 For further information on the HHS budget request, see CRS Report R46321, Department of Health and Human
Services: FY2021 Budget Request. Note that the report covers the FY2021 President’s request for HHS in its entirety,
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amendments (along with a supplemental appropriations request for FY2020) related to the
response to the COVID-19 pandemic.21 These budget amendments affected the FY2021
President’s requested levels for CDC and NIH accounts at HHS.22
The President requested $178.8 billion in discretionary funding for accounts funded by the LHHS
bill, which would have been a decrease of 8.5% from FY2020 levels. In addition, the President
requested $978.3 billion in annually appropriated mandatory funding, for a total of $1.157 trillion
for LHHS as a whole.
Conclusion of the FY2020 Appropriations Process and FY2020
Supplemental Appropriations
FY2020 regular appropriations for LHHS were enacted as part of the Further Consolidated
Appropriations Act, 2020, on December 20, 2019 (FY2020 LHHS omnibus; P.L. 116-94). The
FY2020 LHHS omnibus was agreed to by the House (297-120) on December 17, 2019, and by
the Senate (71-23) on December 19. The bill was signed into law on December 20 (P.L. 116-94).
LHHS discretionary appropriations in the FY2020 LHHS omnibus totaled $195.4 billion. This
amount is 3.2% more than FY2019 enacted and 17.4% more than the FY2020 President’s budget
request. The omnibus also provided $902.3 billion in mandatory funding, for a combined LHHS
total of $1.098 trillion.23
On January 29, 2020, supplemental appropriations of $210 million in additional funding to DOL
to carry out the United States-Mexico-Canada Agreement (USMCA) were enacted (P.L. 116-
113).24
Subsequent to the enactment of annual FY2020 LHHS discretionary appropriations and the
submission of the President’s budget, the effects of the COVID-19 global pandemic on
communities across the world and throughout the United States elicited a legislative response
from Congress and the President during the remainder of FY2020. Four FY2020 supplemental
appropriations were part of this legislative response:25

not just the components of the agency funded through the annual LHHS bill.
21 Executive Office of the President, Office of Management and Budget, Letter from Acting Director Russell T. Vought
to The Honorable Michael R. 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 Amounts shown for the President’s request in the source materials consulted for this report generally appear to reflect
these budget amendments. The source materials used for the President’s request are drawn from or calculated based on
the explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional
Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711.
23 For further information, see CRS Report R46492, Labor, Health and Human Services, and Education: FY2020
Appropriations.
24 Title IX of the United States-Mexico-Canada Agreement Supplemental Appropriations Act, 2019, (USMCA, P.L.
116-113). The USMCA supplemental appropriations of $210 million for DOL were for the Bureau of International
Labor Affairs (ILAB) to support the implementation and enforcement of the USMCA. The labor-related provisions in
the USMCA, which are associated with ILAB’s role, are discussed in CRS Report R44981, The United States-Mexico-
Canada Agreement (USMCA), pp. 32-33.
25 Other divisions of the acts that provided supplemental LHHS appropriations 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 in FFCRA, and provisions modifying
student loan subsidy costs in the CARES Act. The mandatory spending budgetary effects of such provisions are outside
the scope of this report. For further information on the LHHS appropriations provided by these COVID-19 pandemic
response supplementals, see CRS Report R46353, COVID-19: Overview of FY2020 LHHS Supplemental
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 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 billion in supplemental LHHS funds26 (“1st
COVID”);
 Title V, Division A, of the Families First Coronavirus Response Act (FFCRA,
P.L. 116-127), enacted on March 18, 2020, provided $1.25 billion in
supplemental LHHS funds (“2nd COVID”);
 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
billion in supplemental LHHS funds (“3rd COVID”); and
 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 billion in supplemental LHHS funds (“4th COVID”).
In total, FY2020 supplemental appropriations increased regular FY2020 LHHS enacted funding
by about 143%. The bulk of the supplemental funding (89%) was directed at HHS. The $248
billion in supplemental HHS funds represented a 261% increase over the agency’s FY2020
regular appropriations funding level. ED received the next largest increase via supplemental
funds (43%), whereas DOL and RA received the smallest increases relative to their initial
FY2020 enacted levels (5% and 3%, respectively).

Appropriations.
26 Of the amount shown for P.L. 116-123, $300 million (appropriated to the Public Health and Social Services
Emergency Fund at HHS) was contingent upon future HHS actions.
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Summary of FY2021 LHHS Appropriations
Dollars and Percentages in this Report
Amounts displayed in this report are typically rounded to the nearest mil ion or bil ion (as labeled). Dol ar and
percentage changes discussed in the text are based on unrounded amounts.
Unless otherwise specified, appropriations levels displayed in this report refer to the total amount of budget
authority provided in an appropriations bil (i.e., “total in the bil ”), regardless of the year in which the funding
becomes available.
Amounts for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted are generally drawn from or calculated
based on data contained in the explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260),
available in the Congressional Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. (The
amount for P.L. 117-31 is from CBO, Discretionary Spending: Senate Amendment 2123, July 29, 2021,
https://www.cbo.gov/system/files/2021-07/EmergencySecuritySupplementalAppropriationsAct2021.pdf.)
Amounts for the FY2021 House Committee-reported bil are generally drawn from or calculated based on data
contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Throughout this report, the
FY2021 House Appropriations Committee-reported LHHS bil is commonly referred to as the House “committee
bil .” (This report does not contain estimates of the House-passed version of H.R. 7617, as there is no publicly
available source that estimates the account-level budgetary effects of the adopted amendments. However,
information on the LHHS amendments offered during floor consideration can be found in Appendix B.)
Enacted totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated appropriations provided in
P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bil totals (“Total BA in
the Bil ”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614.
Enacted totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations provided in
Division H or M of P.L. 116-260, or P.L. 117-31. For informational purposes, FY2020 enacted, and FY2021
proposed and enacted, emergency-designated amounts are displayed separately at the bottom of tables
throughout the report and not summed. One exception is made in Table A-1, which includes FY2020 and
FY2021 enacted emergency-designated funds in the “Adjusted Appropriations” totals, as scored by the
Congressional Budget Office. In addition, further details on the FY2021 supplemental appropriations can be found
in Appendix C.
For consistency with source materials, the FY2020 and FY2021 numbers in this report generally do not reflect
actual or anticipated post-enactment budgetary adjustments, except as noted.27 CRS calculations do, however,
include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255).
Table 2 displays FY2021 discretionary and mandatory LHHS budget authority provided or
proposed, by bill title, along with FY2020 enacted levels. The amounts shown in this table reflect
total budget authority provided in the annual LHHS bill (i.e., all funds appropriated in the bill,
regardless of the fiscal year in which the funds become available), not total budget authority
available for the current fiscal year. (For a comparable table showing current-year budget
authority, see Table A-2. Note that the totals in this table do not include emergency-designated
appropriations; those amounts are displayed separately at the bottom of the table and are in

27 The general practice for CRS reports on the LHHS bill has been to reflect conventions used in source materials.
These conventions have varied over the years. For instance, CRS reports on LHHS appropriations for FY2012-FY2015
generally relied on source materials that adjusted appropriations amounts in the prior-year column to reflect
sequestration, reestimates of mandatory spending, transfers, reprogramming, and other adjustments for comparability.
However, the FY2016 version of this report broke from that practice due to differing display conventions in source
documents, and did not reflect any such adjustments (except sequestration for the Prevention and Public Health Fund
(PPHF)). The FY2017 version of this report differed from both of these prior practices, in that it reflected a smaller
subset of transfers (generally concentrated at the National Institutes of Health) and other adjustments for comparability
(e.g., program moves from one account to another), but not reprogramming of funds or mandatory sequestration
(except sequestration of the PPHF). The FY2018, FY2019, and FY2020 versions of this report, however, relied on
source materials that generally did not reflect any transfers or other budgetary adjustments pursuant to administrative
authorities except PPHF sequestration. The source materials used for the FY2021 report version, and thus the numbers
in this report, continue this most recent approach.
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addition to regular appropriations. For a discussion of the FY2021 supplemental appropriations
displayed below the bill totals in Table 2, se e Appendix C.)
Table 2. LHHS Appropriations Overview by Bill Title, FY2020-FY2021
(Total budget authority provided in the bill, in billions of dollars)
FY2021
FY2021
House
Enacted
FY2020
FY2021
Cmte.
(P.L. 116-
Bill Title
Enacted
Request
(H.R. 7614)
260)
Title I: Labor
13.8
12.5
14.0
13.9
Discretionary
12.4
11.1
12.7
12.5
Mandatory
1.4
1.4
1.4
1.4
Title II: HHS
934.8
1,005.0
1,016.0
1016.6
Discretionary
94.9
87.0
96.4
97.0
Mandatory
839.9
917.9
919.6
919.6
Title III: Education
76.4
70.2
77.1
77.2
Discretionary
72.8
66.6
73.5
73.5
Mandatory
3.6
3.7
3.7
3.7
Title IV: Related Agencies
72.7
69.4
70.9
70.8
Discretionary
15.4
14.1
15.6
15.5
Mandatory
57.3
55.3
55.3
55.3
Total BA in the Bill
1,097.7
1,157.1
1,178.0
1,178.5
Discretionary
195.4
178.8
198.1
198.5
Mandatory
902.3
978.3
980.0
980.0
Emergency Funding (not included in above totals)

USMCA (P.L. 116-113)
0.2
-
-
-
1st COVID (P.L. 116-123)
6.4
-
-
-
2nd COVID (P.L. 116-127)
1.3
-
-
-
3rd COVID (P.L. 116-136)
172.1
-
-
-
4th COVID (P.L. 116-139)
100.0
-
-
-
Emergency Funding in Annual LHHSa
-
-
19.4
1.6
5th COVID (Division M, P.L. 116-260)
-
-
-
154.9
Afghan special immigrants (P.L. 117-31)
-
-
-
0.0b
Memoranda (non-emergency funds only):

Advances for Future Years
189.1
197.1
197.6
197.6
(provided in current bil )c
Advances from Prior Years
186.7
188.6
189.0
189.0
(for use in current year)c
Additional Scorekeeping Adjustmentsd
-10.5
-9.9
-13.2
-22.5
Source: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are
generally drawn from or calculated based on data contained in the explanatory statement accompanying the
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FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December
21, 2020, pp. H8619-H8711. (The amount for P.L. 117-31 is from CBO, Discretionary Spending: Senate Amendment
2123, July 29, 2021, https://www.cbo.gov/system/files/2021-07/
EmergencySecuritySupplementalAppropriationsAct2021.pdf.) Amounts in the FY2021 House Committee column
are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-450)
accompanying H.R. 7614. Enacted totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated
appropriations provided in P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House
committee bil totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations
proposed in Title VI of H.R. 7614. Enacted totals (“Total BA in the Bil ”) for FY2021 do not include emergency-
designated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with
source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where
applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS
calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L.
114-255), as amended.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bil , regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bil ); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bil s. No
amounts are shown for Title V, because this title consists solely of general provisions.
a. The FY2021 House committee bil included a total of $19.4 bil ion in emergency-designated budget
authority in Title VI, of which $925 mil ion was for DOL and $18.5 bil ion was for HHS. Subsequently,
Division H of P.L. 116-260 enacted $1.6 bil ion in emergency-designated budget authority, of which $925
mil ion was for DOL in Title I, and $638 mil ion was for HHS in Title II.
b. P.L. 117-31 provided $25 mil ion in supplemental appropriations for the Refugee and Entrant Assistance
account at HHS for specified purposes related to Afghan special immigrants, which rounds to $0.0 in bil ions
(the unit of measure used in this table).
c. Totals in this table are based on budget authority provided in the bil (i.e., they exclude advance
appropriations from prior bil s and include advance appropriations from this bil made available in future
years). The calculation for total budget authority available in the current year is as fol ows: Total BA in the
Bil , minus Advances for Future Years, plus Advances from Prior Years.
d. Totals in this table have generally not been adjusted for further scorekeeping. (To adjust for scorekeeping,
add this line to the total budget authority.)
Figure 2 displays the FY2021 enacted discretionary and mandatory LHHS funding levels, by bill
title. (While the dollars and percentages discussed in this section were calculated based on the
FY2021 enacted amounts, they are generally also illustrative—within several percentage points—
of the share of funds directed to each bill title in FY2020 and under the other FY2021 proposals.)
As this figure demonstrates, HHS accounts for the largest share of total FY2021 LHHS
appropriations: $1,017 billion, or 86.3%. This is due to the large amount of mandatory funding
included in the HHS appropriation, the majority of which is for Medicaid grants to states and
payments to health care trust funds. After HHS, ED and the Related Agencies represent the next-
largest shares of total LHHS funding, accounting for 6.6% and 6.0%, respectively. (The majority
of the ED appropriations each year are discretionary, while the bulk of funding for the Related
Agencies goes toward mandatory payments and administrative costs of the Supplemental Security
Income program at the Social Security Administration.) DOL accounts for the smallest share of
total LHHS funds, 1.2%.
The overall composition of LHHS funding is noticeably different when comparing only
discretionary appropriations. HHS accounts for a comparatively smaller share of total
discretionary appropriations (48.8%), while ED accounts for a relatively larger share (37.0%).
Together, these two departments represent the majority (85.9%) of discretionary LHHS
appropriations. DOL and the Related Agencies account for a roughly even split of the remaining
14.1% of discretionary LHHS funds.
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Figure 2. FY2021 Enacted LHHS Appropriations by Title
(Budget authority in billions of dollars [unless otherwise indicated])

Source: Amounts in this figure are generally drawn from or calculated based on data contained in the
explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional
Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. Enacted totals (“Total BA in the Bil ”)
for FY2021 do not include emergency-designated appropriations provided in Division H or M of P.L. 116-260, or
P.L. 117-31. For consistency with source materials, amounts in this figure generally do not reflect mandatory
spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant
to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the
21st Century Cures Act (P.L. 114-255), as amended.
Notes: Details may not add to totals due to rounding. Amounts in this figure (1) reflect all BA appropriated in
the bil , regardless of the year in which funds become available (i.e., totals do not include advances from prior-
year appropriations, but do include advances for subsequent years provided in this bil ); (2) have generally not
been adjusted to reflect scorekeeping; (3) comprise only those funds provided for agencies and accounts subject
to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do
not include appropriations that occur outside of appropriations bil s.
Department of Labor (DOL)
Note that all amounts in this section are based on regular LHHS appropriations only. Amounts in
this section do not include mandatory funds provided outside of the annual appropriations process
(e.g., direct appropriations for Unemployment Insurance benefits payments). All amounts in this
section are rounded to the nearest million or billion (as labeled). The dollar changes and
percentage changes discussed in the text are based on unrounded amounts. For consistency with
source materials, amounts do not reflect sequestration or reestimates of mandatory spending
programs, where applicable.
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About DOL
DOL is a federal department comprised of multiple entities that provide services related to
employment and training, worker protection, income security, and contract enforcement. Annual
LHHS appropriations laws direct funding to all DOL entities (see the text box).29 The DOL
entities fall primarily into two main functional areas—workforce development and worker
protection. First, there are several DOL
entities that administer workforce employment
DOL Entities Funded via the
and training programs—such as the Workforce
LHHS Appropriations Process
Innovation and Opportunity Act (WIOA) state
Employment and Training Administration (ETA)
formula grant programs, Job Corps, and the
Employee Benefits Security Administration (EBSA)
Employment Service—that provide direct
Wage and Hour Division (WHD)
funding for employment activities or
Office of Federal Contract Compliance Programs
administration of income security programs
(OFCCP)
(e.g., for the Unemployment Insurance
Office of Labor-Management Standards (OLMS)
benefits program). Also included in this area is
Office of Workers’ Compensation Programs (OWCP)
the Veterans’ Employment and Training
Occupational Safety and Health Administration (OSHA)
Service (VETS), which provides employment
Mine Safety and Health Administration (MSHA)
services specifically for the veteran
population. Second, there are several agencies
Bureau of Labor Statistics (BLS)
that provide various worker protection
Office of Disability Employment Policy (ODEP)
services. For example, the Occupational
Departmental Management (DM)28
Safety and Health Administration (OSHA),
the Mine Safety and Health Administration (MSHA), and the Wage and Hour Division (WHD)
provide different types of regulation and oversight of working conditions. DOL entities focused
on worker protection provide services to ensure worker safety, adherence to wage and overtime
laws, and contract compliance, among other duties. In addition to these two main functional
areas, DOL’s Bureau of Labor Statistics (BLS) collects data and provides analysis on the labor
market and related labor issues.
FY2021 DOL Appropriations Overview
Table 3 generally displays FY2021 discretionary and mandatory DOL budget authority provided
or proposed, along with FY2020 enacted levels. The totals in this table do not include emergency
supplemental appropriations; amounts provided in supplemental appropriations are displayed
separately at the bottom of the table and are in addition to regular appropriations. (Although not
technically supplemental appropriations, the bottom of the table also includes emergency-
designated discretionary funding proposed or enacted in annual LHHS measures.)
The FY2021 LHHS omnibus increased discretionary appropriations for DOL by $122 million
(+1.0%) compared to the FY2020 enacted levels. Discretionary DOL appropriations would have
increased by $254 million (+2.0%) under the FY2021 House committee bill, compared to
FY2020 enacted, but would have decreased under the FY2021 President’s budget request by $1.3
billion (-10.5%). Of the total funding provided in the bill for DOL, roughly 90% is discretionary.

28 Departmental Management includes the DOL salaries and expenses, Veterans Employment and Training Service
(VETS), IT Modernization, and the Office of the Inspector General.
29 The Pension Benefit Guaranty Corporation (PBGC) is funded primarily through insurance premiums and related fees
from companies covered by the PBGC. For further information, see CRS In Focus IF10492, An Overview of the
Pension Benefit Guaranty Corporation (PBGC).
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Table 3. DOL Appropriations Overview
(In billions of dollars)
FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L. 116-
Funding
Enacted
Request
7614)
260)
Discretionary
12.4
11.1
12.7
12.5
Mandatory
1.4
1.4
1.4
1.4
Total BA in the Bill
13.8
12.5
14.0
13.9
Emergency Funding (not included in above

totals)
USMCA (P.L. 116-113)
0.2
—
—
—
3rd COVID (P.L. 116-136)
0.4
—
—
—
Emergency Funding in Annual
—
—
0.9
0.9
LHHSa
Source: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are
generally drawn from or calculated based on data contained in the explanatory statement accompanying the
FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December
21, 2020, pp. H8619-H8711. Amounts in the FY2021 House Committee column are generally drawn from or
calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated appropriations provided in P.L.
116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bil totals (“Total BA in the
Bil ”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations provided in
Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure
generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or
reprogramming of funds pursuant to executive authorities.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bil , regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bil ); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bil s.
a. The FY2021 House committee bil included a total of $19.4 bil ion in emergency-designated budget
authority in Title VI, of which $925 mil ion was for DOL. Subsequently, Division H of P.L. 116-260 enacted
$1.6 bil ion in emergency-designated budget authority, of which $925 mil ion was for DOL.
Selected DOL Highlights
The following sections present highlights from FY2021 enacted and proposed appropriations
compared to FY2020 enacted appropriations for selected DOL accounts and programs.30
Table 4 displays funding for DOL programs and activities discussed in this section.
Employment and Training Administration (ETA)
ETA administers the primary federal workforce development statute, the Workforce Innovation
and Opportunity Act (WIOA, P.L. 113-128). The WIOA, which replaced the Workforce

30 DOL budget materials can be found at https://www.dol.gov/general/aboutdol#budget.
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Investment Act, was enacted in July 2014 and authorized appropriations for its programs and
activities from FY2015 through FY2020. Authorization of appropriations for WIOA programs
and activities expired at the end of FY2020 but was extended through FY2021 by the FY2021
LHHS omnibus (P.L. 116-260, Division H, Title I).
Title I of WIOA, which authorizes more than half of all funding for the programs authorized by
the four titles of WIOA, includes three state formula grant programs serving Adults, Youth, and
Dislocated Workers. While the FY2021 LHHS omnibus provided a $26 million increase (+0.9%)
for the three WIOA state formula grant programs compared to FY2020, the FY2021 President’s
budget would have provided level funding and the House committee bill would have increased
funding by $50 million (+1.8%), compared to FY2020 enacted levels.
The FY2021 LHHS omnibus provided $281 million for the Dislocated Workers Activities
National Reserve (DWA National Reserve), which was an increase of $10 million (+3.7%)
compared to the FY2020 enacted level. This was the same amount that was proposed by the
House committee bill, whereas the FY2021 President’s budget would have reduced funding for
the DWA National Reserve by $110 million (-40.6%). In addition, the FY2021 LHHS omnibus
maintained a provision in that account (which originated in the FY2018 omnibus and has been
included since then) directing $35 million from the DWA National Reserve toward training and
employment assistance for workers dislocated in both the Appalachian and lower Mississippi
regions. Finally, the FY2021 LHHS omnibus maintained a provision that originated in the
FY2020 omnibus directing $45 million from the DWA National Reserve to be used in developing,
offering, or improving career training programs at community colleges.
The FY2021 LHHS omnibus provided $185 million for the Apprenticeship Grant program, which
was $10 million (+5.7%) more than the level enacted in FY2020 and the same that the House
committee bill would have provided. The FY2021 President’s budget would have increased the
level of funding for the Apprenticeship Grant program by $25 million (+14.3%) compared to the
FY2020 enacted level.
Four ETA programs for which the FY2021 President’s budget proposed no funding—the Native
Americans program, the Migrant and Seasonal Farmworkers program, the Community Service
Employment for Older Americans (CSEOA) program, and the Workforce Data Quality
Initiative—received FY2021 appropriations at roughly the same level as FY2020.
Office of Foreign Labor Certification (OFLC)
The FY2021 LHHS omnibus provided $78 million for OFLC, which was an increase of $9
million (+13.1%) compared to the FY2020 enacted level and the same amount that was proposed
by the House committee bill. This FY2021 enacted level was $2 million less (-2.6%) than the
amount requested in the FY2021 President’s budget. The OFLC, which is part of ETA, is
responsible for labor certification applications for employment-based and immigration and guest
worker programs. Of the $9 million increase, $3 million was for national administration and $6
million was for grants to states. As noted in the FY2021 House committee report, the $6 million
increase in OFLC grants to states was proposed partly in response to an increase in the number of
H-2A applications that resulted in requests from states for additional resources for reviewing,
processing, recruitment of potential domestic agricultural workers, and contract oversight.31

31 H.Rept. 116-450, pp. 20-21.
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Bureau of Labor Statistics (BLS)
The FY2021 LHHS omnibus provided $655 million for BLS, the same level as FY2020 enacted
The House committee bill had previously proposed level funding, whereas the FY2021
President’s budget had proposed a $3 million increase (+0.5%) relative to FY2020. As noted in
the explanatory statement accompanying the FY2021 LHHS omnibus, $13 million of the FY2021
appropriation was for necessary costs associated with the physical relocation of BLS headquarters
to the Suitland Federal Complex, which was initiated in FY2020.32 Similarly, the FY2021 House
committee report indicated continued support for BLS to continue implementation of several data
projects started in FY2020, including work to implement an annual supplement to the Current
Population Survey (CPS) to collect data on contingent workers every two years and other topics
in the alternate years, to restore the production of labor market data in the Local Area
Unemployment Statistics (LAUS) program for New England Minor Civil Divisions with
populations less than 1,000, and to plan and develop a new National Longitudinal Survey of
Youth (NLSY) cohort.33
Bureau of International Labor Affairs (ILAB)
The FY2021 LHHS omnibus provided $96 million for ILAB, which was the same as the FY2020
enacted level and the same amount that the House committee bill would have provided. The
FY2021 President’s budget would have decreased funding by $77 million (-80.6%) for ILAB,
which provides research, advocacy, technical assistance, and grants to promote workers’ rights in
different parts of the world. Language in the FY2021 President’s budget indicated that the
proposed reduction reflected a $67.3 million decrease to eliminate new grants and a $10.3 million
decrease to reduce staff levels, with the remaining $19 million to be used on “efforts to make U.S.
trade agreements fair for U.S. workers by monitoring and enforcing the labor provisions of free
trade agreements (FTAs) and trade preference programs to ensure a fair global playing field for
U.S. workers and businesses.”34
Labor-Related General Provisions
Annual LHHS appropriations acts regularly contain general provisions related to certain labor
issues. This section highlights selected DOL general provisions in the FY2021 LHHS omnibus.
The FY2021 LHHS omnibus continued several provisions that have been included in at least one
previous LHHS appropriations act, including provisions that
 exempt certain insurance claims adjusters from overtime protection for two years
following a “major disaster” (included since FY2016);35
 direct the Secretary of Labor to accept private wage surveys as part of the process
of determining prevailing wages in the H-2B program, even in instances in which
relevant wage data are available from the Bureau of Labor Statistics (included
since FY2016);36

32 Congressional Record, December 21, 2020, Vol. 166, No. 218, Book IV, p. H8619.
33 H.Rept. 116-450, pp. 31-32.
34 See DOL, FY2021 Congressional Budget Justification, Departmental Management, p. DM-41, https://www.dol.gov/
sites/dolgov/files/general/budget/2021/CBJ-2021-V3-02.pdf.
35 See Division H, Title I, §108 of P.L. 116-260.
36 See Division H, Title I, §110 of P.L. 116-260. The H-2B program allows for the temporary employment of foreign
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 authorize the Secretary of Labor to provide up to $2 million in “excess personal
property” to apprenticeship programs to assist training apprentices (included
since FY2018);37
 authorize the Secretary of Labor to employ law enforcement officers or special
agents to provide protection to the Secretary of Labor and certain other
employees and family members at public events and in situations in which there
is a “unique and articulable” threat of physical harm (included since FY2018);38
 authorize the Secretary of Labor to dispose of or divest “by any means the
Secretary determines appropriate” all or part of the real property on which the
Treasure Island Job Corps Center is located (included since FY2018);39 and
 prohibit any funds from the FY2021 omnibus from being used to alter the
Interagency Agreement between DOL and USDA or to close any Civilian
Conservation Centers unless certain conditions are met (included since
FY2020).40
Table 4. Detailed DOL Appropriations
(In millions of dollars)
FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L. 116-
Agency or Selected Program
Enacted
Request
7614)
260)
ETA—Mandatorya
680
634
634
634
ETA—Discretionary
9,293
8,043
9,527
9,392
Discretionary ETA Programs:

Training and Employment Services:
3,611
3,358
3,697
3,663
State Formula Grants:
2,820
2,820
2,870
2,845
Adult Activities Grants to States
855
855
865
863
Youth Activities Grants to States
913
913
925
921
Dislocated Worker Activities (DWA)
Grants to States
1,052
1,052
1,080
1,062
National Activities:
791
538
827
818
DWA National Reserve
271
161
281
281
Native Americans
55
0
56
56
Migrant and Seasonal Farmworkers
92
0
96
94
YouthBuild
95
85
101
97
Reintegration of Ex-Offenders
98
93
103
100

workers in nonagricultural sectors and requires these workers to be paid the “prevailing wage” (i.e., the average wage
paid to similar workers in the local area). Under DOL regulations, private employer surveys may be considered only if
the employer meets certain conditions.
37 See Division H, Title I, §112 of P.L. 116-260.
38 See Division H, Title I, §113 of P.L. 116-260.
39 See Division H, Title I, §114 of P.L. 116-260.
40 See Division H, Title I, §116 of P.L. 116-260.
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FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L. 116-
Agency or Selected Program
Enacted
Request
7614)
260)
Workforce Data Quality Initiative
6
0
6
6
Apprenticeship Grants
175
200
185
185
Job Corps
1,744
1,016
1,756
1,749
Community Service Employment for Older Americans
405
0
410
405
State Unemployment Insurance and Employment
Service Operations (SUI/ESO):
3,375
3,497
3,506
3,417
Unemployment Compensation
2,553
2,665
2,668
2,584
Employment Service
690
688
698
692
Foreign Labor Certification
69
80
78
78
One-Stop Career Centers
63
65
63
63
ETA Program Administration
159
172
159
159
Employee Benefits Security Administration
181
193
181
181
Pension Benefit Guaranty Corp, (PBGC) program
(453)
(465)
(465)
(465)
level (non-add)b
Wage and Hour Division
242
244
246
246
Office of Labor-Management Standards
43
50
42
44
Office of Federal Contract Compliance
106
106
106
106
Programs
Office of Workers’ Compensation Programs—
695
739
739
739
Mandatoryc
Office of Workers’ Compensation Programs—
118
119
118
118
Discretionary
Occupational Safety & Health Administration
582
577
594
592
Mine Safety & Health Administration
380
382
380
380
Bureau of Labor Statistics
655
658
655
655
Office of Disability Employment Policy
39
27
39
39
Departmental Management
776
714
780
784
Salaries and Expenses
348
272
349
349
International Labor Affairs (non-addd)
96
19
96
96
Veterans Employment and Training
311
312
314
316
IT Modernization
25
37
25
27
Office of the Inspector General
91
93
92
91
Total, DOL BA in the Bill
13,789
12,488
14,041
13,909
Subtotal, Mandatory
1,375
1,373
1,373
1,373
Subtotal, Discretionary
12,414
11,114
12,668
12,536
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FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L. 116-
Agency or Selected Program
Enacted
Request
7614)
260)
Emergency Funding (not included in above totals)

USMCA (P.L. 116-113)
210
—
—
—
3rd COVID (P.L. 116-136)
360
—
—
—
Emergency Funding in Annual LHHSe
—
—
925
925
Memoranda (non-emergency funds only)

Total, BA Available in Fiscal Year (current year from
any bil )
13,789
12,548
14,041
13,909
Total, BA Advances for Future Years (provided in
current bil )
1,786
1,726
1,786
1,786
Total, BA Advances from Prior Years (for use in
current year)
1,786
1,786
1,786
1,786
Source: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are
generally drawn from or calculated based on data contained in the explanatory statement accompanying the
FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December
21, 2020, pp. H8619-H8711. Amounts in the FY2021 House Committee column are generally drawn from or
calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated appropriations provided in P.L.
116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bil totals (“Total BA in the
Bil ”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations provided in
Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure
generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or
reprogramming of funds pursuant to executive authorities.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bil , regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bil ); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bil s.
a. Mandatory funding within ETA goes to Federal Unemployment Benefits and Allowances (FUBA) and
Advances to the Unemployment Trust Fund (UTF), if any. FUBA funds Trade Adjustment Assistance for
Workers (TAA).
b. PBGC funding is provided outside the LHHS Appropriations Act.

c. Mandatory programs in the Office of Workers’ Compensation Programs include Special Benefits
(comprising the Federal Employees’ Compensation Benefits and the Longshore and Harbor Workers’
Benefits), Special Benefits for Disabled Coal Miners, Energy Employees Occupational Il ness Compensation
(Administrative Expenses), and the Black Lung Disability Trust Fund.
d. The funding for International Labor Affairs is included in the Salaries and Expenses total.
e. The FY2021 House committee bil included a total of $19.4 bil ion in emergency-designated budget
authority in Title VI, of which $925 mil ion was for DOL. Subsequently, Division H of P.L. 116-260 enacted
$1.6 bil ion in emergency-designated budget authority, of which $925 mil ion was for DOL.
Department of Health and Human Services (HHS)
Note that all amounts in this section are based on regular LHHS appropriations only; they do not
include funds for HHS agencies provided through other appropriations bills (e.g., funding for the
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Food and Drug Administration) or outside of the annual appropriations process (e.g., direct
appropriations for Medicare or mandatory funds provided by authorizing laws, such as the Patient
Protection and Affordable Care Act [ACA, P.L. 111-148]). All amounts in this section are rounded
to the nearest million or billion (as labeled). The dollar changes and percentage changes discussed
in the text are based on unrounded amounts. For consistency with source materials, amounts do
not reflect sequestration or re-estimates of mandatory spending programs, where applicable.
About HHS
HHS Agencies Funded via the
HHS is a large federal department composed
LHHS Appropriations Process
of multiple agencies working to enhance the
Health Resources and Services Administration (HRSA)
health and well-being of Americans. Annual
Centers for Disease Control and Prevention (CDC)
LHHS appropriations laws direct funding to
National Institutes of Health (NIH)
most (but not all) HHS agencies (see text box
Substance Abuse and Mental Health Services
for HHS agencies supported by the LHHS
Administration (SAMHSA)
bill).41 For instance, the LHHS bill directs
Agency for Healthcare Research and Quality (AHRQ)
funding to five Public Health Service (PHS)
Centers for Medicare & Medicaid Services (CMS)
agencies: the Health Resources and Services
Administration for Children and Families (ACF)
Administration (HRSA), Centers for Disease
Administration for Community Living (ACL)
Control and Prevention (CDC), National
Office of the Secretary (OS)
Institutes of Health (NIH), Substance Abuse
and Mental Health Services Administration
(SAMHSA), and Agency for Healthcare Research and Quality (AHRQ).42 These public health
agencies support diverse missions, ranging from the provision of health care services and
supports (e.g., HRSA, SAMHSA), to the advancement of health care quality and medical research
(e.g., AHRQ, NIH), to the prevention and control of infectious and chronic diseases (e.g., CDC).
In addition, the LHHS bill provides funding for annually appropriated components of CMS,43
which is the HHS agency responsible for the administration of Medicare, Medicaid, the State
Children’s Health Insurance Program (CHIP), and consumer protections and private health
insurance provisions of the ACA.
The LHHS bill also provides funding for two HHS agencies focused primarily on the provision of
social services: the Administration for Children and Families (ACF) and the Administration for
Community Living (ACL). ACF’s mission is to promote the economic and social well-being of
vulnerable children, youth, families, and communities. ACL was formed with a goal of increasing
access to community supports for older Americans and people with disabilities. The LHHS bill
also provides funding for the HHS Office of the Secretary (OS), which encompasses a broad
array of management, research, oversight, and emergency preparedness functions in support of
the entire department.

41 Three HHS public health agencies receive annual funding from appropriations bills other than the LHHS bill: the
Food and Drug Administration (funded through the Agriculture appropriations bill), the Indian Health Service (funded
through the Interior-Environment appropriations bill), and the Agency for Toxic Substances and Disease Registry
(funded through the Interior-Environment appropriations bill). In addition, while the National Institutes of Health
(NIH) receive the majority of their appropriations from the LHHS bill, one NIH institute (the National Institute of
Environmental Health Sciences) receives appropriations from two bills: LHHS and the Interior-Environment bill.
42 For more information on HHS PHS agencies, see CRS Report R44916, Public Health Service Agencies: Overview
and Funding (FY2016-FY2018).
43 Much of the funding for CMS activities is provided through mandatory appropriations in authorizing legislation, and
thus is not subject to the annual appropriations process.
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FY2021 HHS Appropriations Overview
Table 5 displays enacted and proposed FY2021 funding levels for HHS, along with FY2020
levels. Note that the totals in this table do not include emergency supplemental appropriations;
amounts provided in supplementals are displayed separately at the bottom of the table and are in
addition to regular appropriations. (Although not technically supplemental appropriations, the
bottom of the table also includes emergency-designated discretionary funding proposed or
enacted in annual LHHS measures.) For a discussion of the FY2021 supplemental appropriations
in Division M of P.L. 116-260 and P.L. 117-31, see Appendix C.
In general, discretionary funds account for about 10% of HHS appropriations in the LHHS bill.
Compared to the FY2020 funding levels, the FY2021 LHHS omnibus increased HHS
discretionary appropriations by 2.2%. The House committee bill would have increased HHS
discretionary appropriations to a lesser degree, by 1.5%, while the President requested an 8.3%
decrease in discretionary HHS funding.
Table 5. HHS Appropriations Overview
(In billions of dollars)
FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L.
Funding
Enacted Request
7614)
116-260)
Discretionary
94.9
87.0
96.4
97.0
Mandatory
839.9
917.9
919.6
919.6
Total BA in the Bill
934.8
1,005.0
1,016.0
1,016.6
Emergency Funding (not included in above
totals)

1st COVID (P.L. 116-123)
6.4
—
—
—
2nd COVID (P.L. 116-127)
1.3
—
—
—
3rd COVID (P.L. 116-136)
140.4
—
—
—
4th COVID (P.L. 116-139)
100.0
—
—
—
Emergency Funding in Annual LHHSa
—
—
18.5
0.6
5th COVID (Division M, P.L. 116-260)
—
—
—
72.9
Afghan special immigrants (P.L. 117-31)
-
-
-
0.0b
Sources: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are
generally drawn from or calculated based on data contained in the explanatory statement accompanying the
FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December
21, 2020, pp. H8619-H8711. (The amount for P.L. 117-31 is from CBO, Discretionary Spending: Senate Amendment
2123, July 29, 2021, https://www.cbo.gov/system/files/2021-07/
EmergencySecuritySupplementalAppropriationsAct2021.pdf.) Amounts in the FY2021 House Committee column
are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-450)
accompanying H.R. 7614. Enacted totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated
appropriations provided in P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House
committee bil totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations
proposed in Title VI of H.R. 7614. Enacted totals (“Total BA in the Bil ”) for FY2021 do not include emergency-
designated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with
source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where
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applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS
calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L.
114-255), as amended.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bil , regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bil ); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bil s.
a. The FY2021 House committee bil included a total of $19.4 bil ion in emergency-designated budget
authority in Title VI, of $18.5 bil ion was for HHS. Subsequently, Division H of P.L. 116-260 enacted $1.6
bil ion in emergency-designated budget authority, of which $638 mil ion was for HHS in Title II.
b. P.L. 117-31 provided $25 mil ion in supplemental appropriations for the Refugee and Entrant Assistance
account at HHS for specified purposes related to Afghan special immigrants, which rounds to $0.0 in bil ions
(the unit of measure used in this table).
Figure 3 provides an HHS agency-level breakdown of FY2021 enacted appropriations. As this
figure demonstrates, annual HHS appropriations are dominated by mandatory funding, the
majority of which goes to CMS to provide Medicaid benefits and payments to health care trust
funds. When taking into account both mandatory and discretionary funding, CMS accounts for
$906.6 billion, which is 89.2% of all enacted appropriations for HHS. NIH and ACF account for
the next-largest shares of total HHS appropriations, receiving about 4.1% apiece.
By contrast, when looking exclusively at discretionary appropriations, funding for CMS
constitutes about 4.6% of FY2021 enacted HHS appropriations. Instead, the bulk of discretionary
appropriations went to the PHS agencies, which combined to account for 63.8% of discretionary
appropriations provided for HHS.44 NIH typically receives the largest share of all discretionary
funding among HHS agencies (42.7% in FY2021), with ACF accounting for the second-largest
share (25.5% in FY2021).

44 For further information about PHS agency funding, see CRS Report R44916, Public Health Service Agencies:
Overview and Funding (FY2016-FY2018).
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Figure 3. FY2021 Enacted HHS Appropriations by Agency
(Budget authority in billions of dollars)

Source: Amounts in this figure are generally drawn from or calculated based on data contained in the
explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional
Record, vol. 166, no. 218, book IV, December 21, 2020, pp. H8619-H8711. Enacted totals (“Total BA in the Bil ”)
for FY2021 do not include emergency-designated appropriations provided in Division H or M of P.L. 116-260, or
P.L. 117-31. For consistency with source materials, amounts in this figure generally do not reflect mandatory
spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant
to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the
21st Century Cures Act (P.L. 114-255), as amended.
Notes: Details may not add to totals due to rounding. The bar representing the combined mandatory and
discretionary total for CMS has been abbreviated due to space constraints. When taking into account both
mandatory and discretionary funding, CMS receives over 20 times the funding appropriated to either ACF or
NIH in the FY2021 LHHS omnibus. Amounts in this table (1) reflect all BA appropriated in the bil , regardless of
the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but
do include advances for subsequent years provided in this bil ); (2) have generally not been adjusted to reflect
scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the
jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not
include appropriations that occur outside of appropriations bil s.
Special Public Health Funding Mechanisms
Annual appropriations for HHS public health service agencies are best understood in the context
of certain HHS-specific funding mechanisms: the Public Health Service Evaluation Set-Aside,
and the Prevention and Public Health Fund (PPHF). In recent years, LHHS appropriations have
used these funding mechanisms to direct additional support to certain programs and activities.
Public Health Service Evaluation Tap
The PHS Evaluation Set-Aside, also known as the PHS Evaluation Tap, is a unique feature of
HHS appropriations. It is authorized by Section 241 of the Public Health Service Act (PHSA),
and allows the Secretary of HHS, with the approval of appropriators, to redistribute a portion of
eligible PHS agency appropriations across HHS for program evaluation purposes.
The PHSA limits the set-aside to not less than 0.2% and not more than 1% of eligible program
appropriations. However, LHHS appropriations acts have commonly established a higher
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maximum percentage for the set-aside and have distributed specific amounts of “tap” funding to
selected HHS programs. Since FY2010, and including in FY2021, this higher maximum set-aside
level has been 2.5% of eligible appropriations.45 (The President’s budget proposed to increase the
set-aside to 2.9%, while the House committee bill would have increased it to 3.0%.)
Before FY2015, the PHS tap traditionally
Display of Evaluation Tap Transfers
provided more than a dozen HHS programs
By convention, tables in this report show only the
with funding beyond their annual
amount of PHS Evaluation Tap funds received by an
appropriations and, in some cases, was the
agency (i.e., tables do not subtract the amount of the
sole source of funding for a program or
evaluation tap from donor agencies’ appropriations).
That is to say, tap amounts shown in the fol owing
activity. However, since FY2015 and
tables are in addition to amounts shown for budget
including in FY2020, LHHS appropriations
authority, but the amounts shown for budget authority
laws have directed tap funds to a smaller
have not been adjusted to reflect potential “transfer-
number of programs or activities within three
out” of funds to the tap.
HHS agencies (NIH, SAMHSA, and OS) and
have not provided any tap transfers to AHRQ, CDC, and HRSA. This has been particularly
notable for AHRQ, which had been funded primarily through tap transfers from FY2003 to
FY2014, but has received discretionary appropriations since then.46 The House committee bill
generally would have maintained the current distributional practice for FY2021, except that it
would have also provided tap funding to AHRQ. The President’s budget proposed to expand the
activities and agencies funded by the PHS tap to include the Public Health Scientific Services at
the CDC and to supplemental funding for organ transplantation activities at HRSA, while
simultaneously proposing to reduce tap transfers to the NIH.
Since FY2015, LHHS appropriations laws have directed the largest share of tap transfers to
NIH.47 The FY2021 LHHS omnibus provided $1.3 billion in tap transfers to NIH, a $41 million
(+3.3%) increase over the FY2020 level. The FY2021 House committee bill proposed that the
NIH transfers be increased by $110 million (+9.0%), whereas the President’s request proposed
that the transfers be reduced by $490 million (-39.8%).

45 See Section 204, Division H, P.L. 116-260 for the FY2021 maximum set-aside level. The last time that an
appropriations act set the PHS tap percentage at a level other than 2.5% was in FY2009, when it was 2.4% (see P.L.
111-8). The FY2021 omnibus also retained a change to this provision, first included in the FY2014 omnibus, allowing
tap transfers to be used for the “evaluation and the implementation” of programs funded in the HHS title of the LHHS
appropriations act. Prior to FY2014, such provisions had restricted tap funds to the “evaluation of the implementation”
of programs authorized under the Public Health Service Act.
46 Until FY2015, AHRQ had not received a discretionary appropriation in an annual appropriations act in more than a
decade. FY2009 was the exception to this general pattern, as AHRQ received a supplemental appropriation from the
American Recovery and Reinvestment Act that year. In recent years, AHRQ has also received some transfers from the
Prevention and Public Health Fund and the Patient-Centered Outcomes Research Trust Fund, though these transfers
were generally much smaller than the transfers AHRQ received from the tap. For more information, see CRS Report
R44136, The Agency for Healthcare Research and Quality (AHRQ) Budget: Fact Sheet.
47 Prior to FY2015, NIH had traditionally been by far the largest net donor of tap funds, rather than a net recipient. The
joint explanatory statement accompanying the FY2015 omnibus explained this shift as being intended to ensure that tap
transfers are a “net benefit to NIH rather than a liability” and noted that this change was in response to a growing
concern at the loss of NIH funds to the tap. Joint Explanatory Statement, Proceedings and Debates of the 113th
Congress, Second Session, Congressional Record, vol. 160, no. 151, Book II, December 11, 2014, p. H9832.
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Prevention and Public Health Fund
Display of PPHF Transfers
The ACA both authorized and appropriated
PPHF transfer amounts displayed in the HHS tables in
mandatory funding to three funds to support
this report are in addition to amounts shown for
budget authority provided in the bil . For consistency
programs and activities within the PHS
with source materials, the amounts shown for PPHF
agencies.48 One of these, the Prevention and
transfers in these tables reflect the estimated effects of
Public Health Fund (PPHF, ACA §4002, as
mandatory spending sequestration; this is not the case
amended), was given a permanent, annual
for other mandatory spending shown in this report
appropriation that was intended to provide
(also for consistency with source materials).
support each year to prevention, wellness, and
related public health programs funded through HHS accounts.
The ACA had appropriated $2 billion in mandatory funds to the PPHF for FY2021, but this
amount was reduced by subsequent laws that decreased PPHF funding for FY2021 and other
fiscal years. Under current law, the FY2021 appropriation was $950 million.49 In addition, this
appropriation was subject to a 5.7% reduction due to sequestration of nonexempt mandatory
spending.50 (For more information on sequestration, see the budget enforcement discussion in
Appendix A.) After sequestration, the total PPHF appropriation available for FY2021 was $896
million, an increase of $2 million relative to FY2020. Of this amount, the LHHS omnibus
allocated $856 million to CDC, $12 million to SAMHSA, and $28 million to ACL.51
PPHF funds are intended to supplement (sometimes quite substantially) the funding that selected
programs receive through regular appropriations. Although the PPHF authority instructs the HHS
Secretary to transfer amounts from the fund to HHS agencies, since FY2014 provisions in annual
appropriations acts and accompanying reports have explicitly directed the distribution of PPHF
funds and prohibited the Secretary from making further transfers for those years.52
CDC commonly receives the largest share of annual PPHF funds. The amount provided to CDC
for FY2021 and proposed by the House committee bill, $854 million, was a $2 million (+0.2%)
increase relative to FY2020. The President’s request proposed increasing the PPHF funding
transferred to CDC to $894 million (+4.6%), and providing no mandated transfers to SAMHSA
or ACL.
Selected HHS Highlights by Agency
This section begins with a limited selection of FY2021 discretionary funding highlights by HHS
agency. The discussion is largely based on the enacted and proposed appropriations levels for
FY2021, compared to FY2020 enacted levels.53 These summaries are followed by a brief
overview of significant provisions from annual HHS appropriations laws that restrict spending in
certain controversial areas, such as abortion and stem cell research. The section concludes with

48 For more information, see CRS Report R41301, Appropriations and Fund Transfers in the Affordable Care Act
(ACA).
49 42 U.S.C. §300u-11.
50 OMB Report to the Congress on the Joint Committee Reductions for Fiscal Year 2021, February 10, 2020, p. 7 of 17,
https://www.whitehouse.gov/wp-content/uploads/2020/02/JC-sequestration_report_FY21_2-10-20.pdf.
51 See explanatory statement accompanying the FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional
Record, December 21, 2020, Vol. 166, No. 218, Book IV, p. H8634, for allocations to specific agency programs and
activities.
52 See Division H, §222, P.L. 116-260.
53 HHS budget materials can be found at http://www.hhs.gov/budget/.
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two tables (Table 6 and Table 7) presenting more detailed information on FY2020 enacted and
FY2021 proposed and enacted funding levels for HHS.
HRSA
The FY2021 LHHS omnibus provided $7.2 billion in discretionary budget authority for HRSA.
This was $171 million (+2.4%) more than HRSA’s FY2020 discretionary funding level and $913
million (+14.5%) more than the FY2021 President’s budget request.
Under the Primary Health Care account, the Community Health Centers program received $1.683
billion, an increase of $57 million (+3.5%) relative to FY2020.54 The explanatory statement also
recommended $102.5 million under that same account for the second year of the Ending the HIV
Epidemic Initiative, which is focused on reducing HIV transmission via increased use of pre-
exposure prophylaxis (PrEP) among high risk groups.55 Under the Ryan White HIV/AIDS
Program appropriation, there is an additional $105 million set aside for this HIV initiative, an
increase of $35 million relative to FY2020. The explanatory statement also “encourages the
acceleration of the development of oral, ultra-long-acting, sustained-release therapies” as part of
this initiative.56
The explanatory statement provided $34 million for telehealth within the Rural Health account, a
$5 million (+17.2%) increase relative to FY2020. Within this amount, $6.5 million was provided
for the Telehealth Centers of Excellence (COE) and $1 million was provided for an evaluation of
nationwide telehealth investments in rural areas and populations.57 It also directed HHS and
HRSA to “continue to utilize the expertise of the COEs in the Ending the HIV Epidemic initiative
to develop best practices for utilizing telehealth in HIV prevention, care, and treatment.”
The Maternal and Child Health (MCH) Block Grant received $713 million, an increase of $25
million (+3.6%) relative to FY2020. Related to maternal health, the explanatory statement set
aside $9 million for the Alliance for Maternal Health Safety Bundles, which are “a set of targeted
and evidence-based best practices that, when implemented, improve patient outcomes and reduce
maternal mortality and severe maternal morbidity,”58 and provided $5 million for State Maternal
Health Innovation Grants. Within the Health Workforce account, the explanatory statement
designated $2.5 million for midwife training “to address the national shortage of maternity care
providers and the lack of diversity in the maternity care workforce.”59
CDC
The FY2021 LHHS omnibus provided $7.0 billion in discretionary budget authority for CDC,
which was $123 million (+1.8%) more than CDC’s FY2020 funding level. The FY2021 LHHS
omnibus did not direct any PHS tap funds to the CDC, continuing the practice started in FY2015.

54 The Health Centers program also received significant additional FY2020 and FY2021 funding related to the COVID-
19 pandemic, totaling roughly $2 billion. For a discussion of this funding, see CRS Report R46711, U.S. Public Health
Service: COVID-19 Supplemental Appropriations in the 116th Congress.
55 Congressional Record, December 21, 2020, Vol. 166, No. 218, Book IV, p. H8620. An amount of $50 million was
set aside in FY2020 for the first year of this initiative (see Congressional Record, December 17, 2019, Vol. 165, No.
204, Book III, p. H11063).
56 Ibid, p. H8621.
57 Ibid, p. H8620. See H.Rept. 116-450, pp. 58-59, for further information.
58 Ibid, p. H8620. See H.Rept. 116-450, p. 51, for a description of this activity.
59 Ibid, p. H8620.
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It also did not direct the transfer of funds from the HHS Nonrecurring Expenses Fund (NEF) to
the CDC (unlike FY2020).60 However, the FY2021 LHHS omnibus did supplement discretionary
CDC appropriations by directing $856 million in PPHF transfers to the CDC, which was $2
million (+0.2%) more than FY2020. All told, this combination of funding—compared to FY2020
funding from discretionary appropriations and directed transfers from the PPHF and NEF—
represented a decrease of $100 million (-1.3%) from FY2020 in budget authority that is inclusive
of directed transfers.
The President’s budget request would have increased discretionary budget authority by $54
million (+0.8%) relative to FY2020, while also requesting that $542 million in tap funds be
directed to the CDC. The President’s budget also requested $894 million in PPHF transfers,
which would have been a $40 million (+4.6%) increase. The President’s budget did not request
that any transfers from the NEF be directed to the CDC. All told, this combination of funding
would have represented an increase of $410 million (+5.1%) from FY2020.
All programmatic accounts received increases relative to FY2020 except Public Health
Preparedness and Response and CDC-Wide Activities and Program Support. Among these
increases: (1) the HIV/AIDS, Viral Hepatitis, STI and TB Prevention account, which was funded
at an increased level of $1.3 billion (+3.2% above FY2020) included a $35 million increase for
the Ending HIV/AIDS Initiative;61 and (2) the Emerging and Zoonotic Infectious Diseases
(EZID) account, which was funded at an increased level of $596 million (+4.5% above FY2020),
included $10 million in funding for a new pilot program that would award competitive grants for
the development of Social Determinants of Health Accelerator Plans62. Other increases included
the Environmental Health account, funded at $206 million (+4.6%)63, and the Public Health
Scientific Services account, funded at $592 million (+6.6%).
With regard to the Injury Prevention and Control account, which received $683 million (+0.8%),
the explanatory statement included funding for several line items that were first included in
FY2020, including child sexual abuse prevention ($1.5 million), suicide prevention ($12 million),
and adverse childhood experiences (ACEs, $5 million).64 The explanatory statement also included
specific funding for Firearm Injury and Mortality Prevention Research program ($12.5 million)
and Opioid Overdose Prevention and Surveillance ($476 million).65

60 The NEF was established by the Consolidated Appropriations Act of 2008 to enable the HHS Secretary to repurpose
certain unobligated balances of expired discretionary funds appropriated to HHS from the General Fund (P.L. 110-161,
Division G, Title II, §223). Most accounts in annual appropriations measures receive appropriations from the General
Fund at the U.S. Treasury. This term refers to all federal money not allocated by law to any other fund account, such as
federal trust funds for Medicare. Funds transferred into the NEF are generally available to the Secretary for capital
acquisitions across HHS, including facilities infrastructure and information technology. Until recently, it has not been
common for LHHS appropriations acts to specify that particular projects are to be funded by the NEF, but there have
been a few such cases since FY2017, including in FY2020 where the LHHS omnibus directed $225 million from the
NEF to the CDC Buildings and Facilities account to support infrastructure improvements for the CDC’s Chamblee
Campus (Congressional Record, December 17, 2019, Vol. 165, No. 204, Book III, p. H11065.)
61 Centers for Disease Control and Prevention, “Ending the HIV Epidemic,” https://www.cdc.gov/endhiv/index.html.
62 Congressional Record, December 21, 2020, Vol. 166, No. 218, Book IV, p. H8623. See H.Rept. 116-450, pp. 76-77,
for a description of this activity.
63 This amount does not include the PPHF transfer of $17 million that was directed to the Environmental Health
account each of FY2020 and FY2021.
64 Ibid., p. H8623.
65 Ibid., p. H8623. When taking account of the $12.5 million in NIH funding that was reserved for the same purpose,
the total provided for Firearm Injury and Mortality Prevention Research was $25 million.
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The Infectious Disease Rapid Response Reserve Fund (IDRRRF) within the CDC-Wide
Activities and Program Support account received $10 million in the explanatory statement.66 The
IDRRRF was established in 2018 by P.L. 115-245 and is codified at 42 U.S.C. §247d-4a as an
emergency reserve account. Funds can be made available for infectious disease emergencies as
declared by the HHS Secretary (PHSA §319), or if an infectious disease outbreak has the
potential to affect national security or the health and security of U.S. citizens, as specified. Funds
may be used to carry out activities related to the research, public health prevention, and response
for infectious disease emergencies.
NIH
The FY2021 LHHS omnibus provided $41.4 billion in discretionary budget authority for NIH.
This was $1.2 billion (+3.0%) more than FY2020 and $3.4 billion (+8.8%) more than the
President’s FY2021 budget request.
As was the case in FY2020, the FY2021 LHHS omnibus directed $225 million from the HHS
Nonrecurring Expenses Fund (NEF)67 to the NIH Buildings and Facilities account to implement
the recommendations in the 2019 National Academies of Sciences, Engineering, and Medicine
report Managing the NIH Bethesda Campus’ Capital Assets in a Highly Competitive Global
Biomedical Research Environment.68 In addition, the FY2021 LHHS omnibus directed $1.3
billion in PHS tap transfers to NIH, an increase of $41 million (+3.3%) from FY2020. The
entirety of the PHS tap transfer was provided to the National Institute of General Medical
Sciences (NIGMS), and was paired with a discretionary appropriation of $1.7 billion. The
NIGMS discretionary appropriation was $14 million (+0.8%) more than FY2020, but when
combined with the tap transfer, total funding for NIGMS increased by $54 million (+1.8%) from
FY2020.
In line with recent practice, the explanatory statement on the FY2021 LHHS omnibus directed
NIH to reserve a specific dollar amount for a number of purposes, for example, $3.1 billion for
Alzheimer’s disease research at the National Institute on Aging.69 It also included a reservation of
funds for Firearm Injury and Mortality Prevention Research of $12.5 million, the same amount as
FY2020.70 Reserving a specific dollar amount for a particular disease or area of research at NIH is
a relatively new practice that has expanded since 2015; still, most NIH funding is not designated
for particular diseases or areas of research.71

66 Ibid., p. H8624.
67 The NEF was established by the Consolidated Appropriations Act of 2008 to enable the HHS Secretary to repurpose
certain unobligated balances of expired discretionary funds appropriated to HHS from the General Fund (P.L. 110-161,
Division G, Title II, §223). Most accounts in annual appropriations measures receive appropriations from the General
Fund at the U.S. Treasury. This term refers to all federal money not allocated by law to any other fund account, such as
federal trust funds for Medicare.
68 See Division H, Title II, §238 of P.L. 116-260. For further details, see Congressional Record, December 21, 2020,
Vol. 166, No. 218, Book IV, p. H8629. (See also Congressional Record, December 17, 2019, Vol. 165, No. 204, Book
III, p. H11074.)
69 Ibid., p. H8626. For a list of specified funding levels in the explanatory statement accompanying the LHHS omnibus,
see Table A-2 in CRS Report R43341, National Institutes of Health (NIH) Funding: FY1996-FY2022.
70 Ibid., p. H8627. When taking account of the $12.5 million in CDC funding that was reserved for the same purpose,
the total provided for Firearm Injury and Mortality Prevention Research was $25 million in both FY2020 and FY2021.
71 As recently as December 2014, the explanatory statement on the FY2015 omnibus stipulated, “In keeping with
longstanding practice, the agreement does not recommend a specific amount of NIH funding for this purpose
[Alzheimer’s disease] or for any other individual disease. Doing so would establish a dangerous precedent that could
politicize the NIH peer review system. Nevertheless, in recognition that Alzheimer’s disease poses a serious threat to
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The FY2021 LHHS omnibus appropriated $404 million to the NIH Innovation Account pursuant
to the 21st Century Cures Act (Cures Act; P.L. 114-255), which was equal to the amount
authorized to be appropriated in that act. The explanatory statement also reiterated the purposes
authorized in the Cures Act, directing that NIH transfer $195 million to the National Cancer
Institute to support cancer research, and $50 million each to the National Institute of Neurological
Disorders and Stroke and the National Institute of Mental Health to support the Brain Research
through Advancing Innovative Neurotechnologies (BRAIN) Initiative. The remaining $109
million was for the Precision Medicine Initiative.72
SAMHSA
The FY2021 LHHS omnibus provided $5.9 billion in discretionary budget authority for
SAMHSA. This amount was $133 million (+2.3%) more than SAMHSA’s FY2020 funding level
and $272 million (+4.9%) more than the President’s FY2021 budget request. The FY2021 LHHS
omnibus also directed $134 million in PHS evaluation tap funding and $12 million in PPHF
funding to SAMHSA, which were the same amounts as FY2019 and FY2020.
The additional funding provided to SAMHSA was spread across several programs in the
explanatory statement. The programs within the Mental Health Programs of Regional and
National Significance (PRNS) received an increase of $26 million (+5.9%) and the programs
within the Substance Abuse Treatment PRNS received an increase of $17 million (+3.6%). Nearly
all Mental Health and Substance Abuse Treatment PRNS programs received level funding or
modest increases from FY2020. The largest increase was provided to the Certified Community
Behavioral Health Clinics (CCBHCs)—$50 million (+25.0%) more than FY2020. The
Community Mental Health Block Grant (MHBG) received an increase of $35 million (+5.0%)
while the Substance Abuse Prevention and Treatment Block Grant (SABG) received the same
amount as FY2020. The State Opioid Response (SOR) grant program continued to be funded at
$1.5 billion, the same amount as FY2019 and FY2020.
AHRQ
The FY2021 LHHS omnibus provided $338 million in discretionary budget authority to AHRQ.
This was the same as the FY2020 level. The FY2021 LHHS omnibus did not direct any PHS tap
transfers to AHRQ, which is in keeping with practices since FY2015 but contrasts with earlier
years (FY2003-FY2014) in which AHRQ had been funded primarily with tap transfers.73 (The
House bill proposed $200 million in tap transfers for AHRQ, but this proposal was not enacted.)
The FY2021 LHHS omnibus continued to fund AHRQ as its own operating division, declining
the President’s proposal to consolidate AHRQ into NIH. The FY2021 President’s budget had

the Nation’s long-term health and economic stability, the agreement expects that a significant portion of the
recommended increase for NIA should be directed to research on Alzheimer’s. The exact amount should be determined
by scientific opportunity of additional research on this disease and the quality of grant applications that are submitted
for Alzheimer’s relative to those submitted for other diseases.” See Congressional Record, daily edition, vol. 160, no.
151, Book II (December 11, 2014), p. H9832.
72 Congressional Record, December 21, 2020, Vol. 166, No. 218, Book IV, p. H8624.
73 In addition to funds provided through the annual appropriations process, AHRQ is also scheduled in FY2021 to
receive a transfer of certain mandatory funds that were authorized and appropriated to the Patient-Centered Outcomes
Research Trust Fund (PCORTF) by ACA Section 6301(e), as amended (26 U.S.C. §9511). Transfers to AHRQ from
the PCORTF are to be used to disseminate the results of patient-centered outcomes research. (PCORTF funds are
generally not displayed in this report, as they are not provided by or modified through annual LHHS appropriations
bills.) For more information on the PCORTF, see HHS, Office of the Assistant Secretary for Planning and Evaluation,
Patient-Centered Outcomes Research Trust Fund, https://aspe.hhs.gov/patient-centered-outcomes-research-trust-fund.
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requested zero funding for AHRQ, proposing instead to continue funding many of AHRQ’s
activities through a new National Institute for Research on Safety and Quality (NIRSQ) in the
NIH.74
CMS
The FY2021 LHHS omnibus provided $4.5 billion in discretionary budget authority for CMS.
This was $21 million (+0.5%) more than FY2020 and $30 million (-0.7%) less than the FY2021
President’s budget request. The LHHS omnibus appropriated $807 million for the CMS Health
Care Fraud and Abuse Control (HCFAC) account, 2.7% more than FY2020, and less (-0.7%) than
the FY2021 President’s request. Of the total amount appropriated for HCFAC, $496 million was
effectively exempt from the discretionary budget caps. (See Appendix A for an explanation of
the LHHS budget cap exemptions.)
The LHHS omnibus provided the CMS Program Management account with $3.7 billion, which
was the same amount provided in FY2020 and FY2019. This account supports CMS program
operations (e.g., claims processing, information technology investments, provider and beneficiary
outreach and education, and program implementation), in addition to federal administration and
other activities related to the administration of Medicare, Medicaid, the State Children’s Health
Insurance Program, and private health insurance provisions established by the ACA. The FY2021
appropriation was less than the amount proposed by the President’s budget (-0.6%) and the House
committee bill (-7.9%). The LHHS omnibus maintained a general provision (§227), included in
LHHS appropriations acts since FY2014, authorizing HHS to transfer additional funds into this
account from Medicare trust funds. The terms of the provision required that such funds be used to
support activities specific to the Medicare program, limited the amount of the transfers to $305
million, and explicitly prohibited such transfers from being used to support or supplant funding
for ACA implementation. The House committee bill would have eliminated this provision.
ACF
The FY2021 LHHS omnibus provided $24.7 billion in discretionary budget authority for ACF.
This was $251 million (+1.0%) more than FY2020 and $4.5 billion (+22.3%) more than the
FY2020 President’s budget request. The President’s budget would have decreased ACF
discretionary funding by almost one-fifth relative to the prior year (-17.4%). The President’s
budget would have achieved much of its proposed reduction by eliminating certain programs
within ACF, such as the Low Income Home Energy Assistance Program (LIHEAP), Preschool
Development Grants (PDG), and the Community Services Block Grant (CSBG). Funding for all
three of these programs was sustained or increased in the FY2021 LHHS omnibus relative to
FY2020: LIHEAP received $3.8 billion (+0.3%), PDG $275 million (+0.0%), and CSBG $745
million (+0.7%).

74 HHS, NIH, National Institute for Research on Safety and Quality, FY2021 Congressional Justification,
https://www.ahrq.gov/sites/default/files/wysiwyg/cpi/about/mission/budget/2021/FY_2021_CJ_NIRSQ.pdf. The
President’s request would have funded NIRSQ at $257 million for FY2021 (not counting transfers from the PCORTF).
A similar proposal was made in the President’s FY2020, FY2019, and FY2018 requests; see HHS, NIH, National
Institute for Research on Safety and Quality, FY2021 Congressional Justification, https://www.ahrq.gov/sites/default/
files/wysiwyg/cpi/about/mission/budget/2020/FY_2020_CJ_-NIRSQ.pdf; HHS, NIH, National Institute for Research
on Safety and Quality, FY2019 Congressional Justification, https://www.ahrq.gov/sites/default/files/wysiwyg/cpi/
about/mission/budget/2019/NIRSQ.pdf; HHS, NIH, National Institute for Research on Safety and Quality, FY 2018
Congressional Justification, https://www.ahrq.gov/sites/default/files/wysiwyg/cpi/about/mission/budget/2018/
NIRSQ.pdf.
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The LHHS omnibus provided $1.9 billion for the Refugee and Entrant Assistance programs
account, an increase of $2 million (+0.1%) relative to FY2020. The LHHS omnibus retained a
provision, included in LHHS appropriations since FY2015, authorizing HHS to augment
appropriations for the Refugee and Entrant Assistance account via transfers from other
discretionary HHS funds. The 15% limit on those transfers was the same as FY2020.
The conference report on the omnibus directed the majority of the appropriation for Refugee and
Entrant Assistance programs toward the Unaccompanied Alien Children (UAC) program ($1.3
billion, the same as FY2020 and FY2019). The UAC program provides for the shelter, care, and
placement of unaccompanied alien children who have been apprehended in the United States. The
LHHS omnibus also included several general provisions that were enacted in FY2020 related to
the UAC program. For instance, the law authorized HHS to accept donations for the care of UAC
arrivals (§230), limited the use of funds for changes to policy directives related to the UAC
program (§231), limited the use of funds for unlicensed facilities for unaccompanied alien
children (§232), and imposed additional congressional notification requirements prior to the use
of unlicensed facilities (§233). It also prohibited HHS appropriations from being used to prevent
a Member of Congress from visiting a UAC facility for oversight purposes provided that the
Office of Refugee Resettlement (ORR) was notified not less than two business days in advance to
ensure that such visit would not interfere with the operations (including child welfare and child
safety operations) of such facility (§234). A number of reporting requirements related to the UAC
program were also included in or carried by reference in the explanatory statement, such as a
monthly report to the appropriations committees that includes estimates of UAC arrivals and any
changes in funding needs as a result of these arrivals, public reporting with respect to children
who have been separated from a parent or legal guardian, a report to the appropriations
committees related to provider facility violations related to standards of child care or the
wellbeing of children, and a semiannual report related to number of children in ORR custody in
residential treatment centers.75
ACL
The FY2021 LHHS omnibus provided $2.3 billion in discretionary budget authority for ACL.
This was $35 million (+1.6%) more than FY2020. In addition, the FY2021 LHHS omnibus
directed $28 million in PPHF transfers to ACL, the same as FY2020. The explanatory statement
accompanying the FY2021 LHHS omnibus specified that the PPHF transfers were for the
Alzheimer’s Disease Program, Chronic Disease Self-Management, and Elder Falls Prevention.
The FY2021 LHHS omnibus did not adopt several ACL proposals made in the President’s budget
submission. These included proposals to consolidate Chronic Disease Self-Management and
Elder Falls Prevention into the Preventive Health Services Program, and to allow states and tribal
organizations to transfer 100% of funds among the home and community-based supportive
services, nutrition, disease prevention and health promotion, and family caregiver support
programs.76

75 Congressional Record, vol. 165, no. 204, December 17, 2019, pp. H11077-H11078. The explanatory statement
included language related to the UACs that noted “The agreement notes that the front matter of this explanatory
statement establishes that language included in House Report 116–450 should be complied with unless specifically
addressed to the contrary in this explanatory statement. In cases where the House Report addresses an issue not
addressed in this joint explanatory statement, the House Report language is deemed to carry the same emphasis as
language included in this explanatory statement.” See H.Rept. 116-450, pp. 177-188 for UAC-related language.
76 Budget of the United States Government, Fiscal Year 2021, Appendix, p. 502, https://www.govinfo.gov/content/pkg/
BUDGET-2021-APP/pdf/BUDGET-2021-APP.pdf#page=506. A similar proposal was made in the President’s FY2020
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Restrictions Related to Certain Controversial Issues
Annual LHHS appropriations measures regularly contain broad restrictions related to certain
controversial issues. For instance, annual LHHS appropriations acts commonly include provisions
limiting the use of federal funds for abortions, the use of human embryos for research, needle
exchange programs, and gun control advocacy.
Abortions: Since FY1977, annual LHHS appropriations acts have included provisions limiting
the circumstances under which LHHS funds (including Medicaid funds) may be used to pay for
abortions. Early versions of these provisions applied only to HHS, but since FY1994 most
provisions have applied to the entire LHHS bill. Under current provisions, (1) abortions may be
funded only when the life of the mother is endangered or in cases of rape or incest; (2) funds may
not be used to buy a managed care package that includes abortion coverage, except in cases of
rape, incest, or endangerment; and (3) federal programs and state and local governments that
receive LHHS funding are prohibited from discriminating against health care entities that do not
provide or pay for abortions or abortion services. The FY2021 LHHS omnibus retained these
existing restrictions (§§506 and 507).77
Human Embryo Research: Since FY1996, annual LHHS appropriations have included a
provision prohibiting any LHHS funds (including NIH funds) from being used to create human
embryos for research purposes or for research in which human embryos are destroyed. The
FY2021 LHHS omnibus retained these existing restrictions (§508).78
Needle Exchange Programs: Since FY1990, annual LHHS appropriations have generally
included a provision prohibiting any LHHS funds from being used for needle exchange programs
(i.e., programs in which sterile needles or syringes are made available to injection drug users in
exchange for used needles or syringes to mitigate the spread of related infections, such as
Hepatitis and HIV/AIDS).79 Starting in FY2016, the provision was modified to allow funds to be
used for needle exchange programs under the following conditions: (1) federal funds may not be
used to purchase the needles, but may be used for other aspects of such programs; (2) the state or
local jurisdiction must demonstrate, in consultation with CDC, that they are experiencing, or at
risk for, a significant increase in hepatitis infections or an HIV outbreak due to injection drug use;
and (3) the program must be operating in accordance with state and local law. The FY2021 House

and FY2019 requests; see, Budget of the United States Government, Fiscal Year 2020, Appendix, p. 488,
https://www.govinfo.gov/content/pkg/BUDGET-2020-APP/pdf/BUDGET-2020-APP-1-11.pdf#page=72; and Budget
of the United States Government, Fiscal Year 2019, Appendix, p. 484, https://www.govinfo.gov/content/pkg/BUDGET-
2019-APP/pdf/BUDGET-2019-APP-1-11.pdf#page=70. During the COVID-19 public health emergency, state and
local agencies on aging have increased flexibility to transfer funds among certain programs; see the discussion of
Section 3222 in CRS Report R46334, Selected Health Provisions in Title III of the CARES Act (P.L. 116-136).
Furthermore, P.L. 116-260, Division N, Section 732 provides that of the home-delivered and congregate nutrition
services program funds that they receive in FY2021, state and local agencies on aging may transfer up to 100% of the
funds between the two programs without prior approval.
77 The current provisions are commonly referred to as the Hyde and Weldon Amendments. For additional information,
see CRS Report RL33467, Abortion: Judicial History and Legislative Response.
78 The current provision is commonly referred to as the Dickey Amendment. For additional information, see CRS
Report RL33540, Stem Cell Research: Science, Federal Research Funding, and Regulatory Oversight.
79 The one exception is the FY1992 LHHS appropriations act (P.L. 102-170), which appears to have included no such
provision. Since the provision’s inception in FY1990, there has been variation in its scope and application during
certain fiscal years. For example, the LHHS appropriations act for FY1998 (P.L. 105-78) made the ban subject to
action by the HHS Secretary. The LHHS appropriations acts for FY2010 (P.L. 111-117, Division D) and FY2011 (P.L.
112-10, Division B) applied the ban only in locations that local authorities determined to be inappropriate.
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committee bill would have omitted this provision entirely, but the FY2021 LHHS omnibus
retained these existing restrictions and conditions (§527).
Gun Control: Since FY1997, annual LHHS appropriations have included provisions prohibiting
the use of certain funds for activities that advocate or promote gun control. Early versions of
these provisions applied only to CDC; since FY2012, annual appropriations acts also have
included HHS-specific restrictions, in addition to restrictions that apply to all LHHS funds
(including funds transferred from the PPHF). FY2021 omnibus retained these existing restrictions
(§210 [HHS] and §503(c) [all LHHS, plus PPHF transfers]).80
Table 6. HHS Appropriations Totals by Agency
(In millions of dollars)
FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L. 116-
HHS Agency
Enacted
Request
7614)
260)
HRSA
7,333
6,571
7,472
7,484
Mandatory BA
286
266
266
266
Discretionary BA
7,047
6,305
7,206
7,218
Evaluation Tap Fundinga
0
13
0
0
CDCb
6,895
6,949
7,126
7,019
Mandatory BA
55
55
55
55
Discretionary BA
6,840
6,894
7,070
6,963
Evaluation Tap Fundinga
0
542
0
0
PPHFc
854
894
856
856
Nonrecurring Expenses Fund Transferd
225
0
0
0
NIHb
40,228
38,070
40,618
41,437
Mandatory BA
0
0
0
0
Discretionary BA
40,228
38,070
40,618
41,437
Evaluation Tap Fundinga
1,231
741
1,341
1,272
Nonrecurring Expenses Fund Transferd
225
0
0
225
SAMHSA
5,737
5,598
5,833
5,870
Mandatory BA
0
0
0
0
Discretionary BA
5,737
5,598
5,833
5,870
Evaluation Tap Fundinga
134
143
134
134
PPHFc
12
0
12
12
AHRQe
338
0
143
338

80 As previously noted, the explanatory statement accompanying the FY2021 LHHS omnibus directed that $12.5
million apiece ($25 million total) be allocated by the CDC and NIH for Firearm Injury and Mortality Prevention
Research (Congressional Record, December 21, 2020, Vol. 166, No. 218, Book IV, pp. H8623 and H8627.). These
CDC and NIH funding reservations for Firearm Injury and Mortality Prevention were first included in LHHS
explanatory statements in FY2020.
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FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L. 116-
HHS Agency
Enacted
Request
7614)
260)
Mandatory BA
0
0
0
0
Discretionary BA
338
0
143
338
Evaluation Tap Fundinga
0
0
200
0
CMS
828,343
906,657
906,942
906,627
Mandatory BA
823,888
902,150
902,150
902,150
Discretionary BA
4,456
4,507
4,792
4,477
ACF
39,523
34,994
41,256
41,190
Mandatory BA
15,079
14,796
16,496
16,496
Discretionary BA
24,444
20,198
24,760
24,695
ACL
2,223
2,108
2,280
2,258
Mandatory BA
0
0
0
0
Discretionary BA
2,223
2,108
2,280
2,258
PPHFc
28
0
28
28
Office of the Secretary (OS)
4,212
4,009
4,309
4,359
Mandatory BA
624
653
653
653
Discretionary BA
3,588
3,356
3,656
3,706
Evaluation Tap Fundinga
65
74
65
65
Total, HHS BA in the Bill
934,832 1,004,955
1,015,978
1,016,583
Mandatory
839,931
917,920
919,620
919,620
Discretionary
94,901
87,036
96,358
96,963
Emergency Funding (not included in above totals)

1st COVID (P.L. 116-123)
6.4
—
—
—
2nd COVID (P.L. 116-127)
1.3
—
—
—
3rd COVID (P.L. 116-136)
140.4
—
—
—
4th COVID (P.L. 116-139)
100.0
—
—
—
Emergency Funding in Annual LHHSf
—
—
18.5
0.6
5th COVID (Division M, P.L. 116-260)
—
—
—
72.9
Afghan special immigrants (P.L. 117-31)
-
-
-
0.0g
Memoranda (non-emergency funds only)

Total, BA Available in Fiscal Year (current year
932,661
996,126
1,007,149
1,007,753
from any bil )
Total, BA Advances for Future Years (provided in
144,303
153,132
153,132
153,132
current bil )
Total, BA Advances from Prior Years (for use in
142,132
144,303
144,303
144,303
current year)
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Labor, Health and Human Services, and Education: FY2021 Appropriations

FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L. 116-
HHS Agency
Enacted
Request
7614)
260)
Total, Additional Scorekeeping Adjustments
-9,420
-9,163
-12,124
-21,068
Sources: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are
generally drawn from or calculated based on data contained in the explanatory statement accompanying the
FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December
21, 2020, pp. H8619-H8711. (The amount for P.L. 117-31 is from CBO, Discretionary Spending: Senate Amendment
2123, July 29, 2021, https://www.cbo.gov/system/files/2021-07/
EmergencySecuritySupplementalAppropriationsAct2021.pdf.) Amounts in the FY2021 House Committee column
are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-450)
accompanying H.R. 7614. Enacted totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated
appropriations provided in P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House
committee bil totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations
proposed in Title VI of H.R. 7614. Enacted totals (“Total BA in the Bil ”) for FY2021 do not include emergency-
designated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with
source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where
applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS
calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L.
114-255), as amended.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bil , regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bil ); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees (e.g., department totals do not include funding for the Food and Drug Administration,
the Indian Health Service, or the Agency for Toxic Substances and Disease Registry, all of which are funded by
other bil s); and (4) do not include appropriations that occur outside of appropriations bil s.
a. By convention, this table shows only the amount of PHS Evaluation Tap funds received by an agency, not the
amount of tap funds donated by an agency. That is to say, tap amounts shown in this table are in addition to
amounts shown for budget authority, but the amounts shown for budget authority have not been adjusted
to reflect potential “transfer-out” of funds to the tap.
b. Each year, CDC and NIH also receive funding in the Interior-Environment appropriations bil as part of their
overall budget authority.
c. PPHF funds are not appropriated in the LHHS bil , but are shown here for il ustrative purposes as they may
be used to supplement the funding selected agencies and programs receive through the appropriations
process. Amounts shown for PPHF in this table are in addition to amounts shown for budget authority.
d. The Nonrecurring Expenses Fund (NEF) was established by the Consolidated Appropriations Act of 2008,
to enable the HHS Secretary to repurpose certain unobligated balances of expired discretionary funds
appropriated to HHS from the General Fund. The FY2020 omnibus specified that HHS must transfer $225
mil ion apiece from the NEF to the buildings and facilities accounts at CDC and NIH. The FY2021 omnibus
specified that HHS must transfer $225 mil ion to the building and facilities account at NIH. Amounts shown
for the NEF transfer are in addition to amounts shown for budget authority.
e. The President’s budget for FY2020 proposed that AHRQ be eliminated, and that certain functions be
transferred to NIH. This proposal was not adopted by the House or the Senate version of the LHHS bil , or
included in FY2020 enacted appropriations.
f.
The FY2021 House committee bil included a total of $19.4 bil ion in emergency-designated budget
authority in Title VI, of which $18.5 bil ion was for HHS. Subsequently, Division H of P.L. 116-260 enacted
$1.6 bil ion in emergency-designated budget authority, of which $638 mil ion was for HHS in Title II.
g. P.L. 117-31 provided $25 mil ion in supplemental appropriations for the Refugee and Entrant Assistance
account at HHS for specified purposes related to Afghan special immigrants, which rounds to $0.0 in bil ions
(the unit of measure used in this table).
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Table 7. HHS Discretionary Appropriations for Selected
Programs or Activities, by Agency
(In millions of dollars)
FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L. 116-
Agency or Selected Program
Enacted
Request
7614)
260)
HRSA

Community Health Centers
1,626
1,728
1,651
1,683
National Health Service Corps
120
120
120
120
Children’s Hospitals Graduate Medical Education
340
0
340
350
Maternal & Child Health Block Grant
688
761
713
713
Autism and Other Developmental Disorders
52
0
53
53
Healthy Start
126
126
131
128
Ryan White AIDS Programs
2,389
2,484
2,414
2,424
Organ Transplantation
28
17
33
29
Telehealth
29
29
42
34
Rural Communities Opioid Response
110
110
110
110
Family Planning (Title X)
286
286
286
286
CDC

Immunization and Respiratory Diseases
433
577
470
449
PPHFa
370
303
370
372
HIV/AIDS, Viral Hepatitis, STDs, TB Prevention
1,274
1,553
1,288
1,314
Emerging and Zoonotic Infectious Diseases
570
599
594
596
Chronic Disease Prevention and Health Promotion
985
962
1,050
1,022
PPHFa
255
454
257
255
Birth Defects and Developmental Disabilities
161
112
163
168
Public Health Scientific Services
555
115
593
592
Environmental Health
197
182
220
206
PPHFa
17
0
17
17
Injury Prevention and Control
677
730
695
683
National Institute for Occupational Safety and
343
111
345
345
Health
Evaluation Tap Fundingb
0
79
0
0
Global Health
571
621
573
593
Buildings and Facilities
25
30
30
30
Nonrecurring Expenses Fund Transferc
225
0
0
0
NIH

National Institute of Allergy and Infectious Diseases
5,885
5,885
6,013
6,070
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FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L. 116-
Agency or Selected Program
Enacted
Request
7614)
260)
National Institute of General Medical Sciences
1,706
1,931
1,631
1,720
Evaluation Tap Funding
1,231
741
1,341
1,272
National Institute on Aging
3,544
3,226
3,609
3,899
National Institute on Drug Abuse
1,462
1,432
1,475
1,480
NIH Innovation Accountd
492
404
404
404
SAMHSA

Mental Health Programs of Regional & National
449
441
469
475
Significance (PRNS)
PPHF
12
0
12
12
Mental Health Block Grant
702
737
737
737
Evaluation Tap Fundingb
21
21
21
21
Certified Community Behavioral Health Clinics
200
225
225
250
Children’s Mental Health
125
125
125
125
Substance Abuse Treatment PRNS
478
365
488
495
Evaluation Tap Fundingb
79
79
79
79
Substance Abuse Block Grant
1,779
1,779
1,779
1,779
Evaluation Tap Fundingb
79
79
79
79
State Opioid Response Grants
1,500
1,585
1,500
1,500
Substance Abuse Prevention PRNS
206
97
209
208
Health Surveillance and Support
129
97
129
129
Evaluation Tap Fundingb
31
42
31
31
AHRQe

Research on Health Costs, Quality, and Outcomes
197
0
0
197
Evaluation Tap Fundingb
0
0
200
0
Medical Expenditure Surveys
70
0
72
70
Program Support
71
0
71
71
CMS

CMS Program Management
3,670
3,694
3,985
3,670
Health Care Fraud and Abuse Control
786
813
807
807
ACF

Low Income Home Energy Assistance Program
3,740
0
3,765
3,750
Formula Grants
Refugee and Entrant Assistance Programs
1,908
2,456
1,911
1,910
Child Care and Development Block Grant
5,826
5,826
5,926
5,911
Head Start
10,613
10,613
10,763
10,748
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FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L. 116-
Agency or Selected Program
Enacted
Request
7614)
260)
Preschool Development Grants
275
0
300
275
Child Welfare Services
269
269
269
269
Adoption Opportunities
42
42
42
44
Community Services Block Grant
740
0
750
745
ACL

Home & Community-Based Supportive Services
390
390
400
393
Family Caregiver Support Services
186
151
194
189
Nutrition Services Programs
937
937
957
952
Alzheimer’s Disease Demonstrations
12
27
12
13
PPHFa
15
0
15
15
State Health Insurance Program (SHIP)
52
36
54
52
Paralysis Resource Center
10
10
10
10
Limb Loss Resource Center
4
4
4
4
Developmental Disabilities Programs
180
136
184
183
WIOA Activities (transferred from ED)
265
236
265
267
Office of the Secretary

Office of Nat'l Coord. for Health Information
60
51
60
62
Technology
Office of the Inspector General
80
90
80
80
Public Health and Social Services Emergency Fund
2,737
2,641
2,827
2,847
Sources: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are
generally drawn from or calculated based on data contained in the explanatory statement accompanying the
FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December
21, 2020, pp. H8619-H8711. Amounts in the FY2021 House Committee column are generally drawn from or
calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated appropriations provided in P.L.
116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bil totals (“Total BA in the
Bil ”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations provided in
Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure
generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or
reprogramming of funds pursuant to executive authorities. CRS calculations do, however, include LHHS funding
provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255), as amended.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bil , regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bil ); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees (e.g., department totals do not include funding for the Food and Drug Administration,
the Indian Health Service, or the Agency for Toxic Substances and Disease Registry, all of which are funded by
other bil s); and (4) do not include appropriations that occur outside of appropriations bil s.
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a. PPHF funds are not appropriated in the LHHS bil , but are shown here for il ustrative purposes as they may
be used to supplement the funding selected agencies and programs receive through the appropriations
process. Amounts shown for PPHF in this table are in addition to amounts shown for budget authority.
b. By convention, this table shows the amount of PHS Evaluation Tap funds received by an agency for a
particular program or activity separately from the budget authority appropriated for that program or
activity. Tap amounts are in addition to amounts shown for budget authority, though the amounts shown for
budget authority have not been adjusted to reflect potential “transfer-out” of funds to the tap.
c. The NEF was established by the Consolidated Appropriations Act of 2008, to enable the HHS Secretary to
repurpose certain unobligated balances of expired discretionary funds appropriated to HHS from the
General Fund. The FY2020 omnibus required that HHS transfer $225 mil ion apiece from the NEF to the
buildings and facilities accounts at CDC and NIH. The FY2021 omnibus required that $225 mil ion be
transferred to NIH. Amounts shown for the NEF transfer are in addition to amounts shown for budget
authority.
d. The Cures Act created the NIH Innovation Account and specified that funds in the account must be
appropriated in order to be available for expenditure. In keeping with the purposes and amounts authorized
in the Cures Act, for FY2021, the FY2021 LHHS explanatory statement directed that NIH transfer $195
mil ion to the National Cancer Institute to support cancer research, and $50 mil ion each to the National
Institute of Neurological Disorders and Stroke and the National Institute of Mental Health to support the
Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative. The remaining $109
mil ion was for the Precision Medicine Initiative.
e. The President’s budget for FY2021 proposed that AHRQ be eliminated, and that certain functions be
transferred to NIH. This proposal was not adopted by the House or the Senate version of the LHHS bil , or
included in FY2021 enacted appropriations.
Department of Education (ED)
Note that amounts in this section are based on regular LHHS appropriations only. They do not
include mandatory funds provided outside of the annual appropriations process (e.g., direct
appropriations for the Federal Direct Student Loan program and the mandatory portion of the
Federal Pell Grant program). Amounts are rounded to the nearest million or billion (as labeled).
The dollar and percentage changes discussed are based on unrounded amounts. For consistency
with source materials, amounts do not reflect sequestration or reestimates of mandatory spending
programs, where applicable.
About ED
Federal policymakers established the U.S. Department of Education in 1980.81 Its mission is to
“promote student achievement and preparation for global competitiveness by fostering
educational excellence and ensuring equal access.”82 Typically, about three-quarters of ED’s
discretionary appropriations go either to local educational agencies—which primarily use the
funds to provide educational and related services for economically disadvantaged students and
students with disabilities—or to low-income postsecondary students in the form of Pell Grants,
which help pay for college. The remainder of ED’s discretionary budget provides for a wide
range of activities, including (but not limited to) support for minority-serving institutions;
educational research; and career, technical, and adult education.

81 ED in its current incarnation became a department in 1980 pursuant to the Department of Education Organization
Act (enacted on October 17, 1979). However, the department dates its origins to 1867. See U.S. Department of
Education, “About ED: The Federal Role in Education,” http://www2.ed.gov/about/overview/fed/role.html.
82 U.S. Department of Education, “About ED,” http://www2.ed.gov/about/landing.jhtml, accessed on June 9, 2021.
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The federal government provides roughly 7% of overall funding for elementary and secondary
education in the United States.83 The majority of school funding—about 84%—comes from states
and local districts, which have primary responsibility for the provision of elementary and
secondary education. With regard to higher education, the federal government provided roughly
59% of undergraduate and graduate student aid in academic year (AY) 2019-2020.84
FY2021 ED Appropriations Overview
Table 8 displays FY2021 discretionary and mandatory ED budget authority provided and
proposed, along with FY2020 enacted levels. The totals in this table do not include emergency
supplemental appropriations; amounts provided in supplementals are displayed separately at the
bottom of the table and are in addition to regular appropriations. For a discussion of the FY2021
supplemental appropriations in Division M of P.L. 116-260 and P.L. 117-31, see Appendix C.
Discretionary funds represent the majority of ED’s annual appropriations, accounting for roughly
95% of the FY2020 and FY2021 enacted levels.85 The FY2021 enacted discretionary ED
appropriations were 1.1% higher than FY2020 levels. Proposed discretionary ED appropriations
for FY2021 compared to FY2020 would have decreased under the President’s budget (-8.5%) and
increased under the House committee bill (+1.0%).
Table 8. ED Appropriations Overview
(In billions of dollars)
FY2021
FY2021
House
Enacted
Cmte.
(P.L.
FY2020
FY2021
(H.R.
116-
Funding
Enacted
Request
7614)
260)
Discretionary
72.8
66.6
73.5
73.5
Mandatory
3.6
3.7
3.7
3.7
Total BA in the Bill
76.4
70.2
77.1
77.2
Emergency Funding (not included in above totals)

3rd COVID (P.L. 116-136)
30.9
—
—
—
5th COVID (Division M, P.L. 116-260)
—
—
—
82.0
Sources: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are
generally drawn from or calculated based on data contained in the explanatory statement accompanying the
FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December
21, 2020, pp. H8619-H8711. Amounts in the FY2021 House Committee column are generally drawn from or
calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated appropriations provided in P.L.

83 U.S. Department of Education, “The FY 2021 Education Budget Summary,” ”Appendix: Total Expenditures for
Elementary and Secondary Education in the U.S.,” at https://www2.ed.gov/about/overview/budget/budget21/summary/
21summary.pdf.
84 For the purposes of this calculation, the federal contribution included $143 billion (grants, loans, work-study, and tax
benefits) out of a total of $242 billion (federal aid, state aid, institutional grants, and private and employer-provided
grants). See the College Board’s Trends in College Pricing and Student Aid 2020, p. 30,
https://research.collegeboard.org/pdf/trends-college-pricing-student-aid-2020.pdf.
85 The only mandatory ED funding provided in the LHHS Appropriations Act in each of these years is for Vocational
Rehabilitation State Grants. This excludes any rescissions of mandatory appropriations that are used in the
appropriations process.
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116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bil totals (“Total BA in the
Bil ”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations provided in
Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure
generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or
reprogramming of funds pursuant to executive authorities.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bil , regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bil ); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bil s.
Selected ED Highlights
The following sections highlight FY2021 appropriations for selected ED accounts and
programs.86 Table 9 tracks funding levels for major ED budget and appropriations accounts, and
selected items within those accounts.
Education for the Disadvantaged
The Education for the Disadvantaged account is the largest account related to elementary and
secondary education and the third largest overall within ED based on funding provided through
the annual appropriations process. Within the account, a majority of funds are appropriated for
Grants to Local Educational Agencies, authorized under Title I-A of the Elementary and
Secondary Education Act (ESEA), as amended by the Every Student Succeeds Act (ESSA; P.L.
114-95). Title I-A grants provide supplementary educational and related services to low-achieving
and other students attending elementary and secondary schools with relatively high
concentrations of students from low-income families, as well as eligible students who live in the
areas served by these public schools but attend private schools.87
The enacted FY2021 appropriation for Title I-A grants was $16.5 billion, compared to an FY2020
appropriation level of $16.3 billion (+1.4%). The House committee bill had recommended a
funding level of $16.6 billion for the program. President Trump’s FY2021 budget requested no
new funding for the Education for the Disadvantaged account, but proposed to consolidate the
Title I-A program, along with 28 other competitive and formula grant programs,88 into a single
Elementary and Secondary Education for the Disadvantaged Block Grant under a new
“Improving Elementary and Secondary Education” account. Under the proposal, block grants
would have been allocated to state educational agencies and local educational agencies by
formula and could have been used for any purpose of the consolidated programs.89

86 ED budget materials can be found at https://www2.ed.gov/about/overview/focus/performance.html.
87 Although Title I-A funds are used to serve eligible private school students, funds remain under the control of public
school authorities (i.e., they are not transferred to private schools).
88 ED budget materials propose $19.3 billion in new budget authority for this block grant (including $6.8 billion to
become available in FY2021 and an advance appropriation of $12.5 billion to become available in FY2022. For a full
list of programs that would be combined into a single block grant under the proposal, see Budget of the United States
Government, Fiscal Year, 2021, Major Savings and Reforms, p. 20, https://www.govinfo.gov/content/pkg/BUDGET-
2021-MSV/pdf/BUDGET-2021-MSV.pdf.
89 For more information about the legislative proposal, see U.S. Department of Education, “Improving Elementary and
Secondary Education,” Justification of Appropriation Estimates to the Congress: Fiscal Year 2021,
https://www2.ed.gov/about/overview/budget/budget21/justifications/a-iese.pdf.
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Student Financial Assistance
The Pell Grant program within the Student Financial Assistance account provides need-based
financial aid primarily to low-income undergraduate students to help them cover the cost of
higher education.90 Pell Grants are the largest single source of federal grant aid for undergraduate
students; ED projected that they would provide approximately $30.3 billion in aid to roughly 7.1
million undergraduate students in FY2021.91 The explanatory statement accompanying the
FY2021 LHHS Omnibus directed $22.5 billion in discretionary funding to the Pell Grant
program, which was level funding compared to FY2020. (Additional mandatory funding for the
program is appropriated outside the LHHS bill.) The President’s budget and the House committee
bill both proposed level discretionary funding, as well.
The total maximum Pell Grant award is the sum of the discretionary maximum award level and
the mandatory add-on award level. The discretionary award program costs may be funded
through (1) annual discretionary appropriations; (2) a permanent, definite mandatory
appropriation; and (3) the Pell Grant program surplus.92 The mandatory add-on award program
costs are funded by a permanent, indefinite mandatory appropriation. Both mandatory
appropriation sources are provided outside the annual appropriations process, are authorized by
and funded in the Higher Education Act of 1965 (HEA), as amended, and do not appear in Table
9.
The FY2021 LHHS omnibus increased the discretionary maximum Pell Grant award level to
$5,435, which is $150 (+2.8%) more than the FY2020 level. The House committee bill
recommended the same amount. The President’s budget requested the same discretionary
maximum Pell Grant award level as in FY2020.
As a result of Pell Grant award rules established in the HEA, the increase in the discretionary
maximum Pell Grant award level increases FY2021 program costs, assuming no other changes. In
order to pay for the estimated increase in FY2021 mandatory add-on award program costs, the
FY2021 LHHS omnibus rescinded $28 million of the FY2021 definite mandatory appropriation.93
The House committee bill would have reduced the FY2020 definite mandatory appropriation by
the same amount.
The FY2021 LHHS omnibus implemented another provision related to the Pell Grant program
surplus: it rescinded $500 million of the surplus, which offset the cost of appropriations in the
act.94

90 For more information about the program, see CRS Report R45418, Federal Pell Grant Program of the Higher
Education Act: Primer.
91 U.S. Department of Education, “Student Aid Overview,” Justification of Appropriation Estimates to the Congress:
Fiscal Year 2021, pp. O-6–O-7, https://www2.ed.gov/about/overview/budget/budget21/justifications/o-sao.pdf.
92 Because discretionary funds and the base award are appropriated in advance of the award year, they are based on cost
estimates. This can result in surpluses (or shortfalls) in discretionary appropriations. When annual discretionary funding
available exceeds annual discretionary program costs, the Pell Grant program is able to accumulate a surplus that
remains available to fund discretionary award program costs in subsequent years. The Congressional Budget Office
(CBO) has estimated a surplus of $12.5 billion at the start of FY2021. See Congressional Budget Office, Pell Grant
Program—CBO’s February 2021 Baseline, p. 2, https://www.cbo.gov/system/files/2021-02/51304-2021-02-
pellgrant.pdf.
93 P.L. 116-260, Division H, §309.
94 P.L. 116-260, Division H, §308.
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Table 9. Detailed ED Appropriations
(In millions of dollars)
FY2021
FY2021
House
Enacted
FY2020
FY2021
Cmte.
(P.L. 116-
Account and Selected Program
Enacted
Request
(H.R. 7614)
260)
Education for the Disadvantaged
16,997
0a
17,258
17,227
Grants to Local Educational Agencies
16,310
0a
16,564
16,537
Comprehensive Literacy Development Grants
192
0a
192
192
Impact Aid
1,486
1,411
1,491
1,501
School Improvement Programs
5,405
392
5,454
5,444
Supporting Effective Instruction State Grants
2,132
0a
2,154
2,143
21st Century Community Learning Centers
1,250
0a
1,263
1,260
Student Support and Academic Enrichment Grants
1,210
0a
1,220
1,220
Indian Education
181
181
181
181
Innovation and Improvement
1,104
0a
1,075
1,114
Safe Schools and Citizenship Education
210
0a
218
217
English Language Acquisition
787
0a
797
797
Special Education
13,885
13,985
14,093
14,071
Part B—Assistance for Education of all Children with
13,159
13,259
13,356
13,335
Disabilities
Part C—Infants and Toddlers with Disabilities
477
477
482
482
Rehabilitation Services
3,748
3,783
3,828
3,814
Vocational Rehabilitation State Grants (mandatory)
3,610
3,668
3,668
3,675
Special Institutions for Persons with Disabilities
249
249
254
256
Career, Technical, and Adult Education
1,961
2,723
1,986
2,031
Career and Technical Education
1,290
2,053
1,308
1,342
Student Financial Assistance
24,520
22,975
24,565
24,545
Pell maximum grant (non-add)
5,285
5,285
5,435
5,435
Federal Pell Grant Program
22,475
22,475
22,475
22,475
Federal Direct Student Loan Program Account
50
0
50
50
Student Aid Administration
1,769
1,883
1,769
1,854
Higher Education
2,476
1,789
2,557
2,542
Federal TRIO Programs
1,090
950
1,100
1,097
Howard University
240
240
254
251
College Housing & Academic Facilities Loansb
0
0
0
0
HBCU Capital Financing Program Account
46
40
48
48
Institute of Education Sciences
623
565
630
642
Departmental Management
623
647
626
624
Total, ED BA in the Bill
76,361
70,228
77,135
77,212
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FY2021
FY2021
House
Enacted
FY2020
FY2021
Cmte.
(P.L. 116-
Account and Selected Program
Enacted
Request
(H.R. 7614)
260)
Subtotal, Mandatory
3,610
3,668
3,668
3,675
Subtotal, Discretionary
72,751
66,561
73,467
73,537
Emergency Funding (not included in above totals)

3rd COVID (P.L. 116-136)
30,925
—
—
—
5th COVID (Division M, P.L. 116-260)
—
—
—
82,000
Memoranda (non-emergency funds only)

Total, BA Available in Fiscal Year (current year from
76,225
70,228
77,135
77,212
any bil )
Total, BA Advances for Future Years (provided in
22,597
22,597
22,597
22,597
current bil )
Total, BA Advances from Prior Years (for use in
22,597
22,597
22,597
22,597
current year)
Sources: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are
generally drawn from or calculated based on data contained in the explanatory statement accompanying the
FY2021 LHHS omnibus (P.L. 116-260 ), available in the Congressional Record, vol. 166, no. 218, book IV,
December 21, 2020, pp. H8619-H8711. Amounts in the FY2021 House Committee column are generally drawn
from or calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614.
Enacted totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated appropriations provided
in P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bil totals (“Total BA
in the Bil ”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614.
Enacted totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations provided
in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure
generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or
reprogramming of funds pursuant to executive authorities.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bil , regardless of the year in which funds become available (i.e., totals do not include
advances from prior year appropriations, but do include advances for subsequent years provided in this bil ); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bil s.
Non-add amounts are displayed in italics and parentheses; these amounts are not part of the appropriations
totals.
a. The President’s FY2021 budget proposed to eliminate funding for this program and to consolidate it into a
new Elementary and Secondary Education for the Disadvantaged Block Grant. The amount proposed for
that Block Grant is not reflected in the source materials described above; as such, it is not reflected this
table. ED budget materials propose $19.3 bil ion in new budget authority for this block grant (including $6.8
bil ion to become available in FY2021 and an advance appropriation of $12.5 bil ion to become available in
FY2022. For more information about the legislative proposal, see U.S. Department of Education, “Improving
Elementary and Secondary Education,” Justification of Appropriation Estimates to the Congress: Fiscal Year 2021,
https://www2.ed.gov/about/overview/budget/budget21/justifications/a-iese.pdf.
b. Actual amount for Col ege Housing & Academic Facilities Loans is $435,000 in each column, which rounds
to $0 in mil ions (the unit of measure used in this table).
Related Agencies
Note that all amounts in this section are based on regular LHHS appropriations only; they do not
include funds provided outside of the annual appropriations process (e.g., mandatory
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appropriations for Social Security benefit payments). All amounts in this section are rounded to
the nearest million or billion (as labeled). The dollar changes and percentage changes in the text
are based on unrounded amounts. For consistency with source materials, amounts do not reflect
sequestration or re-estimates of mandatory spending programs, where applicable.
FY2021 Related Agencies Appropriations Overview
Table 10 displays FY2021 proposed and enacted funding levels for LHHS related agencies, along
with FY2020 enacted levels. Totals in this table do not include emergency supplemental
appropriations; amounts provided in supplementals are displayed separately at the bottom of the
table and are in addition to regular appropriations.
In general, discretionary funding constitutes about 20% of total appropriations for LHHS related
agencies each year. The FY2021 LHHS omnibus increased discretionary appropriations for
related agencies by about 0.6% compared to FY2020. The President’s budget would have
decreased discretionary appropriations for related agencies by about 8.2%, while the House
committee bill would have increased such appropriations by 1.4%.
Table 10. Related Agencies Appropriations Overview
(In billions of dollars)
FY2021
House
FY2021
Cmte.
Enacted
FY2020
FY2021
(H.R.
(P.L.
Funding
Enacted
Request
7614)
116-260)
Discretionary
15.4
14.1
15.6
15.5
Mandatory
57.3
55.3
55.3
55.3
Total BA in the Bill
72.7
69.4
70.9
70.8
Emergency Funding (not included in above

totals)
3rd COVID (P.L. 116-136)
0.4
—
—
—
Sources: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are
generally drawn from or calculated based on data contained in the explanatory statement accompanying the
FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December
21, 2020, pp. H8619-HH8711. Amounts in the FY2021 House Committee column are generally drawn from or
calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated appropriations provided in P.L.
116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bil totals (“Total BA in the
Bil ”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations provided in
Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this table
generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or
reprogramming of funds pursuant to executive authorities.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bil , regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bil ); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bil s.
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The largest share of funding appropriated to related agencies in the LHHS bill consistently goes
to the SSA. When taking into account both mandatory and discretionary funding, SSA usually
represents roughly 97% of total appropriations to related agencies in the LHHS bill. The bulk of
mandatory funding provided to SSA from the LHHS bill supports the Supplemental Security
Income (SSI) program, which provides means-tested cash assistance to disabled adults and
children and to seniors aged 65 or older.
When looking exclusively at discretionary funding, SSA received 84.3% of discretionary
appropriations for LHHS related agencies in the FY2021 LHHS omnibus. After SSA, the next-
largest related agency in terms of appropriations is usually the Corporation for National and
Community Service (CNCS), which accounted for about 1.6% of total appropriations and 7.3% of
discretionary appropriations to LHHS related agencies in FY2021. Typically, each of the
remaining related agencies receives less than $1 billion from the annual LHHS appropriations
bill. For more information, see Table 11.
Selected Related Agencies Highlights
The following sections highlight FY2021 appropriations issues for selected related agencies.
Table 11 tracks funding levels for these related agencies.
SSA Limitation on Administrative Expenses (LAE)
The SSA LAE account consists mainly of funds that are used by SSA to administer the Social
Security and SSI programs and to support CMS in administering portions of Medicare. The
account also contains funds that are specifically set aside for certain program integrity activities,
such as continuing disability reviews (CDRs) and SSI nonmedical redeterminations. The FY2021
LHHS omnibus provided $12.9 billion to the LAE account, which was an increase of $60 million
(+0.5%) relative to the FY2020 enacted level. The President’s request would have provided about
$480 million (+3.7%) more for the LAE account relative to FY2020, while the House committee
bill would have increased LAE funding by $100 million (+0.8%).
Of the $12.9 billion provided to the LAE account for FY2021, nearly $1.6 billion (12.2% of this
total) was dedicated to program integrity activities. The program integrity portion of the LAE
account included $273 million in base funding subject to the discretionary spending caps
established by the Budget Control Act of 2011, as well as additional funding that was effectively
exempt from those caps and subject to an annual limit (cap adjustment funding; see Appendix A
for further information). The FY2021 LHHS omnibus provided $1.3 billion in cap adjustment
funding, which was the maximum amount permitted for FY2021.95 Federal law allowed slightly
more cap adjustment funding for FY2020 than for FY2021, and additional FY2021 funds to
sustain the prior year level of funding were subject to the cap. The combined amount of program
integrity funding enacted for FY2021 was $7 million (-0.4%) less than the combined amount
enacted for FY2020, reflecting the reduction to the cap adjustment funding permitted for FY2021
relative to FY2020. Both the FY2021 President’s budget and the House committee bill would
have also provided the maximum amount of cap adjustment funding permitted for FY2021.

95 See 2 U.S.C. §901(b)(2)(B).
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Corporation for National and Community Service
The CNCS is an independent federal agency that administers a variety of national and community
service programs, such as AmeriCorps and the National Senior Volunteer Corps.96 The FY2021
LHHS omnibus provided $1.1 billion in total CNCS funding, a $17 million (+1.5%) increase
from the FY2020 enacted level. The FY2021 President’s budget had requested $92 million (-
91.7%) for CNCS,97 noting that these funds would be used to execute an orderly shutdown of
CNCS operations, with the agency’s closure slated to be complete by the end of FY2021.98 The
House committee bill declined the President’s proposal, proposing instead to increase CNCS
funding by $50 million (+4.5%) compared to the FY2020 enacted level.
National Labor Relations Board (NLRB)
The NLRB is an independent board that enforces provisions in the National Labor Relations Act
(NLRA). The FY2021 LHHS omnibus maintained the FY2020 funding levels for the NLRB of
$274 million. The FY2021 President’s budget would have decreased funding for the NLRB by
$27 million (-10.0%) compared to the FY2020 enacted level, while the House committee bill
would have increased funding for the NLRB by $4 million (+1.3%).
The FY2021 LHHS omnibus retained a provision that has been included in the LHHS bill since
FY2012 that prohibits any funds appropriated to the NLRB in the bill, or any prior appropriations
act, from being used to issue a directive or regulation to provide employees a means of voting
through any electronic method in an election determining representation for collective bargaining
(§407).
Table 11. Detailed Related Agencies Appropriations
(In millions of dollars)
FY2021
FY2021
House
Enacted
Cmte.
(P.L.
FY2020
FY2021
(H.R.
116-
Agency, Program, Project, or Activity
Enacted
Request
7614)
260)
Committee for Purchase from People Who Are Blind or
Severely Disabled (U.S. AbilityOne Commission)
10
14
10
11
Corporation for National and Community Service
(CNCS)
1,104
92a
1,154
1,121
Selected CNCS Programs/Initiatives:

Volunteers in Service to America (VISTA)
93
5
95
97

96 See CRS Report RL33931, The Corporation for National and Community Service: Overview of Programs and
Funding.
97 This report uses the figure that was published in the FY2021 LHHS omnibus explanatory statement, which is the
source document used by this report for the FY2021 request. (See the Source notes for Table 11 for further
information.) According to the Corporation for National and Community Service (CNCS) FY2021 budget justification,
the total amount requested for CNCS was $82 million (see CNCS, FY2021 Congressional Budget Justification,
February 10, 2020, p. 2, https://americorps.gov/sites/default/files/documents/
CNCS%20FY%202021%20Congressional%20Budget%20Justification%20w%20IG%20Message%20%28Final%29_5
08.pdf).
98 The budget request indicated that the elimination of CNCS would return the “responsibility to fund national service
and volunteerism to the private and nonprofit sectors.” See ibid. Previous President’s budgets for FY2018, FY2019,
and FY2020 had also proposed an elimination of CNCS.
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FY2021
FY2021
House
Enacted
Cmte.
(P.L.
FY2020
FY2021
(H.R.
116-
Agency, Program, Project, or Activity
Enacted
Request
7614)
260)
National Senior Volunteer Corps
221
0b
239
225
AmeriCorps State and National Grants
429
2
447
455
National Civilian Community Corps
33
23
35
34
National Service Trust
208
10c
212
185
Corporation for Public Broadcasting (CPB)
485
0
535
495
Federal Mediation and Conciliation Service
47
49
49
49
Federal Mine Safety and Health Review Commission
17
17
17
17
Institute of Museum and Library Services (IMLS)
252
23
257
257
Medicare Payment Advisory Commission (MedPAC)
13
14
13
13
Medicaid and CHIP Payment and Access Commission
(MACPAC)
9
9
9
9
National Council on Disability
3
3
3
3
National Labor Relations Board (NLRB)
274
247
278
274
National Mediation Board
14
14
14
14
Occupational Safety and Health Review Commission
13
14
13
13
Railroad Retirement Board (RRB)
150
144
150
147
Dual Benefits (minus tax receipts)
15
12
12
12
Federal Payment to RR Retirement Account (mandatory)d
0
0
0
0
Limitation on Administration
124
120
127
124
Inspector General
11
11
11
12
Social Security Administration (SSA)
70,314
68,759
68,369
68,329
Payments to Social Security Trust Funds (mandatory)
11
11
11
11
Supplemental Security Income (SSI) (mandatory)
57,328
55,282
55,282
55,282
Limitation on Administrative Expenses (LAE)
12,870
13,349
12,970
12,930
Regular LAE (incl. user fees, non-add)
11,288
11,774
11,395
11,355
Program Integrity (non-add)
1,582
1,575
1,575
1,575
Office of Inspector General
106
116
106
106
Total, Related Agencies BA in the Bill
72,706
69,398
70,871
70,752
Subtotal, Mandatory
57,339
55,294
55,294
55,294
Subtotal, Discretionary
15,367
14,104
15,577
15,459
Emergency Funding (not included in above totals)

3rd COVID (P.L. 116-136)
430
—
—
—
Memoranda (non-emergency funds only)

Total, BA Available in Fiscal Year (current year from any bil )
72,486
69,728
71,101
71,022
Total, BA Advances for Future Years (provided in current bil )
20,365
19,600
20,115
20,075
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FY2021
FY2021
House
Enacted
Cmte.
(P.L.
FY2020
FY2021
(H.R.
116-
Agency, Program, Project, or Activity
Enacted
Request
7614)
260)
Total, BA Advances from Prior Years (for use in current year)
20,145
19,930
20,345
20,345
Sources: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are
generally drawn from or calculated based on data contained in the explanatory statement accompanying the
FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December
21, 2020, pp. H8619-HH8711. Amounts in the FY2021 House Committee column are generally drawn from or
calculated based on data contained in the committee report (H.Rept. 116-450) accompanying H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated appropriations provided in P.L.
116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House committee bil totals (“Total BA in the
Bil ”) for FY2021 do not include emergency-designated appropriations proposed in Title VI of H.R. 7614. Enacted
totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations provided in
Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with source materials, amounts in this figure
generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or
reprogramming of funds pursuant to executive authorities.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bil , regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bil ); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bil s.
a. This report uses the figure that was published in the FY2021 LHHS omnibus explanatory statement, which
is the source document used by this report for the FY2021 request. (See the Source notes for further
information.) According to the Corporation for National and Community Service (CNCS) FY2021 budget
justification, the total amount requested for CNCS was $82 mil ion (see CNCS, FY2021 Congressional
Budget Justification, February 10, 2020, p. 2, https://americorps.gov/sites/default/files/documents/
CNCS%20FY%202021%20Congressional%20Budget%20Justification%20w%20IG%20Message%20%28Final%2
9_508.pdf).
b. The actual amount requested is roughly $333,000, which rounds to $0 in mil ions (the unit of measure used
in this table).
c. This report uses the figure that was published in the FY2021 LHHS omnibus explanatory statement, which
is the source document used by this report for the FY2021 request. (See the “Source” notes for further
information.) According to the CNCS FY2021 budget justification, the total amount requested for the
National Service Trust was $0 (see CNCS, FY2021 Congressional Budget Justification, February 10, 2020,
p. 2, https://americorps.gov/sites/default/files/documents/
CNCS%20FY%202021%20Congressional%20Budget%20Justification%20w%20IG%20Message%20%28Final%2
9_508.pdf).
d. The actual amount of mandatory federal payments to the Railroad Retirement account is roughly $150,000
in each column, which rounds to $0 in mil ions (the unit of measure used in this table).
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Appendix A. Budget Enforcement Activities
The framework for budget enforcement under the congressional budget process has both statutory
and procedural elements. The statutory elements include the discretionary spending limits and
mandatory spending sequester derived from the Budget Control Act of 2011 (BCA; P.L. 112-25)
and the Balanced Budget and Emergency Deficit Control Act of 1985 (BBEDCA; P.L. 99-177),
as amended. The procedural elements are primarily associated with the budget resolution and
limit both total discretionary spending and spending under the jurisdiction of each appropriations
subcommittee.
Statutory budget enforcement requirements that apply to FY2021 discretionary spending were
altered prior to the start of the fiscal year by the Bipartisan Budget Act of 2019 (BBA 2019; P.L.
116-37) which was enacted on August 2, 2019. This law increased the defense and nondefense
discretionary spending limits for FY2020 and FY2021, and extended mandatory spending
sequestration through FY2029.99 Subsequently, mandatory spending sequestration was further
extended through FY2030 by the CARES Act (P.L. 116-136), enacted on March 27, 2020.
Budget Control Act and Sequestration
The BCA provides budget process mechanisms to reduce mandatory spending and further reduce
discretionary spending over an extended period.100 For mandatory spending, reductions are to
occur through sequestration in each of fiscal years between FY2013-FY2030.101 For discretionary
spending, reductions occurred through sequestration in FY2013, but were to be achieved through
lower discretionary spending limits for each of the fiscal years between FY2014-FY2021. (At this
time, there are no statutory discretionary spending limits in place for FY2022 or future years.)
The BCA does not require a sequester of discretionary spending in FY2014-FY2021 unless one or
both of the statutory discretionary spending limits (on “defense” and “nondefense” spending) is
breached. Only discretionary spending subject to a given spending limit would be affected by a
breach of that limit, and the LHHS bill only includes funding in the nondefense category.
FY2021 Mandatory Spending Sequestration
On February 10, 2020, concurrent with the release of the President’s budget submission,
President Trump issued the required FY2021 sequestration order, calling for nonexempt
mandatory spending to be reduced on October 1, 2020.102 At that time, the Office of Management
and Budget (OMB) estimated that the FY2021 sequestration percentages would equal 2% of

99 For a discussion of how these discretionary spending requirements for FY2014-FY2019 were modified by the
Bipartisan Budget Act of 2013, the Bipartisan Budget Act of 2015, and the Bipartisan Budget Act of 2018, see CRS
Report R43236, Labor, Health and Human Services, and Education: FY2014 Appropriations; and CRS Report
R44287, Labor, Health and Human Services, and Education: FY2016 Appropriations, and CRS Report R45083, Labor,
Health and Human Services, and Education: FY2018 Appropriations.
100 The BCA initially imposed limits on discretionary spending for each of FY2012-FY2021. Further reductions to
discretionary spending were triggered when the Joint Committee on Deficit Reduction did not report legislation to
achieve a specified amount of budgetary savings.
101 As originally enacted, mandatory sequestration was scheduled to run through FY2021, but this period has
subsequently been incrementally extended to FY2030 by P.L. 113-67, P.L. 113-82, P.L. 114-74, P.L. 115-123, P.L.
116-37, and P.L. 116-136.
102 Sequestration Order for Fiscal Year 2021 Pursuant to Section 251A of the Balanced Budget and Emergency Deficit
Control Act, As Amended, Federal Register Volume 85, No. 30, February 13, 2020, p. 8129, https://www.govinfo.gov/
content/pkg/FR-2020-02-13/pdf/2020-03044.pdf.
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nonexempt Medicare spending and 5.7% of other nonexempt nondefense mandatory spending,
for a total reduction of $21 billion in FY2021.103 (OMB also estimated an 8.3% reduction,
totaling $924 million, in nonexempt defense mandatory spending, which does not affect LHHS
funds.)
On March 27, 2020, over a month after President Trump issued the sequestration order for
FY2021 and OMB released the sequester report, the CARES Act (P.L. 116-136) was enacted.
This law included a provision temporarily suspending Medicare sequestration from May 1, 2020,
through December 31, 2020. Subsequent laws (P.L. 116-260 and P.L. 117-7) extended this
suspension through December 31, 2021. A result of these combined provisions is that Medicare
sequestration was effectively required to be suspended throughout the entirety of FY2021
(October 2020 through September 2021).
FY2021 Statutory Discretionary Spending Limits
With regard to discretionary spending, the FY2021 statutory spending limits that were in effect
were $672 billion for defense spending and $627 billion for nondefense spending.104 Relative to
FY2020, the defense and nondefense limits allowed for an increase in spending subject to each
respective limit of $5 billion apiece. Once all regular annual appropriations acts were enacted for
FY2021 and allowable adjustments to the spending limits (discussed below) were made, OMB
determined that those appropriations did not violate either of the spending limits, and thus no
sequestration of discretionary spending would be required.105
Cap Adjustments, Exemptions, and Special Rules
The BCA allows for certain adjustments to the discretionary spending limits for FY2012-
FY2021.106 An adjustment effectively raises the applicable spending limit when funding subject
to that adjustment is enacted. In addition to the LHHS-specific adjustments that are discussed in
the paragraph below, the BCA includes an adjustment for funding designated as an “emergency
requirement.” The BCA includes no dollar limit to the amount of appropriations each fiscal year
that can be designated in this manner, and no criteria that would restrict the use of this adjustment
to certain accounts or activities. All FY2021 LHHS supplemental discretionary appropriations
(totaling $155 billion) were designated as an emergency requirement, as were a small portion of
annual LHHS appropriations ($1.6 billion).
The BCA also provides adjustments that are specifically for LHHS accounts and activities, all of
which are subject to dollar limits each fiscal year. As originally enacted, the BCA allowed
increases to the nondefense limit (up to a point) to accommodate new budget authority for

103 OMB Report to the Congress on the Joint Committee Reductions for Fiscal Year 2021, February 10, 2020,
https://www.whitehouse.gov/wp-content/uploads/2020/02/JC-sequestration_report_FY21_2-10-20.pdf. See the report’s
appendix for an itemized list of budget accounts that include mandatory spending subject to sequestration in FY2021,
the dollar amounts subject to sequestration (based on OMB’s current law baseline), the percentage by which they
would be reduced, and the dollar amount of the reduction. While the report displays reductions at the account level, the
sequester itself is implemented at the program, project, or activity level.
104 OMB Sequestration Preview Report to the President and Congress for Fiscal Year 2021, February 10, 2020,
https://www.whitehouse.gov/wp-content/uploads/2020/02/Sequestration_Preview_2-10-20.pdf.
105 OMB, Budget Enforcement Act Report (Seven-Day-After), Consolidated Appropriations Act, 2021, January 15,
2021, https://www.whitehouse.gov/wp-content/uploads/2021/01/7_Day_After_Report_Omni_1-15-21.pdf.
106 For further information, see CRS Report R45778, Exceptions to the Budget Control Act’s Discretionary Spending
Limits.
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specified program integrity initiatives at HHS and the Social Security Administration (SSA).107
The Bipartisan Budget Act of 2015 (P.L. 114-74) amended the list of SSA activities covered by
this “cap adjustment” to include costs associated with work-related continuing disability reviews,
Cooperative Disability Investigations, and fraud prosecutions by Special Assistant U.S. Attorneys,
and revised the amount of the allowable SSA adjustment amounts to be more generous in
FY2017-FY2019 compared to what was previously allowed, but less generous in FY2021.108 The
BBA 2018 then added a new cap to accommodate new budget authority for the DOL to help fund
the reemployment services and eligibility assessments conducted by the states related to
unemployment compensation.109
Separate from these cap adjustments, the 21st Century Cures Act (Cures Act, P.L. 114-255), which
was enacted on December 13, 2016, includes additional budget enforcement procedures related to
the discretionary spending limits.110 For the purposes of FY2021 LHHS appropriations, these
procedures apply only to the NIH Innovation Account that was created by the act.111 The Cures
Act provides that discretionary appropriations from this account (up to the amount authorized) are
to be subtracted from any cost estimates provided for purposes of budget controls. Thus, the
Cures Act ensures that appropriations from this account will not count against any spending
limits, such as the statutory discretionary spending limits imposed by the BCA.
An additional set of statutory exemptions and special rules that apply to sequestration are relevant
for the LHHS bill. The LHHS bill contains several programs that are exempt from sequestration,
including Medicaid, payments to health care trust funds, Supplemental Security Income, Special
Benefits for Disabled Coal Miners, retirement pay and medical benefits for commissioned Public
Health Service officers, foster care and adoption assistance, and certain family support payments.
The LHHS bill also contains several programs that are subject to special rules under
sequestration, such as unemployment compensation, certain student loans, health centers, and
portions of Medicare.112
Budget Resolution and 302(b) Suballocations
The procedural elements of budget enforcement generally stem from requirements under the
Congressional Budget Act of 1974 (P.L. 93-44) that are associated with the adoption of an annual
budget resolution. Through this process, the Appropriations Committee in each chamber receives
a procedural limit on the total amount of discretionary budget authority for the upcoming fiscal

107 For further information about the allowable FY2018 adjustments, see OMB Sequestration Preview Report to the
President and Congress for Fiscal Year 2018, May 23, 2017, https://www.whitehouse.gov/sites/whitehouse.gov/files/
omb/sequestration_reports/2018_preview_report_may2017_potus.pdf.
108 For further information, see CRS Report R44250, Social Security and Social Security Disability Insurance (SSDI)
Provisions in the Bipartisan Budget Act of 2015.
109 For information on the programmatic changes associated with this cap adjustment that were also included in the
BBA 2018, see CRS Report R44836, Unemployment Insurance: Legislative Issues in the 115th Congress.
110 These procedures originally applied to two accounts within the scope of the LHHS bill that were created by the
Cures Act: the NIH Innovation Account (FY2017-FY2026) and the Account for the State Response to the Opioid
Abuse Crisis (FY2017-FY2018). These procedures have lapsed for the State Response to the Opioid Abuse Crisis
account as of the end of FY2018, but are still in effect for the NIH Innovation Account through FY2026.
111 The 21st Century Cures Act also created a non-LHHS account—the FDA Innovation Account—and made it subject
to similar budget enforcement-related provisions. For more information, see CRS Report R44720, The 21st Century
Cures Act (Division A of P.L. 114-255).
112 For more information, see CRS Report R42050, Budget “Sequestration” and Selected Program Exemptions and
Special Rules.
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year, referred to as a 302(a) allocation. The Appropriations Committee subsequently divides this
allocation among its 12 subcommittees. These subcommittee-level spending limits are referred to
as 302(b) suballocations. The 302(b) suballocations restrict the amount of budget authority
available to each subcommittee for the agencies, projects, and activities under its jurisdiction,
effectively acting as a cap on each of the 12 regular appropriations bills. Enforcement of the
302(a) allocation and 302(b) suballocations occurs through points of order.
For the FY2021 appropriations cycle, the House and the Senate relied on alternate mechanisms
provided by BBA 2019 to provide the basis for the Appropriations Committees spending
allocations.113 These procedures allowed those spending allocations to be established via
statements submitted to the Congressional Record by the chairs of the House and Senate budget
committees, without the adoption of a budget resolution.114 Among other requirements, these
spending allocations were required to be consistent with the levels established by the statutory
discretionary spending limits. The FY2021 committee-level spending allocations were submitted
in the House on May 1, and in the Senate on May 4, 2020.115 The House Appropriations
Committee subsequently adopted 302(b) suballocations for each of its 12 subcommittees on July
9.116 The House initial LHHS discretionary suballocation for FY2021 was $182.9 billion.117 The
Senate Appropriations Committee did not formally adopt suballocations prior to the enactment of
full-year appropriations for FY2021, although a majority proposal for these suballocations was
released on November 10, 2020.118
For current-year LHHS discretionary funding, Table A-1 displays FY2020 enacted levels, the
House FY2021 initial suballocations, and enacted FY2021 LHHS appropriations. The table
shows that the House would have decreased regular LHHS discretionary appropriations by about
$128 million (-0.1%) compared to the prior fiscal year. Final enacted appropriations were about
$9 billion (-4.9%) lower than the prior fiscal year. However, readers should note that the LHHS
funding amounts calculated via this method are the net of billions of dollars in offsets included in
each proposal, such as certain rescissions of previously enacted funding and changes in
mandatory program spending (CHIMPS). When those offsets are excluded from this calculation,
FY2021 regular discretionary appropriations in the House committee bill and those that were
ultimately enacted represent an increase to LHHS funding relative to FY2020.119

113 For a discussion of budget enforcement mechanisms that may be adopted in the absence of a budget resolution, see
CRS Report R44296, Deeming Resolutions: Budget Enforcement in the Absence of a Budget Resolution; and CRS
Report R43535, Provisions in the Bipartisan Budget Act of 2013 as an Alternative to a Traditional Budget Resolution.
114 Ibid. For a general discussion of budget enforcement mechanisms that may be adopted in the absence of a budget
resolution, see CRS Report R44296, Deeming Resolutions: Budget Enforcement in the Absence of a Budget Resolution.
115 “Publication of Budgetary Material,” Congressional Record, daily edition, Vol. 166, No. 82 (May 1, 2020), pp.
H1968-H1969. “Budget Enforcement Levels for Fiscal Year 2021,” Congressional Record, daily edition, Vol. 166, No.
83 (May 4, 2020), pp. S2205-S2206.
116 House Appropriations Committee, “Appropriations Committee Approves FY2021 Subcommittee Allocations,” July
9, 2020, press release, https://appropriations.house.gov/news/press-releases/appropriations-committee-approves-fy-
2021-subcommittee-allocations.
117 H.Rept. 116-443. The House Appropriations Committee subsequently reported revised 302(b) suballocations
(H.Rept. 116-454, July 16, 2020), although the LHHS discretionary suballocation was unchanged from the initial
amount.
118 See linked draft 302(b) suballocation text in the Senate Appropriations Committee majority press release,
“Committee Releases FY21 Bills in Effort to Advance Process, Produce Bipartisan Results,” November 10, 2020,
https://www.appropriations.senate.gov/news/committee-releases-fy21-bills-in-effort-to-advance-process-produce-
bipartisan-results.
119 See the funding totals and scorekeeping adjustments in Table A-2. For the FY2021 House committee bill, see also
the House Appropriations Committee, “Appropriations Committee Releases Fiscal Year 2021 Labor-HHS-Education
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The table also displays funding for which adjustments may be made to the discretionary spending
limits under the BCA, including funding for certain LHHS program integrity activities and
emergency requirements, where applicable. The “Adjusted Appropriations” total includes this
funding.
Compliance with discretionary spending allocations is evaluated based on budget authority
available in the current fiscal year, adjusted for scorekeeping by CBO. As such, totals shown in
this table may not be comparable to other totals shown in this report. Current-year budget
authority totals exclude advance appropriations for future years, but include advance
appropriations from prior years that become available in the current year. (Advance
appropriations are provided to selected LHHS accounts, generally in order to manage specific
planning concerns and ensure continuity of operations at the start of a new fiscal year.)
Table A-1. LHHS Discretionary FY2020 Enacted Levels, FY2021 House 302(b)
Suballocations, and FY2021 Enacted Levels
(Budget authority in billions of dollars)
FY2020
FY2021 Initial
FY2021

Enacted
House 302(b)
Enacted
Regular Appropriations
183.042
182.914
174.073
Adjustments:

Program Integrity
1.842
1.881
1.881
Emergency
Requirementsa
280.000
—
156.588
Adjusted Appropriations
464.884
184.795
332.542
Sources: Table prepared by CRS. Amounts shown for FY2020 Enacted are as scored by CBO (see Fiscal Year
2020 House Current Status of Discretionary Appropriations as of April 24, 2020, https://www.cbo.gov/system/files?
file=2020-05/FY2020-House-2020-4-24.pdf). The House Initial 302(b) is as reported in H.Rept. 116-443 on July
13, 2020. Amounts shown for FY2021 Enacted are as scored by CBO (Report on the Status of Discretionary
Appropriations, Fiscal Year 2021, House of Representatives, as of July 30, 2021, https://www.cbo.gov/system/files?file=
2021-09/FY2021-House.pdf).
Notes: It is common for suballocations to be revised over the course of the year to reflect actual action on
appropriations bil s and changes in congressional priorities. Regular appropriations reflect current-year
discretionary budget authority subject to the spending limits. Adjusted appropriations include, where applicable,
discretionary funds for which special rules apply with regard to the spending limits, including certain funds for
program integrity activities. Enacted appropriations include advance appropriations enacted in prior fiscal years
that first become available in those fiscal years. They also include the enacted LHHS appropriations that were
designated as emergency requirements in FY2020 (P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, and
P.L. 116-139) and FY2021 (Divisions H and M of P.L. 116-260, and P.L. 117-31). Enacted amounts do not include,
where applicable, funds provided under certain authorities in the 21st Century Cures Act (P.L. 114-255) that are
effectively exempt from discretionary spending limits. (For FY2020, these funds totaled $492 mil ion; for FY2021,
these funds totaled $404 mil ion.)
a. The House initial 302(b) for LHHS did not include an allocation for the $19.4 bil ion in emergency-
designated appropriations subsequently proposed in Title VI of the House committee bil (H.R. 7614).

Funding Bill,” press release, July 6, 2020, https://appropriations.house.gov/news/press-releases/appropriations-
committee-releases-fiscal-year-2021-labor-hhs-education-funding. For FY2021 enacted, see also Senate Appropriations
Committee Vice Chair, Senator Patrick Leahy, “Summary, Labor, Health and Human Services, Education, and Related
Agencies Fiscal Year 2021 Appropriations Bill,” December 21, 2020, p. 1, https://www.appropriations.senate.gov/imo/
media/doc/LHHS.pdf.
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Current-Year Budget Authority
Table A-2 displays the total LHHS current-year budget authority, by title. The amounts shown in
this table reflect total budget authority available for obligation in the fiscal year, regardless of the
year in which it was first appropriated. (In other words, these amounts exclude advance
appropriations for future years, but include advance appropriations from prior years that became
available in the applicable current year.) Amounts in the FY2020 enacted column include FY2020
budget authority provided by the FY2018 omnibus (P.L. 115-141) and FY2019 omnibus (P.L.
116-94). Similarly, the FY2021 President’s budget, House committee, and enacted columns
include FY2021 budget authority provided by the FY2019 and FY2020 omnibuses. (For a
comparable table showing total budget authority in the bill, rather than current-year budget
authority, see Table 2 in this report.) As mentioned above, it is current-year budget authority
(adjusted for scorekeeping by CBO) that is used to determine compliance with discretionary
spending allocations.
Table A-2. LHHS Appropriations Overview, by Bill Title: FY2020-FY2021
(Current-year budget authority in billions of dollars)
FY2021
FY2021
Enacted
FY2020
FY2021
House Cmte.
(P.L. 116-
Bill Title
Enacted
Request
(H.R. 7614)
260)
Title I: Labor
13.8
12.5
14.0
13.9
Discretionary
12.4
11.2
12.7
12.5
Mandatory
1.4
1.4
1.4
1.4
Title II: HHS
932.7
996.1
1007.1
1007.8
Discretionary
94.9
87.0
96.4
97.0
Mandatory
837.8
909.1
910.8
910.8
Title III: Education
76.4
70.2
77.1
77.2
Discretionary
72.8
66.6
73.5
73.5
Mandatory
3.6
3.7
3.7
3.7
Title IV: Related Agencies
72.5
69.7
71.1
71.0
Discretionary
15.3
14.1
15.5
15.4
Mandatory
57.1
55.6
55.6
55.6
Total Current Year BAa
1,095.3
1,148.6
1,169.4
1,169.9
Discretionary
195.4
178.9
198.0
198.5
Mandatory
899.9
969.7
971.4
971.4
Emergency Funding (not included in above totals)

USMCA (P.L. 116-113)
0.2
-
-
-
1st COVID (P.L. 116-123)
6.4
-
-
-
2nd COVID (P.L. 116-127)
1.3
-
-
-
3rd COVID (P.L. 116-136)
172.1
-
-
-
4th COVID (P.L. 116-139)
100.0
-
-
-
Emergency Funding in Annual LHHSb
-
-
19.4
1.6
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FY2021
FY2021
Enacted
FY2020
FY2021
House Cmte.
(P.L. 116-
Bill Title
Enacted
Request
(H.R. 7614)
260)
5th COVID (Division M, P.L. 116-260)
-
-
-
154.9
Afghan special immigrants (P.L. 117-31)
-
-
-
0.0c
Memoranda:

Advances for Future Years (provided in current
189.1
197.1
197.6
197.6
bil )d
Advances from Prior Years (for use in current
186.7
188.6
189.0
189.0
year)d
Additional Scorekeeping Adjustmentse
-10.5
-9.9
-13.2
-22.5
Sources: Amounts in this table for the FY2020 Enacted, FY2021 Request, and FY2021 Enacted columns are
generally drawn from or calculated based on data contained in the explanatory statement accompanying the
FY2021 LHHS omnibus (P.L. 116-260), available in the Congressional Record, vol. 166, no. 218, book IV, December
21, 2020, pp. H8619-H8711. (The amount for P.L. 117-31 is from CBO, Discretionary Spending: Senate Amendment
2123, July 29, 2021, https://www.cbo.gov/system/files/2021-07/
EmergencySecuritySupplementalAppropriationsAct2021.pdf.) Amounts in the FY2021 House Committee column
are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-450)
accompanying H.R. 7614. Enacted totals (“Total BA in the Bil ”) for FY2020 do not include emergency-designated
appropriations provided in P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. House
committee bil totals (“Total BA in the Bil ”) for FY2021 do not include emergency-designated appropriations
proposed in Title VI of H.R. 7614. Enacted totals (“Total BA in the Bil ”) for FY2021 do not include emergency-
designated appropriations provided in Division H or M of P.L. 116-260, or P.L. 117-31. For consistency with
source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where
applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
current-year budget authority; (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only
those funds provided (or requested) for agencies and accounts subject to the jurisdiction of the LHHS
Subcommittees of the House and the Senate Committees on Appropriations; and (4) do not include
appropriations that occur outside of appropriations bil s. No amounts are shown for Title V, because this title
consists solely of general provisions.
a. Totals in this table are based on current-year budget authority, meaning budget authority that is available
for obligation in a given fiscal year, regardless of the year in which it was first appropriated (i.e., totals
exclude advance appropriations for future years, but include advance appropriations from prior years that
became available in the applicable current year).
b. The FY2021 House committee bil included a total of $19.4 bil ion in emergency-designated budget
authority in Title VI, of which $925 mil ion was for DOL and $18.5 bil ion was for HHS. Subsequently,
Division H of P.L. 116-260 enacted $1.6 bil ion in emergency-designated budget authority, of which $925
mil ion was for DOL in Title I, and $638 mil ion was for HHS in Title II.
c. P.L. 117-31 provided $25 mil ion in supplemental appropriations for the Refugee and Entrant Assistance
account at HHS for specified purposes related to Afghan special immigrants, which rounds to $0.0 in bil ions
(the unit of measure used in this table).
d. The calculation for total budget authority in the bil (rather than total budget authority available for
obligation in the current fiscal year) is as fol ows: Total Current Year BA minus Advances from Prior Years
plus Advances for Future Years. The amount for both Advances from Prior Years and Advances for Future
Years is the combined total of mandatory and discretionary spending.
e. Totals in this table have generally not been adjusted for further scorekeeping. (To adjust for scorekeeping,
add this line to the total budget authority.)
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Appendix B. House Floor Amendments Offered to
H.R. 7617
The House began its initial floor consideration of FY2021 LHHS appropriations on July 30, 2020.
Those appropriations were initially considered on the floor as part of a consolidated
appropriations package and passed the House (217-197), as amended, on July 31, 2020 (Division
E of H.R. 7617). This package would have provided appropriations for five other appropriations
acts in addition to LHHS: Department of Defense; Commerce, Justice, Science; Energy and
Water Development; Financial Services and General Government; and Transportation, Housing,
and Urban Development.120 LHHS amendments were keyed to Division F of what was to be the
base text for amendment (Rules Committee Print 116–60). The LHHS division was redesignated
as Division E after House passage due to the omission of the Department of Homeland Security
division from the bill.
Floor action on H.R. 7617 was regulated by the terms of a special rule (H.Res. 1067) that made in
order 92 amendments to the LHHS title of the bill.121 That rule also provided the authority for the
chair of the Appropriations Committee or her designee to offer any of the amendments made in
order en bloc (i.e., in groups of amendments to be disposed of together). All but three LHHS
amendments were considered in this manner.122 When counted as 92 separate amendments, 84
were adopted and 8 were rejected.
All of the amendments that were offered and their dispositions are listed in Table B-1 below.
Table B-1. LHHS House Floor Amendments Offered to H.R. 7617
En
Bloc
Amdt. No. and Summary from the Rules Committee
No.
Disposition
218. Adams (NC): Prohibits the use of funds for the enforcement of WHD Field Bul etin 5
Adopted,
No. 2020-2, which attempts to limit liquidated damages for violations of minimum wage
Voice
and overtime protections.
219. Allen (GA): Reduces funds made available in Division F (LHHS) by 5 percent.
NA
Rejected,
123-292
220. Bera (CA): Increases and decreases the School Improvement Account by $500,000
4
Adopted,
with the intent of directing the Department of Education to col ect and share best
Voice
practices for offering online classroom instruction with local education agencies,
including resources from the What Works Clearinghouse and lessons learned by
schools from the transition to online learning this past school year as a result of
COVID-19.

120 H.R. 7617 was initially expected to provide appropriations for the act funding the Department of Homeland
Security, but that division was ultimately omitted under the terms of the special rule that regulated floor consideration
(H.Res. 1067).
121 For a list of these LHHS amendments (numbered 218-309) and the text of each that was made in order, see H.Rept.
116-461, pp. 23-32 and 89-108.
122 For the en bloc amendments proposing changes to the LHHS division of the bill, see consideration of amendments
en bloc nos. 3, 4, and 5 in Congressional Record, daily edition, Vol. 166, No. 135 (July 30, 2020), pp. H4134-H4139,
H4143-H4169.
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Labor, Health and Human Services, and Education: FY2021 Appropriations

En
Bloc
Amdt. No. and Summary from the Rules Committee
No.
Disposition
221. Bera (CA): Decreases and increases funds by $1 mil ion in the CDC Public Health
5
Adopted,
Preparedness and Response account to urge CDC to integrate early warning
Voice
surveillance data, such as network-connected devices like smart thermometers and
pulse oximeters or symptom surveys, into its COVID-19 syndromic surveillance to help
identify potential hotspots even before individuals present to a health care facility.
222. Bera (CA): Decreases and increases funds by $1 mil ion in the CDC Immunization
5
Adopted,
and Respiratory Diseases account to urge CDC to prioritize assistance to State, local,
Voice
tribal, and territorial health departments regarding Immunization Information Systems to
best prepare for management and distribution of seasonal influenza and COVID-19
vaccines and to support mass vaccination efforts.
223. Beyer (VA): Increases and decreases funds by $500,000 to highlight the need for a
4
Adopted,
GAO study on standardized tests for col ege admissions, the accountability and
Voice
oversight of the organizations managing such tests, efficacy of such tests, impact in
admissions decisions, and economic impact on col ege applicants.
224. Beyer (VA): Requires the National Academies of Sciences Engineering and Medicine
5
Adopted,
do to a holistic review of the U.S. coronavirus response and offer recommendations,
Voice
including but not limited to how to build public health security and pandemic
preparedness.
225. Bishop, Dan (NC): Restricts any of the funds in the Act from being used to
3
Rejected,
withdraw the rule allowing Health Reimbursement Arrangements to be used to
voice
purchase individual market coverage.
226. Burgess (TX): Increases and decreases funds by $100 mil ion in the Public Health
4
Adopted,
and Social Services Emergency fund to highlight the need for manufacturing process
Voice
improvements to increase yields of Immunoglobulin G in plasma manufacturing in the
United States.
227. Cárdenas (CA): Increases funding for the National Child Traumatic Stress Initiative
4
Adopted,
by $1 mil ion and decreases funding for HHS’s General Departmental Management
Voice
account by $1 mil ion.
228. Cohen (TN): Prohibits the use of funds to enter into any new contract, grant, or
5
Adopted,
cooperative agreement with any Trump related business listed in the President Trump’s
Voice
Annual Financial Disclosure Report submitted to the Office of Government Ethics as
well as certain Trump related properties listed on the Trump Organization’s website.
The specific business are listed in the amendment.
229. Crow (CO): Increases the carve-out for Project SERV from $5 mil ion to $6
4
Adopted,
mil ion, which funds grants to local education agencies for mental health, counseling, and
Voice
technical assistance in the wake of traumatic events at schools that are disruptive to
learning—such as natural disasters, violence at school, or pandemics.
230. Davis, Danny K. (IL), Burgess (TX): Increases funding to the account of Birth
4
Adopted,
Defects, Development Disabilities, Disabilities and Health by $2,000,000, and decreases
Voice
the administration account in the Office of the Secretary of Health and Human Services
by $2,000,000. Currently under this account, there are zero dol ars allocated for the
Public Health Approach to Blood Disorders Program for Sickle Cell Disease that wil
support the CDC's sickle cell disease surveillance program to better identify affected
individuals, to understand their health outcomes, and to evaluate strategies to prevent
complications and risk factors that affect individuals living with this disease.
231. DeSaulnier (CA): Increases and decreases the Department of Labor budget by $2
4
Adopted,
mil ion with the intention of funding a study that examines the cost savings of
Voice
teleworking/telecommuting, specifically as it relates to worker productivity, cost savings
to the employer, transportation emission reductions, child care costs, etc.
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En
Bloc
Amdt. No. and Summary from the Rules Committee
No.
Disposition
232. DeSaulnier (CA), Thompson, Glenn (PA): Increases funding for Statewide Family
4
Adopted,
Engagement Centers at the Department of Education by $1 mil ion.
Voice
233. Escobar (TX): Increases and decreases funding by $1 mil ion in the Substance Abuse 4
Adopted,
and Mental Health Administration (SAMHSA) account to encourage the agency to
Voice
streamline the application process for SAMHSA grants.
234. Escobar (TX), Torres Small, Xochitl (NM), Jackson Lee (TX): Increases and
5
Adopted,
decreases funding by $1 mil ion in the Office of the Secretary account to urge the U.S.-
Voice
Mexico Border Health Commission to develop and implement a bi-national strategy to
address COVID-19 in the border region.
235. Escobar (TX): Prohibits funds from being used to implement or enforce the
5
Adopted,
restrictions under the rule entitled, ‘ Order Under Sections 362 and 365 of the Public
Voice
Health Service Act; Order Suspending Introduction of Certain Persons From Countries
Where a Communicable Disease Exists (42 U.S.C. 265, 268)’ at the U.S. borders with
Canada and Mexico.
236. Espail at (NY), Jackson Lee (TX): Increases and decreases by $10,000,000 to
4
Adopted,
support greater minority patient outreach and minority candidate inclusion by the
Voice
National Institute of Allergy and Infectious Diseases in clinical trial participation for any
vaccine or therapeutics to treat the novel Coronavirus 2019 (COVID-19).
237. Espail at (NY): Prohibits the Office of Refugee Resettlement and the U.S.
5
Adopted,
Department of Health and Human Services from contracting with any for-profit
Voice
contractor for the purposes of housing unaccompanied children (UAC).
238. Espail at (NY), Grijalva (AZ): Increases and decreases funds by $10 mil ion in Part A
4
Adopted,
of Title III of the ESEA to highlight the need for English Language Acquisition (ELA)
Voice
grants and technical assistance to local education agencies supporting the education of
English learners (ELs).
239. Finkenauer (IA): Increases funding for endometriosis research at the National
NA
Adopted,
Institute of Child Health and Human Development to $26 mil ion, doubling funding for
Voice
endometriosis research over FY 19 level.
240. Finkenauer (IA), Mul in (OK): Increases funding by $5 mil ion for Certified
4
Adopted,
Community Behavioral Health Clinics, decreases $5 mil ion from the Office of the
Voice
Secretary account.
241. Foster (IL), Kelly, Mike (PA): Strikes Section 510, thereby removing a
NA
Adopted,
ban on HHS promulgating rules on unique patient identifiers.
Voice
242. Foxx (NC), Flores (TX), Walden (OR): Prohibits the delay or weakening of the
3
Rejected,
November 27, 2019 rule relating to price transparency requirements for hospitals.
voice
243. Gomez (CA): Provides an additional $5 mil ion for the NIH's National Institute on
4
Adopted,
Minority Health and Health Disparities (NIMHD), decreases $5 mil ion from the Office
Voice
of the Secretary account.
244. Gomez (CA): Provides an additional $5 mil ion for the Health Centers program,
4
Adopted,
decreases $5 mil ion from the Office of the Secretary account.
Voice
245. Gottheimer (NJ): Increases and decreases funds by $1,000,000 in the Centers For
4
Adopted,
Disease Control And Prevention Environmental Health account to emphasize the
Voice
importance of every child having access to drinking water at school that’s free of lead
and dangerous materials.
246. Gottheimer (NJ): Increases and decreases the Public Health Emergency Fund by $1
4
Adopted,
mil ion to highlight the need for al Members of Congress to have access to the weekly
Voice
updates on the Strategic National Stockpile from the Secretary of HHS provided to
House and Senate Appropriations Committees.
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Labor, Health and Human Services, and Education: FY2021 Appropriations

En
Bloc
Amdt. No. and Summary from the Rules Committee
No.
Disposition
247. Hastings (FL): Provides an additional $500,000 for civics education, split equally
4
Adopted,
between American History and Civics Academies, and American History and Civics
Voice
National Activities.
248. Hil , French (AR): Strikes guidance requiring $100 mil ion to be obligated to carry
3
Rejected,
out the ACA navigator program.
voice
249. Hil , French (AR): Transfers $2.6 mil ion from the National Labor Relations Board
3
Rejected,
(NLRB) account to the Office of Labor Management Standards (OLMS) account.
voice
250. Hudson (NC): Increase Impact Aid 7003(b) by $1,000,000 and decrease
4
Adopted,
Department of Education Departmental Management Program Administration fund by
Voice
$1,000,000
251. Jackson Lee (TX): Increases and decreases funds by $10,000,000 increase in funding
4
Adopted,
to support greater diversity in the pool of diabetes research professionals and patients
Voice
participating in clinical trials.
252. Jackson Lee (TX): Increases and decreases funds by $10,000,000 with the intent of
4
Adopted,
supporting programs that provide outreach and support services targeting program
Voice
participants at greatest risk of not completing a col ege degree due to COVID-19
education disruption.
253. Jayapal (WA), Hayes (CT), Moulton (MA), Kennedy (MA), Trahan (MA): Prohibits
5
Adopted,
use of funds to implement or enforce Secretary DeVos' Interim Final Rule entitled
Voice
“CARES Act Programs; Equitable Services to interpretation of the CARES Act to divert
federal emergency aid dol ars intended for public schools to private school students.
Students and Teachers in Non-Public Schools," an unlawful
254. Keating (MA): Increases the Bureau of Health Workforce account by $5 mil ion to
4
Adopted,
go toward the Nurse Corps Loan Repayment Program, decreases the Office of the
Voice
Secretary account by $5 mil ion.
255. Keating (MA): Increases the NIH budget by $2 mil ion to go towards a study and a
4
Adopted,
report to Congress reviewing the increased use of opioids during the COVID-19
Voice
pandemic.
256. Kelly, Robin (IL): Increases CDC firearm injury and mortality prevention research
5
Adopted,
by $5,000,000.
Voice
257. Lee, Susie (NV): Increases funding for the Ful -Service Community Schools Program 4
Adopted,
(FSCS) by $1 mil ion. This Department of Education program helps provide
Voice
comprehensive wrap-around services in schools.
258. Lee, Susie (NV), Thompson, Glenn (PA): Provides an additional $1,000,000 to Area
4
Adopted,
Health Education Centers (AHEC) within HRSA’s Bureau of Health Workforce account
Voice
to address shortages and increase diversity in communities’ health workforce pipelines
by developing education and training networks among local academic institutions and
community-based organizations. Makes corresponding reduction in the General
Departmental Management sub-account of HHS’s Office of the Secretary.
259. Levin, Andy (MI): Increases and decreases by $1 mil ion for ILAB funding with the
5
Adopted,
intent that the funds support workers’ rights and capacity to organize independent
Voice
unions in Mexico.
260. Levin, Andy (MI): Prohibits any of the funds made available by this Act to be used
5
Adopted,
by the Department of Education for Education Freedom Scholarship private school
Voice
vouchers.
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En
Bloc
Amdt. No. and Summary from the Rules Committee
No.
Disposition
261. Lujan (NM), Pappas (NH), Guthrie (KY): Increases funding for Comprehensive
4
Adopted,
Opioid Recovery Centers (CORCs) under the SAMHSA Mental Health account by $8
Voice
mil ion, bringing total funding for CORCs to the ful $10 mil ion authorized by the
SUPPORT Act. Offset by a corresponding reduction to HHS Office of the Secretary.
262. Maloney, Sean (NY): Increases and decreases funding by $10 mil ion in the Institute
4
Adopted,
of Museum and Library Services account to highlight the need for technological
Voice
advancements, like Wi-Fi and computers, in Libraries, especial y those in communities
that are economically distressed.
263. McAdams (UT): Increases funding for the Suicide Lifeline program under the
4
Adopted,
SAMHSA Mental Health account by $4 mil ion with offsets.
Voice
264. McBath (GA): Increases funding for CDC Injury Prevention and Control fund by
5
Adopted,
$5,000,000, decreases the General Departmental Management fund under the office of
Voice
the HHS Secretary by $5,000,000.
265. McBath (GA), Speier (CA), Dingell (MI), Moore (WI), Kuster (NH): Increase overall 4
Adopted,
budget for Children and Family Services by $5,000,000, thereby increasing the budget
Voice
for FVPSA by $5,000,000. Decrease the General Departmental Management fund under
the Office of the HHS Secretary by $5,000,000.
266. McKinley (WV), Pascrell (NJ): Provides an additional $1 mil ion to the Alternatives
4
Adopted,
to Opioids in the Emergency Department which is authorized in Section 7091 of the
Voice
SUPPORT for Patients and Communities Act, P.L. 115-271.
267. McKinley (WV), Doyle (PA): Funds Sec. 7081 of the SUPPORT Act, preventing
4
Adopted,
overdoses while in emergency rooms by creating a coordinated care model.
Voice
268. Newhouse (WA): Strikes Section 247 of Title II, which prohibits the use of funds to 3
Rejected,
implement, enforce, or otherwise give effect to the revision to section 447.10 of title 42,
voice
Code of Federal Regulations, contained in the final rule entitled ‘‘Medicaid Program;
Reassignment of Medicaid Provider Claims’ (84 Fed. Reg. 19718 (May 6, 2019)).
269. Norcross (NJ): Increases and decreases OSHA by $5 mil ion with the intent of
5
Adopted,
directing them to issue a comprehensive emergency temporary standard to protect
Voice
workers, employers, and customers from the COVID19 pandemic.
270. Norcross (NJ): Increases and decreases the Public Health and Social Services
5
Adopted,
Emergency Fund by $5 mil ion with the intention of directing the Department to
Voice
establish a nationwide standard for diagnostic testing and contact tracing related to
COVID-19. The standard should focus on child care facilities, child care providers,
parents, and anyone who may come in contact with a child care setting.
271. Norcross (NJ), Hartzler (MO): Appropriates $11.5 mil ion for military and civilian
4
Adopted,
partnership for trauma readiness grants as authorized by section 204 of the Pandemic
Voice
and All-Hazards Preparedness and Advancing Innovation Act of 2019.
272. Omar (MN): Transfers $1 mil ion to the CDC with the intention that the agency
4
Adopted,
use the funds to conduct a study on the health impacts of mercury exposure caused by
Voice
the use of commercial skin lightening products.
273. Panetta (CA), Yarmuth (KY), Davis, Danny K. (IL), Hastings (FL): Increases and
4
Adopted,
decreases School Improvement Programs funding by $1 mil ion to emphasize the need
Voice
for additional funding for the McKinney Vento Homeless Assistance Act’s Education for
Homeless Children and Youth program (EHCY).
274. Pappas (NH), Gooden (TX), Suozzi (NY), Kustoff (TN), Brindisi (NY), Trone (MD):
4
Adopted,
Increases and decreases by $4,000,000 funding for NIH Office of the Director in order
Voice
to establish a pilot program to support research and development jointly with Israel for
effective responses to COVID-19
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En
Bloc
Amdt. No. and Summary from the Rules Committee
No.
Disposition
275. Pascrell (NJ), Bacon (NE): Decreases the General Departmental Management
4
Adopted,
funding by $1 mil ion and provides funding $1 mil ion for the National Concussion
Voice
Surveillance System within the Centers for Disease Control and Prevention, authorized
by 42 U.S.C. 280b-3.
276. Perlmutter (CO), Wilson, Joe (SC), Lujan (NM), Crow (CO): Increases the Energy
4
Adopted,
Employees Occupational Il ness Program by $2 mil ion in order to fund the Department
Voice
of Labor Office of the Ombudsman through Fiscal Year 2021.
277. Perlmutter (CO): Increases the Energy Employees Occupational Il ness Program by
4
Adopted,
$300,000 to fund a support contractor for the Advisory Board on Toxic Substances and
Voice
Worker Health and help the Board fulfil its legislative mandate.
278. Porter (CA): Ensures that ACA open enrol ment data is disaggregated by race,
5
Adopted,
ethnicity, preferred language, age, and sex to support better understanding of
Voice
enrol ment information.
279. Porter (CA): Increases funding to provide $500,000 for the Maternal Mental Health
4
Adopted,
Hotline.
Voice
280. Porter (CA): Increases funding to provide $55,500,000 for the Child Care Access
4
Adopted,
Means Parents in School Program (CCAMPIS).
Voice
281. Pressley (MA): Increases funding by $5 million for the National Institute of Arthritis
4
Adopted,
and Musculoskeletal and Skin Diseases, which conducts research for alopecia areata, by
Voice
decreasing the General Departmental Management budget for the Department of
Health and Human Services' Office of the Secretary.
282. Richmond (LA): Increases and decreases Student Support and Academic
4
Adopted,
Enrichment State Grants by $1 mil ion to focus additional efforts on comprehensive
Voice
dropout prevention programs including those with experiential learning components.
283. Schakowsky (IL): Providing $1,000,000 in funding for an interagency Col ege
5
Adopted,
Campus Task Force on mental and behavioral health and $1,000,000 for efforts aimed at
Voice
reducing the stigma associated with mental health services to ensure that students at
institutions of higher education have the support they need to successful y complete
their education, as authorized in the 21st Century Cures Act (P.L. 114-255).
284. Schrier (WA): Increases funding for vaccines by $2 mil ion and reduce by $2 mil ion
5
Adopted,
the Office of the Secretary of Health and Human Services to ensure that the Centers
Voice
for Disease Control and Prevention (CDC) has the resources to disaggregate, detailed
vaccination acceptance data by race and ethnicity.
285. Schrier (WA): Increases then decrease by $200 mil ion funding to promote
4
Adopted,
innovation in antibacterial research and development by funding the CARB-X program
Voice
that develops products directly supporting the government-wide National Action Plan
for Combating AntibioticResistant Bacteria.
286. Sherril (NJ): Increases and decreases funds by $20,000,000 to highlight the need for 5
Adopted,
the Mental and Substance Use Disorder Workforce Training Demonstration Program
Voice
under HRSA Health Workforce.
287. Sherril (NJ): Increases the National Institute of Mental health budget by $5,000,000
4
Adopted,
to address youth mental health disparities.
Voice
288. Slotkin (MI): Increases and decreases the Institute of Education Sciences by
5
Adopted,
$1,000,000 to highlight the need for academic research on issues of racial inequality.
Voice
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En
Bloc
Amdt. No. and Summary from the Rules Committee
No.
Disposition
289. Smith, Christopher (NJ), Peterson (MN), Stefanik (NY), Delgado (NY), Rose, Max
4
Adopted,
(NY): Redirects $4 mil ion from General Departmental Management at the Department
Voice
of Health and Human Services to Emerging Zoonotic and Infectious Diseases at the
Centers for Disease Control, for Lyme Disease and other Vector-Borne Diseases. (10
minutes)
290. Smith, Jason (MO): Increases and decreases funds by $1 mil ion to highlight the
4
Adopted,
need for the Secretary of HHS, in col aboration with the HHS Assistant Secretary for
Voice
Preparedness and Response, the FDA Commissioner, the CDC Director, and the
Secretary for Homeland Security, to determine, and annually update, a list of 300-400
medications for which it is critical that the Federal government ensure availability in the
event of a public health emergency.
291. Speier (CA), Dingell (MI), Moore (WI), McBath (GA), Haaland (NM): Increases
4
Adopted,
funding for the Rape, Prevention and Education program by $5.25 mil ion to ensure that
Voice
diverse stakeholders, including educational institutions, rape crisis centers, community
organizations and state agency partners have sufficient resources to implement their
programming to prevent sexual violence.
292. Speier (CA), Jayapal (WA), Jackson Lee (TX), Rice, Kathleen (NY), Tlaib
5
Adopted,
(MI): Increases funding for OSHA’s Whistleblower Protection Program by $1,436,000 in
Voice
order to ensure the office that enforces over 20 whistleblower laws has the funding
needed to respond to the increase in complaints related to the COVID-19 pandemic.
Decreases funding for the Office of the Secretary by $2,436,000.
293. Stauber (MN), Young (AK): Increases SAMHSA for American Indian and Alaska
4
Adopted,
Native Suicide Prevention by $2,869,000 to combat the rampant suicide of Native
Voice
Americans.
294. Stevens (MI), Wasserman Schultz (FL): Reduces and increases funds by $5 mil ion in
4
Adopted,
the CDC's Injury Prevention and Control account to highlight the need to fund the
Voice
CDC's work on drowning prevention.
295. Taylor (TX), Shalala (FL): Requires the Secretary of the Department of Health and
4
Adopted,
Human Services to enter into an agreement with the National Academies of Science,
Voice
Engineering, and Medicine to commission a report on the differences between state,
local, and federal vital statistics and death reporting standards; to provide
recommendations on how to harmonize these standards; and provide information on
the feasibility of establishing and implementing national standards for vital statistics and
death reporting.
296. Taylor (TX): Increases and decreases funds by $1 mil ion with the intention of
3
Rejected,
requiring the Inspector General of the Department of Labor to report on the Bureau of
voice
Labor Statistics (BLS) media lock-ups, including a comparison to the Federal Reserve’s
media lock-up and best practices for market moving information from the Federal
Reserve and BLS, examine the ability of the Federal Reserve to release more market
moving information such as the BLS economic data, if discontinuing media lock-ups pose
a single point of failure security risk, determine best practices to ensure equal access by
traders, determine best practices to enable media access to examine data prior to
releases, and determine if lock-ups pose a cybersecurity concern.
297. Trahan (MA), Jayapal (WA): Increases and decreases funding under Title I of the
5
Adopted,
Elementary and Secondary Education Act of 1965 (referred to in this Act as ‘ ESEA’’) to
Voice
underscore congressional intent that funding designated as emergency aid during the
COVID-19 pandemic not be redirected by the Secretary of Education away from public
elementary and secondary schools to private schools unless specifically authorized under
such Acts, the ESEA, IDEA, or other law in effect prior to the enactment of this Act.
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Labor, Health and Human Services, and Education: FY2021 Appropriations

En
Bloc
Amdt. No. and Summary from the Rules Committee
No.
Disposition
298. Trahan (MA), Correa (CA): Increases and decreases the Program Administration
5
Adopted,
account at the Department of Education to il ustrate the serious consequences of using
Voice
federal funding to coerce schools into resuming in-person instruction as they reopen
during the COVID-19 pandemic.
299. Trahan (MA): Increases and decreases funding at the HHS Office of the Secretary
5
Adopted,
General Management account for the intention of directing the Secretary to engage the
Voice
National Academies of Sciences, Engineering, and Mathematics to study the health
effects and injury impacts caused by the use of kinetic impact projectiles.
300. Trone (MD), Gallagher (WI): Increases funding by $1 mil ion for SAMHSA’s mental
4
Adopted,
health programs to implement an Interagency Task Force on Trauma-Informed Care to
Voice
identify and disseminate evidence based approaches on prevention and identification of
trauma, community-based practices to support children and their families, and
opportunities for state- and local-level partnerships, as authorized by the SUPPORT for
Patients and Communities Act. Decreases by $1 mil ion the Office of the Secretary -
General Departmental Management.
301. Velázquez (NY): Prevents funds from this Act from being used to reject grant
5
Adopted,
applications due to the use of the term “vulnerable," "entitlement," "diversity,"
Voice
"transgender," "fetus," "evidence-based", or "science-based”.
302. Waters (CA), Schakowsky (IL), Dingell (MI): Prohibits the use of funds to
5
Adopted,
implement the Administration’s July 2019 proposed rule, ‘‘Medicare and Medicaid
Voice
Programs; Requirements for Long-Term Care Facilities: Regulatory 5 Provisions To
Promote Efficiency, and Transparency” which deregulates nursing homes and weakens
infection prevention standards in nursing homes.
303. Waters (CA), Watson Coleman (NJ): Prohibits the use of funds to require
5
Adopted,
hospitals, hospital laboratories, and acute care facilities to report COVID-19 data using
Voice
the “teletracking.protect.hhs.gov” website that was announced by the Department of
Health and Human Services in the document entitled “COVID-19 Guidance for Hospital
Reporting and FAQs for Hospitals, Hospital Laboratory, and Acute Care Facility Data
Reporting Updated July 10, 2020”, instead of the CDC.
304. Waters (CA), Lee, Barbara (CA), Chu (CA): Increases funds for the Minority AIDS
4
Adopted,
Initiative by $5 mil ion and reduces remaining funds for the Office of the Secretary, HHS,
Voice
General Departmental Management, by the same amount.
305. Waters (CA), Smith, Christopher (NJ): Increases funds for the BOLD
4
Adopted,
Infrastructure for Alzheimer’s Act, within the CDC’s “Chronic Disease Prevention and
Voice
Health Promotion” account, by $5 mil ion and reduces funds for the Office of the
Secretary, HHS, General Departmental Management, by the same amount.
306. Waters (CA), Schakowsky (IL): Increases funds for the Alliance for Innovation on
4
Adopted,
Maternal Health (AIM) within HRSA’s Maternal and Child Health account by $5 mil ion
Voice
and reduces funds for the Office of the Secretary, HHS, General Departmental
Management, by the same amount.
307. Watson Coleman (NJ): Increases and decreases funds by $500,000 to highlight the
5
Adopted,
need for a GAO study examining: 1) whether public health entities are including racial
Voice
and ethnic demographic data when reporting COVID–19 cases & deaths, identifying
challenges, and recommendations for improvement; and 2) whether changes after July
10 to HHS reporting requirements make it more difficult to report demographic data.
308. Watson Coleman (NJ): Increases and decreases funds by $5,000,000 to highlight
5
Adopted,
the need for a GAO study auditing hiring, retention, and promotion practices at CDC
Voice
to evaluate whether current policies equitably support staff of color, and identifying
recommendations to remedy disparities.
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Labor, Health and Human Services, and Education: FY2021 Appropriations

En
Bloc
Amdt. No. and Summary from the Rules Committee
No.
Disposition
309. Wright (TX), Foxx (NC): Strikes Sec. 114 in division F, removing the prohibition
3
Rejected,
against DOL OFCCP's rule Implementing Legal Requirements Regarding the Equal
voice
Opportunity Clause’s Religious Exemption from taking effect.
Sources: The amendment numbers and summaries are from H.Rept. 116-461. En bloc amendment numbers are
from Congressional Record, daily edition, Vol. 166, No. 135 (July 30, 2020), pp. H4134-H4139, H4143-H4169. The
amendment dispositions are from Congress.gov.
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link to page 76 link to page 76 Labor, Health and Human Services, and Education: FY2021 Appropriations

Appendix C. Enacted FY2021 LHHS Supplemental
Appropriations
Five appropriations acts have been signed into law related to the COVID-19 pandemic. Four of
these provided FY2020 supplemental discretionary appropriations for LHHS programs and
activities, and one provided FY2021 supplemental discretionary appropriations. All five of these
are summarized in CRS Report R46775, Overview of COVID-19 LHHS Supplemental
Appropriations: FY2020 and FY2021.
For FY2021, the same law that provided “regular” annual LHHS appropriations for FY2021 in
Division H also provided supplemental discretionary appropriations in Division M (H.R. 133,
P.L. 116-260). This law, which was enacted on December 27, 2020, provided a total of $154.9
billion in supplemental LHHS funds (Title III, Coronavirus Response and Relief Supplemental
Appropriations Act, 2021; CRRSA).123 Unlike the regular discretionary appropriations in
Division H, 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).124
In addition, prior to the end of FY2021, a second supplemental appropriations act containing
LHHS appropriations was enacted (P.L. 117-31) on July 30, 2021. This law provided $25 million
in supplemental appropriations for the Refugee and Entrant Assistance account at HHS for
specified purposes related to Afghan special immigrants.
The FY2021 discretionary regular and supplemental LHHS appropriations are summarized in
Table C-1. In total, FY2021 supplemental appropriations increased regular FY2021 LHHS
enacted funding by about 78%. This funding was split roughly equally between HHS (48%) and
ED (53%). (None was enacted for DOL or RA.) The ED supplemental funding budgetary increase
of $82 billion was 112% of its FY2021 regular appropriations. HHS regular appropriations were
increased by 75% (+$73 billion).125
The majority of HHS funds (66%) in the FY2021 supplemental appropriations measure were
appropriated to the Public Health and Social Services Emergency Fund (PHSSEF) within the
Office of the Secretary. 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 in the Office of the HHS Assistant Secretary for Preparedness and
Response.
Accounts at the CDC received approximately 12% of the supplemental HHS appropriations
provided in the FY2021 supplemental measure, which more than doubled its discretionary
funding level for FY2021. The FY2021 supplemental appropriations also increased SAMHSA
funding by 72%, and ACF funding by 42%. Remaining supplemental appropriations to NIH and

123 This amount excludes funding appropriated in Title 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. It also does not
include funds provided in other titles and divisions of this law. For instance, $175 million in mandatory funds provided
to ACL Aging and Disability Services Programs for nutrition services provided in Title VII of Division N.
124 Division H also included $1.6 billion in emergency-designated funding, but these are not considered to be “regular”
annual appropriations. These are thus excluded from the “regular appropriations” numbers in Table C-1.
125 For a discussion of the FY2020 and FY2021 COVID-19-related supplemental appropriations for the Public Health
Service Agencies at HHS, see CRS Report R46711, U.S. Public Health Service: COVID-19 Supplemental
Appropriations in the 116th Congress.
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Labor, Health and Human Services, and Education: FY2021 Appropriations

ACL augmented total agency funding levels to a lesser extent. No FY2021 supplemental funds
were appropriated to HRSA, CMS, or AHRQ.
The majority of ED funds ($81.9 billion or 99.9%) in the FY2021 supplemental appropriations
measure were for the Education Stabilization Fund (ESF). The ESF supports three emergency
relief funding streams: (1) a Governor’s Emergency Education Relief (GEER) Fund, (2) an
Elementary and Secondary School Emergency Relief (ESSER) Fund, and (3) a Higher Education
Emergency Relief Fund (HEERF). The ESF is not typically funded in regular appropriations acts.
Remaining FY2021 supplemental funds for ED, which combined to account for 0.1% of ED’s
FY2021 supplemental funds, went to accounts that typically receive regular appropriations,
including accounts for Student Aid Administration, the Institute for Education Sciences, Special
Institutions for People with Disabilities, Howard University, and Departmental Management.
Table C-1. Summary of Enacted FY2021 Discretionary Regular and Supplemental
Appropriations
(Budget authority in millions of dollars)
FY2021
CRRSA,
P.L. 117-
Grand

Regular
Title III
31
Total
Department of Labor
12,536
-
-
12,536
Department of Health and Human Services
96,963
72,945
25
169,933
HRSA
7,218
-
-
7,218
CDC
6,963
8,750
-
15,713
NIH
41,437
1,250
-
42,687
SAMHSA
5,870
4,250
-
10,120
AHRQ
338
-
-
338
CMS
4,477
-
-
4,477
ACF
24,695
10,250
25
34,970
ACL
2,258
100
-
2,358
OS
3,706
48,345
-
52,051
Department of Education
73,537
82,000
-
155,537
Related Agencies
15,459
-
-
15,459
LHHS Total:
198,494
154,945
25
353,464
Sources: Compiled by CRS from LHHS amounts specified in P.L. 116-260, Divisions H and Title III of M, and
P.L. 117-31. This report excludes funding appropriated to the Food and Drug Administration (FDA) Salaries and
Expenses account in Title III (P.L. 116-260, Division M), as this funding is generally not under the purview of the
LHHS appropriations act. This table does not include the $1.6 bil ion in emergency-designated funding enacted in
Division H of P.L. 116-260, as these generally are not considered to be “regular appropriations.” Funds provided
in other titles and divisions of this law are beyond the scope of this report and are excluded from the table. (For
instance, the table does not include $175 mil ion in mandatory funds provided to ACL Aging and Disability
Services Programs for nutrition services provided in Title VII of Division N, P.L. 116-260.) FY2021 regular
amounts include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255).
Notes: All supplemental funds are designated as an emergency requirement. The display of funds in this table is
based on the accounts in which they were appropriated. When the supplemental bil text calls for transfers,
funds are tabulated based on the account to which they were appropriated, not on the account to which they
are to be transferred. For further information about how these funds were distributed, see CRS Report R46775,
Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021.
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Labor, Health and Human Services, and Education: FY2021 Appropriations

Author Information

Karen E. Lynch, Coordinator
David H. Bradley
Specialist in Social Policy
Specialist in Labor Economics

Jessica Tollestrup, Coordinator
Angela Napili
Specialist in Social Policy
Senior Research Librarian

Kyle D. Shohfi
William R. Morton
Analyst in Education Policy
Analyst in Income Security

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or
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