Full text
COVID-19
HHS Funds Allocated
to Support
Disproportionately
Affected Communities
Report to Congressional Addressees
January 2023
GAO-23-105500
United States Government Accountability Office
United States Government Accountability Office
Highlights of GAO-23-105500, a report to
congressional addressees
January 2023
COVID-19
HHS Funds Allocated to Support Disproportionately
Affected Communities
What GAO Found
The Department of Health and Human Services (HHS) provided $75 billion in
pandemic relief funding from its Public Health and Social Services Emergency
Fund to four agencies: the Centers for Disease Control and Prevention (CDC),
Health Resources and Services Administration, Indian Health Service, and Office
of Minority Health. CDC received more than half of the funding. GAO found that
these agencies directed $29 billion (over 35 percent) of this funding to programs
specifically supporting communities disproportionately affected by COVID-19. In
addition, the agencies allocated $33 billion to programs with a recommendation
that awardees—often state health departments—support such communities with
the funds.
HHS Agencies’ Allocations of Selected Funds to Programs Supporting Communities
Disproportionately Affected by COVID-19
Note: Amounts do not sum to $75 billion in pandemic relief funding due to rounding.
aHHS officials told GAO that many recipients opted to support disproportionately affected
communities with these funds.
States had discretion in targeting the allocation and use of federal relief funds
provided through various CDC programs. Five selected states GAO reviewed
allocated selected CDC funds to support a range of COVID-19 testing,
vaccination, and other response efforts in disproportionately affected
communities. However, state officials reported challenges in doing so—
challenges that CDC officials said many other states faced:
•
Delays in state acceptance of federal funds. The health departments in
three selected states waited between 3 and 9 months for the state to accept
certain funds awarded by CDC.
•
Capacity challenges. Consistent with findings in other GAO work, all five
selected states reported hiring and workload issues, as well as challenges
due to the limited capacity of local partners, which constrained their efforts to
allocate and use the CDC funds.
View GAO-23-105500. For more information,
contact Carolyn L. Yocom at (202) 512-7114
or YocomC@gao.gov.
Why GAO Did This Study
Between March 2020 and March 2021,
six pandemic relief laws appropriated
billions of dollars to HHS’s Public
Health and Social Services Emergency
Fund. This fund is used for HHS
emergency preparedness and
response activities, including
addressing the health effects felt
disproportionately among certain
communities.
The CARES Act includes a provision
for GAO to report on its ongoing
COVID-19 monitoring and oversight
efforts. GAO was also asked to review
how HHS allocated pandemic relief
funds to support communities
disproportionately affected by COVID-
19. This report describes (1) how much
four HHS agencies allocated to support
communities disproportionately
affected by COVID-19; and (2) how a
sample of states allocated selected
funding from CDC to support
disproportionately affected
communities.
GAO reviewed agency data and
documentation, and interviewed
agency officials from the four HHS
agencies. GAO also reviewed
documentation and interviewed health
department officials from five states.
The states—Arizona, Louisiana,
Michigan, New Hampshire, and
Washington—were selected to reflect
variation in geography and racial and
ethnic populations, among other
characteristics.
HHS provided technical comments on
a draft of this report, which were
incorporated as appropriate.
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GAO-23-105500 Pandemic Relief Funds
Letter
1
Background
4
HHS Agencies Allocated Over 35 Percent of $75 Billion in Relief
Funds to Specifically Support Communities Disproportionately
Affected by
8
COVID-19
8
Selected States Allocated CDC Funds for a Range of Activities to
Support Disproportionately Affected Communities; All Reported
Challenges
14
Agency Comments
22
Appendix I
Programs Specifically Supporting Communities Disproportionately
Affected by COVID-19 with Selected Pandemic Relief Funds
26
Appendix II
GAO Contact and Staff Acknowledgments
28
Tables
Table 1: Four HHS Agencies’ Roles in Supporting Public Health
7
Table 2: Allocation of $29 Billion in Selected Pandemic Relief
Funds Specifically Supporting Communities
Disproportionately Affected by COVID-19, by HHS
Agency
10
Table 3: CDC Programs Funded with Selected Pandemic Relief
Funds with Guidance Recommending Support for
Communities Disproportionately Affected by COVID-19
11
Table 4: Examples of New HHS Programs Supporting
Communities Disproportionately Affected by COVID-19
with Selected Pandemic Relief Funding
12
Table 5: Examples of Existing HHS Programs That Received
Selected Pandemic Relief Funds to Support COVID-19
Response Activities for Disproportionately Affected
Communities
13
Table 6: Examples of How Selected States Allocated CDC
Program Funds to Support Disproportionately Affected
Communities
18
Table 7: HHS Agencies’ Allocations of Selected Pandemic Relief
Funds to Programs Specifically Supporting Communities
Disproportionately Affected by COVID-19
26
Contents
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GAO-23-105500 Pandemic Relief Funds
Figures
Figure 1: Examples of Communities Disproportionately Affected
by COVID-19
5
Figure 2: Timeline of Appropriation of Selected Pandemic Relief
Funds Provided to Four HHS Agencies
6
Figure 3: HHS Agencies’ Allocations of Selected Pandemic Relief
Funds to Programs Supporting Communities
Disproportionately Affected by COVID-19
9
Figure 4: Examples of Selected States’ Allocations of COVID-19
Health Disparities Program Funds to Support
Disproportionately Affected Communities
16
Abbreviations
CDC
Centers for Disease Control and Prevention
HRSA
Health Resources and Services Administration
HHS
Department of Health and Human Services
IHS
Indian Health Service
OMH
Office of Minority Health
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GAO-23-105500 Pandemic Relief Funds
441 G St. N.W.
Washington, DC 20548
January 24, 2023
Congressional Addressees
The COVID-19 pandemic has had widespread effects on the health of the
nation, including more than one million deaths attributed to the disease.
These effects, however, have been uneven, with certain communities
experiencing disproportionate health outcomes related to COVID-19,
such as hospitalizations and deaths. For example, available Centers for
Disease Control and Prevention (CDC) data indicate that Hispanic or
Latino individuals, as well as non-Hispanic Black or African American and
American Indian or Alaska Native individuals have been hospitalized with
COVID-19 at a rate two or more times that of non-Hispanic White
individuals.1 According to CDC, individuals over age 65, individuals living
in rural communities, and others have also seen worse outcomes due to
the pandemic.
From March 2020 through March 2021, six pandemic relief laws
appropriated funds to support the Department of Health and Human
Services’ (HHS) COVID-19 response efforts.2 HHS reported that together,
these laws appropriated about $349 billion to HHS’s Public Health and
Social Services Emergency Fund, a budget account used to fund HHS
emergency preparedness and response activities. The majority of the
1Hospitalization rates are adjusted by age and reflect data as of September 2022. Rates
are based on COVID-NET, a CDC surveillance system that collects data on COVID-19-
associated hospitalizations confirmed by laboratory testing, in select counties in 13 states
representing about 10 percent of the U.S. population. See Centers for Disease Control
and Prevention, “Risk for COVID-19 Infection, Hospitalization, and Death By
Race/Ethnicity,” accessed November 1, 2022, https://www.cdc.gov/coronavirus/2019-
ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html.
2For the purposes of our review, these pandemic relief laws consist of the six laws
providing comprehensive relief across federal agencies and programs that the Department
of the Treasury uses to report COVID-19 spending. These six laws are the American
Rescue Plan Act of 2021, Pub. L. No. 117-2, 135 Stat. 4; Consolidated Appropriations Act,
2021, Pub. L. No. 116-260, 134 Stat. 1182 (2020); Paycheck Protection Program and
Health Care Enhancement Act, Pub. L. No. 116-139, 134 Stat. 620 (2020); CARES Act,
Pub. L. No. 116-136, 134 Stat. 281 (2020); Families First Coronavirus Response Act, Pub.
L. No. 116-127, 134 Stat. 178 (2020); and the Coronavirus Preparedness and Response
Supplemental Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146.
Letter
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GAO-23-105500 Pandemic Relief Funds
$349 billion was for providing relief to health care providers and activities
such as developing and procuring COVID-19 tests and vaccines.3
According to HHS, about $75 billion of the $349 billion went to CDC, the
Health Resources and Services Administration (HRSA), the Indian Health
Service (IHS), and HHS’s Office of Minority Health (OMH) for their
COVID-19 response efforts; CDC received more than half of these funds.
In this report, we refer to the $75 billion provided to these four agencies
as selected pandemic relief funds.4 The four agencies, which we refer to
collectively as HHS agencies, allocated these funds to a range of federal
programs, including programs that awarded relief funds to states.5 States,
in turn, had some discretion within federal guidelines in allocating and
using those funds.
The CARES Act includes a provision for GAO to report on its ongoing
monitoring and oversight efforts related to the COVID-19 pandemic.6 In
addition, you asked us to examine HHS’s allocation of pandemic relief
funds to support communities disproportionately affected by COVID-19. In
this report, we describe
1. how much of the selected pandemic relief funding CDC, HRSA,
IHS, and OMH allocated to support communities
disproportionately affected by COVID-19; and
2. how a sample of states allocated selected pandemic relief funding
from CDC to support disproportionately affected communities.
To describe how much of the selected pandemic relief funding CDC,
HRSA, IHS, and OMH allocated to support communities
disproportionately affected by COVID-19, we reviewed data from these
four agencies on their allocation of the funds by activity and program. We
also reviewed agency documentation and interviewed officials to identify
3For GAO work on the use of these funds, see GAO, COVID-19: Current and Future
Federal Preparedness Requires Fixes to Improve Health Data and Address Improper
Payments, GAO-22-105397 (Washington, D.C.: Apr. 27, 2022).
4In addition to funds appropriated to CDC, HRSA, and IHS through the Public Health and
Social Services Emergency Fund, the six pandemic relief laws also appropriated funds to
these agencies outside of this fund.
5States also received other federal funding to support their COVID-19 response efforts
through other programs and agencies.
6Pub. L. No. 116-136, § 19010(b), 134 Stat. 281, 580 (2020). All of GAO’s reports related
to the COVID-19 pandemic are available on GAO’s website at
https://www.gao.gov/coronavirus.
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GAO-23-105500 Pandemic Relief Funds
the purposes and communities supported by the funds, how funds were
allocated, and whether the programs were established since the COVID-
19 pandemic began.7 We compared agency information on communities
supported with the funds with the communities identified by the
Presidential COVID-19 Health Equity Task Force as having been
disproportionately affected by COVID-19.8 We determined the amount of
funds allocated to programs (1) with a stated purpose of supporting
disproportionately affected communities; (2) with a recommendation that
awardees use funds to support these communities; and (3) without a
requirement or recommendation that the funds directly support these
communities. Amounts include costs associated with the administration of
these programs. To assess the reliability of the agencies’ data, we
discussed them with agency officials and reviewed them for
completeness and consistency with agency documentation; we found the
data to be sufficiently reliable for our purposes.
To describe how a sample of states allocated selected pandemic relief
funds from CDC to support disproportionately affected communities, we
reviewed documents and interviewed health department officials from five
states: Arizona, Louisiana, Michigan, New Hampshire, and Washington.
We selected these states to provide variation in geographic location, the
degree to which state public health infrastructures were centralized or
decentralized, and racial and ethnic population distribution. We focused
on states’ allocation of funds from five CDC programs, each of which
accounted for at least $1 billion in pandemic relief funds and provided
funds directly to states to allocate within federal guidelines.9 We reviewed
7For the purposes of our analysis, we considered new activities (such as COVID-19
testing) that were funded through programs that existed prior to the pandemic as existing
programs.
8Specifically, we assessed whether the communities supported by agency programs
funded by selected pandemic relief funds matched communities listed in the Presidential
COVID-19 Health Equity Task Force Final Report. Department of Health and Human
Services, Office of the Assistant Secretary for Health, Presidential COVID-19 Health
Equity Task Force Final Report and Recommendations (Washington, D.C.: October
2021).
9These five CDC programs are the National Initiative to Address COVID-19 Health
Disparities Among Populations at High-Risk and Underserved Communities, Including
Racial and Ethnic Minority Populations and Rural Communities (National Initiative to
Address COVID-19 Health Disparities) program; two programs focusing on COVID-19
testing, surveillance, and related activities—the Epidemiology and Laboratory Capacity for
Prevention and Control of Emerging Infectious Diseases (Epidemiology and Laboratory
Capacity) Enhancing Detection and Reopening Schools programs; and two focusing on
the public health workforce (the COVID-19 Crisis Response program, and Disease
Intervention Specialists Workforce Development program).
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GAO-23-105500 Pandemic Relief Funds
documents states submitted to CDC, such as work plans and progress
reports that described funding allocations and any challenges states
faced allocating funds. In addition, we interviewed state health
department officials about how, if at all, they allocated funds to support
disproportionately affected communities; we also asked them open-ended
questions about challenges they faced allocating and using funds to
support those communities. We also asked CDC officials whether other
states had reported experiencing the same challenges our selected states
identified.
We conducted this performance audit from October 2021 through January
2023 in accordance with generally accepted government auditing
standards. Those standards require that we plan and perform the audit to
obtain sufficient, appropriate evidence to provide a reasonable basis for
our findings and conclusions based on our audit objectives. We believe
that the evidence obtained provides a reasonable basis for our findings
and conclusions based on our audit objectives.
COVID-19 has had a disproportionate effect on the health of a range of
communities in the United States. Certain groups of people, for example,
have been at increased risk of COVID-19 exposure based on where they
live or work. In addition, certain groups have been at increased risk of
severe illness, hospitalization, or death.10 (See fig. 1.) For some people,
their characteristics or circumstances include them in more than one of
the communities disproportionately affected by COVID-19. In addition, the
pandemic’s effect on communities has changed over time, including as a
result of the introduction of vaccines and new COVID-19 variants.11 For
example, during the initial months of the pandemic, urban counties had
higher rates of COVID-19 deaths than rural counties. Later, rural counties
10For example, people who are older, have certain underlying medical conditions, or are
pregnant are at increased risk for severe illness, hospitalization, and death due to COVID-
19. See Centers for Disease Control and Prevention, “Understanding Risk,” accessed
October 26, 2022, https://www.cdc.gov/coronavirus/2019-ncov/your-health/understanding-
risk.html.
11COVID-19 variants have led to changing effects on communities. The Omicron variant
led to a surge in COVID-19 cases in December 2021 and January 2022, according to
CDC estimates. Death rates during this surge were relatively higher among people over
age 65, Black or African American and Hispanic or Latino individuals, and other
communities. See Centers for Disease Control and Prevention, “COVID Data Tracker:
COVID-19 Weekly Cases and Deaths per 100,000 Population by Age, Race/Ethnicity, and
Sex,” accessed September 6, 2022, https://covid.cdc.gov/covid-data-
tracker/#demographicsovertime.
Background
Communities
Disproportionately
Affected by COVID-19
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GAO-23-105500 Pandemic Relief Funds
had increasing COVID-19 death rates, including rates that at times
surpassed urban counties’ rates.12
Figure 1: Examples of Communities Disproportionately Affected by COVID-19
From March 2020 through March 2021, six pandemic relief laws
appropriated about $484 billion for HHS and its agencies to support
COVID-19 response efforts. According to HHS, most of these funds—
$349 billion—were appropriated to its Public Health and Social Services
12See Centers for Disease Control and Prevention, “COVID Data Tracker: Trends in
COVID-19 Cases and Deaths in the United States, by County-level Population Factors,”
accessed September 6, 2022, https://covid.cdc.gov/covid-data-tracker/#pop-
factors_7daynewdeaths.
Federal Funding for HHS
COVID-19 Response
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GAO-23-105500 Pandemic Relief Funds
Emergency Fund. Of this $349 billion, $75 billion was provided to CDC,
HRSA, IHS, and OMH.13 (See fig. 2.)
Figure 2: Timeline of Appropriation of Selected Pandemic Relief Funds Provided to Four HHS Agencies
Notes: Amounts include appropriations to HHS’s Public Health and Social Services Emergency Fund
that were provided to the Centers for Disease Control and Prevention (CDC), the Health Resources
and Services Administration (HRSA), the Indian Health Service (IHS), and HHS’s Office of Minority
Health (OMH). Amounts do not include other funds CDC, HRSA, and IHS received for COVID-19
response, outside of the Public Health and Social Services Emergency Fund. Amounts also do not
include funds appropriated to the Public Health and Social Services Emergency Fund for the Provider
Relief Fund administered by HRSA, which reimburses eligible health care providers for health care-
related expenses or lost revenues attributable to COVID-19.
In addition to the $75 billion provided to CDC, HRSA, IHS, and OMH
through HHS’s Public Health and Social Services Emergency Fund, the
six pandemic relief laws also appropriated funds to CDC, HRSA, and IHS
outside of this fund. Some of these other funds could be used for
programs and activities similar to those funded through HHS’s Public
Health and Social Services Emergency Fund. For example, CDC
13Also included in the $349 billion was $178 billion for the Provider Relief Fund, which is
administered by HRSA, and about $96 billion for other HHS agencies and offices, such as
the Office of the Assistant Secretary for Preparedness and Response, the Office of the
Assistant Secretary for Health, the Food and Drug Administration, and the National
Institutes of Health, which we did not include in our scope.
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GAO-23-105500 Pandemic Relief Funds
received funds from multiple sources to support COVID-19 vaccination
efforts.
The four HHS agencies—CDC, HRSA, IHS, and OMH—all play a role in
supporting public health and have existing programs that support a range
of organizations and communities, which can be leveraged in times of
emergencies. (See table 1.) For example, CDC provides funding and
technical assistance to support state, local, tribal, and territorial health
department efforts to manage public health and fight infectious diseases.
Table 1: Four HHS Agencies’ Roles in Supporting Public Health
Agency
Role
Centers for Disease Control and
Prevention
Protects the public health of the nation by providing leadership and direction in the prevention and
control of diseases and other preventable conditions, and responding to public health emergencies.
Health Resources and Services
Administration
Supports health care for people who are geographically isolated, or economically or medically
vulnerable.
Indian Health Service
Provides American Indians and Alaska Natives with comprehensive health services by developing
and managing programs to meet their health needsa
Office of Minority Health
Dedicated to improving the health of racial and ethnic minority populations through the development
of health policies and programs that will help eliminate disparities.
Source: GAO summary of Department of Health and Human Services (HHS) information. | GAO-23-105500
aFederally recognized tribes and individuals who meet the applicable statutory and regulatory
definitions of “Indian” have a unique political status and are eligible for certain federal programs,
benefits, and services because of that status, including health care. Racial self-identification as
American Indian or Alaska Native is distinct from political status.
HHS Agencies’ Roles in
Supporting Public Health
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GAO-23-105500 Pandemic Relief Funds
Of the $75 billion in selected pandemic relief funding that we reviewed,
HHS agencies—CDC, HRSA, IHS, and OMH—allocated more than 35
percent of the funds, or $29 billion, to programs specifically supporting
communities disproportionately affected by the pandemic; and
recommended that awardees of an additional $33 billion use the funds to
support such communities.14 The HHS agencies allocated the remaining
$14 billion without requiring or recommending that the funds support
disproportionately affected communities. (See fig. 3.)
14The $29 billion includes funding HHS agencies allocated to federal programs that
directly serve disproportionately affected communities, as well as funding HHS agencies
awarded with a requirement that the funds support disproportionately affected
communities.
HHS Agencies
Allocated Over 35
Percent of $75 Billion
in Relief Funds to
Specifically Support
Communities
Disproportionately
Affected by
COVID-19
HHS Allocated $29 Billion
to Programs Specifically
Supporting
Disproportionately
Affected Communities and
Recommended that
Awardees of Another $33
Billion Also Do So
Selected Pandemic Relief Funds
The $75 billion that was appropriated in six
COVID-19 relief laws to the Public Health and
Social Services Emergency Fund and
provided to four Department of Health and
Human Services agencies:
• Centers for Disease Control and
Prevention
• Health Resources and Services
Administration
• Indian Health Service
• Office of Minority Health
Source: GAO. | GAO-23-105500
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GAO-23-105500 Pandemic Relief Funds
Figure 3: HHS Agencies’ Allocations of Selected Pandemic Relief Funds to
Programs Supporting Communities Disproportionately Affected by COVID-19
Notes: Selected pandemic relief funds refers to $75 billion that was appropriated in six COVID-19
relief laws to the Public Health and Social Services Emergency Fund and provided to four agencies
(Centers for Disease Control and Prevention; Health Resources and Services Administration (HRSA);
Indian Health Service; and Office of Minority Health). It does not include funds for the Provider Relief
Fund administered by HRSA, which reimburses eligible health care providers for health care-related
expenses or lost revenues attributable to COVID-19.
Communities disproportionately affected by COVID-19 include, for example, people who are older,
have certain underlying medical conditions, or are from certain ethnic and racial groups.
Amounts do not sum to $75 billion total due to rounding.
aPrograms with an agency recommendation to support refers to HHS programs with guidance
recommending that awardees—often state health departments—use funds to support communities
disproportionately affected by COVID-19.
For the $29 billion allocated to programs specifically supporting
disproportionately affected communities, the funds went to programs
serving the types of organizations and communities that the agencies
have historically supported. (See app. I for a list of the programs
specifically supporting communities disproportionately affected by
COVID-19.) For example, HRSA allocated funds to providers and
programs serving vulnerable and medically underserved populations.
CDC allocated funds to state, local, and territorial health departments
nationwide, with a requirement that the departments use the funds to
serve disproportionately affected communities within their jurisdictions.
(See table 2.)
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GAO-23-105500 Pandemic Relief Funds
Table 2: Allocation of $29 Billion in Selected Pandemic Relief Funds Specifically Supporting Communities Disproportionately
Affected by COVID-19, by HHS Agency
Agency
Amount allocated
Types of organizations funded and communities served
Health Resources and
Services Administration
$18 billion
Providers serving underserved and vulnerable populations, including in rural
areas; and programs supporting health infrastructure, including the training of
health professionals and the advancement of telehealth.
Centers for Disease Control
and Prevention
$9.2 billion
State, local, and territorial health departments serving disproportionately
affected communities nationwide and other organizations serving
communities disproportionately affected by COVID-19.
Indian Health Service
$1.1 billion
Federally and tribally operated health care facilities and urban Indian
organizations serving American Indians and Alaska Natives.
Office of Minority Health
$315 million
Community-based organizations serving racial and ethnic minority
populations.
Source: GAO analysis of Department of Health and Human Services (HHS) information. | GAO-23-105500
Notes: Selected pandemic relief funds refers to the $75 billion that was appropriated in six COVID-19
relief laws to the Public Health and Social Services Emergency Fund and provided to four HHS
agencies (Centers for Disease Control and Prevention; Health Resources and Services
Administration (HRSA); Indian Health Service; and Office of Minority Health). It does not include
funds for the Provider Relief Fund administered by HRSA, which reimburses eligible health care
providers for health care-related expenses or lost revenues attributable to COVID-19.
Communities disproportionately affected by COVID-19 include, for example, those who are older,
have certain underlying medical conditions, or are from certain ethnic and racial groups.
Amounts do not sum to $29 billion due to rounding.
In addition to the $29 billion, HHS agencies—specifically, CDC—allocated
another $33 billion to programs in which the agency recommended funds
be used to support disproportionately affected communities, and provided
program-specific guidance for doing so. For example, CDC issued
guidance recommending that awardees—often state health
departments—include disproportionately affected communities in their
planning, or use certain data or tools that identify vulnerable
communities—such as CDC’s Social Vulnerability Index—to inform their
pandemic planning, response, or strategies. CDC’s Social Vulnerability
Index ranks the vulnerability of each Census tract based on factors such
as poverty, vehicle access, and housing, and can be used to identify
communities that will need extra support before, during, or after an
emergency event. (See table 3.) CDC officials told us they did not require
awardees to use the relief funding to support these communities, because
they wanted to allow some flexibility for awardees who may have other
sources of funding to support disproportionately affected communities.
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Table 3: CDC Programs Funded with Selected Pandemic Relief Funds with Guidance Recommending Support for
Communities Disproportionately Affected by COVID-19
Program
Amount awarded and purpose of funds
CDC guidance
Epidemiology and Laboratory
Capacity Enhancing Detection
$29.4 billion to support awardees in conducting
a broad range of COVID-19 testing and
epidemiologic surveillance related activities.a
Guidance recommends that awardees include
plans for testing populations at increased risk of
becoming infected by COVID-19.
COVID-19 Crisis Response
$2 billion to support awardees with public health
workforce enhancements.
Guidance recommends that awardees use CDC’s
Social Vulnerability Index data to inform their
COVID-19 planning, response, and hiring
strategy.b
Disease Intervention Specialists
Workforce Development
$1.1 billion to support awardees with mitigating
the spread of COVID-19 and other infections.
Guidance recommends that awardees use CDC’s
Social Vulnerability Index data or U.S. Census
Bureau’s Community Resilience Estimates to
inform their planning, response, and hiring
strategy.b
Source: GAO analysis of Centers for Disease Control and Prevention (CDC) information. | GAO-23-105500
Notes: Selected pandemic relief funds refers to $75 billion that was appropriated in six COVID-19
relief laws to the Public Health and Social Services Emergency Fund and provided to four
Department of Health and Human Services agencies (CDC, Health Resources and Services
Administration (HRSA), Indian Health Service, and Office of Minority Health). It does not include
funds for the Provider Relief Fund administered by HRSA, which reimburses eligible health care
providers for health care-related expenses or lost revenues attributable to COVID-19.
Amounts do not sum to $33 billion total due to rounding.
aIncludes an initial allocation of $10.3 billion and a subsequent amount of $19.1 billion that CDC
described as expansion funding.
bCDC’s Social Vulnerability Index ranks the vulnerability of each Census tract based on factors such
as poverty, vehicle access, and housing, and can be used to identify communities that will need extra
support before, during, or after an emergency event.
cU.S. Census Bureau’s Community Resilience Estimates summarize how at-risk every neighborhood
in the United States is to the impacts of disasters, including COVID-19.
HHS agencies allocated the remaining $14 billion to support broad
COVID-19 response and other efforts without a requirement or
recommendation that the funds support disproportionately affected
communities. For example, CDC allocated $10 billion to state, local, and
territorial health departments to fund COVID-19 testing efforts to support
the reopening of schools for the 2021-2022 school year, and did not
require or recommend that awardees support specific communities with
the funds. CDC officials told us they allocated funds in this manner in
order to give awardees flexibility to identify how to best support their local
public health needs. CDC officials also told us that they worked with
recipients to ensure they were able to address the needs of their local
populations, and many awardees told the agency that they had used
CDC’s Social Vulnerability Index and other data to assist them in
supporting vulnerable populations with this funding.
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GAO-23-105500 Pandemic Relief Funds
For the $29 billion in relief funds specifically supporting disproportionately
affected communities, HHS agencies allocated most of the funds (about
$24 billion) to an array of new programs established during the pandemic.
Most of these new programs were established to implement directives
included in the six COVID-19 relief laws. (See table 4.)
Table 4: Examples of New HHS Programs Supporting Communities Disproportionately Affected by COVID-19 with Selected
Pandemic Relief Funding
Agency
Program
Amount
allocated
Description
Centers for
Disease Control
and Prevention
National Initiative to
Address COVID-19
Health Disparities
Among Populations at
High-Risk and
Underserved
Communities
$2.3 billion
Funded 108 selected state, local, territorial, and freely associated
state health departments to expand their capacity to prevent and
control COVID-19 infection or transmission among populations at
higher risk and who are medically underserved.
Increasing Community
Access to Testing
$875 million
Funded the provision of no-cost COVID-19 testing for persons who
were symptomatic, exposed, or at high-risk of severe outcomes in
vulnerable communities, including those experiencing a surge in
COVID-19 cases.
Health
Resources and
Services
Administration
Rural Payments
$8.5 billion
Supported health care providers serving rural beneficiaries
covered by Medicare, Medicaid, or the Children’s Health Insurance
Program.
Uninsured Program
Fund
$6.8 billion
Reimbursed health care providers for costs associated with
COVID-19 testing for uninsured individuals.
Community-Based
Workforce for COVID-
19 Vaccine Outreach
$330 million
Funded community organizations’ efforts to enhance vaccine
confidence and bolster COVID-19 vaccinations in underserved
communities.
Rural Tribal COVID-19
Response
$16 million
Awarded 57 selected tribes, tribal organizations, and others with
funding to aid COVID-19 response activities in rural communities.
Office of Minority
Health
Advancing Health
Literacy to Enhance
Equitable Community
Responses to COVID-
19
$250 million
Funded 73 local health departments (representing urban and rural
areas) to enhance both health literacy and COVID-19 testing and
other mitigation measures in racial and ethnic minority and other
socially vulnerable populations.
Source: GAO analysis of Department of Health and Human Services (HHS) information. | GAO-23-105500
Notes: Selected pandemic relief funds refers to $75 billion that was appropriated in six COVID-19
relief laws to the Public Health and Social Services Emergency Fund and provided to four HHS
agencies (Centers for Disease Control and Prevention, Health Resources and Services
Administration (HRSA), Indian Health Service, and Office of Minority Health). It does not include
funds for the Provider Relief Fund administered by HRSA, which reimburses eligible health care
providers for health care-related expenses or lost revenues attributable to COVID-19.
HHS Agencies Largely
Allocated Funds
Specifically Supporting
Disproportionately
Affected Communities to
Programs Established
during the Pandemic
Page 13
GAO-23-105500 Pandemic Relief Funds
HHS agencies allocated about $5 billion—the remainder of the $29
billion—to existing programs, including many programs that were already
serving disproportionately affected communities. The funding directed to
programs already serving disproportionately affected communities
expanded their scope to include COVID-19 response activities. In
contrast, some of the funding directed to broader public health programs
narrowed their focus to serving disproportionately affected communities in
certain settings, such as prisons, homeless service sites, and health care
settings. (See table 5.)
Table 5: Examples of Existing HHS Programs That Received Selected Pandemic Relief Funds to Support COVID-19 Response
Activities for Disproportionately Affected Communities
Program
Amount
Funding awardees
Health Centers
$700 million
Over 1,300 HRSA-funded health centers and 78 other health centers serving
underserved and vulnerable populations
Rural Health Clinics
$689 million
Over 4,000 Rural Health Clinics serving underserved rural areasa
Small Rural Hospital
Improvement Program
$547 million
46 states supported over 1,500 small hospitals with 49 or fewer beds serving
rural communities
Source: GAO analysis of Department of Health and Human Services (HHS) information. | GAO-23-105500
Notes: Selected pandemic relief funds refers to $75 billion that was appropriated in six COVID-19
relief laws through the Public Health and Social Services Emergency Fund and provided to four HHS
agencies (Centers for Disease Control and Prevention, Health Resources and Services
Administration (HRSA), Indian Health Service, and Office of Minority Health). It does not include
funds for the Provider Relief Fund administered by HRSA, which reimburses eligible health care
providers for health care-related expenses or lost revenues attributable to COVID-19.
aUnder Medicare, there is an existing Rural Health Clinic designation and payment methodology that
is administered by the Centers for Medicare & Medicaid Services. These designations were used to
distribute the COVID-19 funding reflected in this table.
Both the newly established and existing programs used the relief funds to
support disproportionately affected communities in a variety of ways,
including by
•
funding the provision of COVID-19 testing and mitigation efforts in
disproportionately affected communities;
•
funding federal programs and other health care providers serving
disproportionately affected communities; and
•
enhancing recruiting and retention for the health care and public
health workforce serving disproportionately affected communities.
As the four HHS agencies determined how to allocate the selected
pandemic relief funds, agency officials told us they first considered
congressional direction and intent. In some cases, the pandemic relief
laws appropriated the funds for COVID-19 relief purposes through
particular programs or for certain communities. In other cases, the
Page 14
GAO-23-105500 Pandemic Relief Funds
pandemic relief laws provided HHS with discretion on how to allocate the
funds to support a broader purpose, such as serving high risk and
underserved communities.
Agency officials also told us they considered HHS leadership priorities,
assessed public health needs, and worked with agency leaders to
determine the most appropriate and effective programs to fund. In
addition, HHS agencies took a variety of approaches in awarding funds
within particular programs. In some cases, HHS agencies awarded
funding equally among a set of awardees, whereas in other cases the
agencies considered the size of an awardee’s population, the number of
uninsured patients served, or the number of COVID-19 cases.
Our five selected states—Arizona, Louisiana, Michigan, New Hampshire,
and Washington—allocated funds from five CDC programs for a range of
activities to support COVID-19 response efforts in disproportionately
affected communities. Specifically, these states allocated funds from the
following CDC programs we focused on: the newly established COVID-19
health disparities program, which required states to focus on
Selected States
Allocated CDC Funds
for a Range of
Activities to Support
Disproportionately
Affected
Communities; All
Reported Challenges
States Allocated Selected
CDC Funds for a Wide
Range of Testing,
Vaccination, and Other
Pandemic Response
Efforts
Page 15
GAO-23-105500 Pandemic Relief Funds
disproportionately affected communities, and four other CDC programs
that had no such requirement.15
Selected States’ Allocations of COVID-19 Health Disparities Program
Funds
Our selected states allocated the COVID-19 health disparities program
funds for a wide range of activities to support rural communities, certain
racial and ethnic groups, and other disproportionately affected
communities.16 All five states, for example, allocated funds for testing and
vaccination efforts targeting disproportionately affected communities.
States also allocated the program funds for other efforts, such as
transportation and behavioral health services. (See fig. 4.)
15We focused on five CDC programs, each of which accounted for at least $1 billion in
pandemic relief funds and provided funds directly to states to allocate within federal
guidelines. These programs were the National Initiative to Address COVID-19 Health
Disparities program, Epidemiology and Laboratory Capacity Enhancing Detection
program, Epidemiology and Laboratory Capacity Reopening Schools program, COVID-19
Crisis Response program, and Disease Intervention Specialists Workforce Development
program. States also received funds from other federal programs for their pandemic
response. For example, states received funds from other CDC programs, as well as funds
from other federal agencies such as the Federal Emergency Management Agency and the
Department of the Treasury. For information about other federal programs that provided
states with funding supporting the pandemic response, see GAO-22-105397.
16The five selected states each received from about $25 million to $37 million in CDC
funds under this program.
CDC’s National Initiative to Address
COVID-19 Health Disparities Program
This program was established to address
COVID-19-related health disparities and
advance health equity by expanding
awardees’ capacity to prevent and control
COVID-19 infection or transmission among
populations at higher risk and who are
medically underserved.
Source: GAO based on Centers for Disease Control and
Prevention (CDC) documentation. | GAO-23-105500
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GAO-23-105500 Pandemic Relief Funds
Figure 4: Examples of Selected States’ Allocations of COVID-19 Health Disparities
Program Funds to Support Disproportionately Affected Communities
Page 17
GAO-23-105500 Pandemic Relief Funds
In addition to supporting specific communities, CDC allowed states to
allocate the COVID-19 health disparities program funds for broader
efforts, such as improving state data or expanding state health equity
efforts; all five selected states did so. Louisiana, for example, allocated
funds to improve the COVID-19 contact tracing and case tracking data
system so data could be analyzed by demographic group. In Arizona,
funds were allocated to expand the health department’s Office of Health
Equity; develop a health equity community of practice including tribal
groups, local health departments, and others; and support other health
equity initiatives. New Hampshire allocated funds to expand the state’s
health care workforce, such as by hiring community health workers to
support disproportionately affected communities and investing in efforts to
address workforce shortages.
When deciding how to allocate the COVID-19 health disparities program
funds, state officials considered data and stakeholder input. For example:
•
Michigan allocated funds to establish health equity councils in a
number of state regions that were highly affected by COVID-19,
state documentation indicated. To select those regions, officials
used data on regions’ racial and ethnic composition, CDC’s Social
Vulnerability Index, and other information.
•
In Washington, officials said they sought input from over 100
community partners on their proposed funding priorities and
revised their plans as a result. For example, they allocated funds
for COVID-19 related outreach and care for people with substance
use disorders—a population they had not initially prioritized.
•
Arizona officials said they allocated funds to seven local health
departments and collaborated with local health officials on how to
target those funds to address health disparities.
Selected States’ Allocation of Other CDC Program Funds
For the four other CDC programs we reviewed, all five selected states
allocated at least some of the funds to support COVID-19 response
efforts in disproportionately affected communities.17 CDC did not require
17The four CDC programs we reviewed provided different funding amounts to the five
selected states. For the Epidemiology and Laboratory Capacity Enhancing Detection
program, the five states each received funding ranging from about $139 million to $890
million; this included an initial amount and a later amount states received for expansion
funding. For the Epidemiology and Laboratory Capacity Reopening Schools program,
these states received funding ranging from about $41 million to $301 million. For the
COVID-19 Crisis Response program, the five states received funding ranging from about
$9 million to $59 million. Finally, for the Disease Intervention Specialists Workforce
Development program, these states received funding ranging from $5 million to about $28
million.
Page 18
GAO-23-105500 Pandemic Relief Funds
states to allocate funds from these programs to support disproportionately
affected communities, though for three of the four programs it
recommended that states do so. (See table 6.)
Table 6: Examples of How Selected States Allocated CDC Program Funds to Support Disproportionately Affected
Communities
Program
How states allocated funds to support disproportionately affected communities
COVID-19 testing, surveillance, and related activities
Epidemiology and Laboratory
Capacity Enhancing Detection
•
Testing in high-risk regions. Michigan officials said they used CDC’s Social Vulnerability
Index to identify high-risk regions and then worked with community members to identify
neighborhood locations that would best meet local needs.
•
Call center staff for vulnerable populations. New Hampshire funded a COVID-19 call
center with staff dedicated to helping vulnerable populations obtain access to services such
as COVID-19 testing and home-based care, officials said.
Epidemiology and Laboratory
Capacity Reopening Schools
•
Support for schools with at-risk populations. In Washington, officials said all schools
could access COVID-19 testing, but they prioritized outreach to schools serving at-risk
populations. Schools were identified based on how many students received free and
reduced price lunch and other measures. Officials also allocated additional funds for
schools in areas with COVID-19 testing and vaccination access problems.
Public health workforce
COVID-19 Crisis Response
•
Staff for schools in at-risk regions. Louisiana allocated funds for new school nurses and
other health staff in schools in the state’s most at-risk regions according to CDC’s Social
Vulnerability Index, officials said.
•
Local health department workforce. Arizona officials said they allocated funds to local
health departments using CDC’s Social Vulnerability Index as a measure of local risk. They
also allocated funds to tribal groups to address workforce gaps.
Disease Intervention
Specialists Workforce
Development
•
Targeted funds for disease investigation. Washington officials said they allocated funds
using the Census Bureau’s Community Resilience Estimates, race and ethnicity data, and
other data, as well as input from community partners. Officials funded regional investigative
support for local health departments, and extra support for five departments in areas with
COVID-19 outbreaks or high disease burden.
Source: GAO analysis of information from Arizona, Louisiana, Michigan, New Hampshire, and Washington. | GAO-23-105500
Notes: The Centers for Disease Control and Prevention (CDC) recommended recipients of funds from
the Epidemiology and Laboratory Capacity Enhancing Detection, COVID-19 Crisis Response, and
Disease Intervention Specialists Workforce Development programs to use funds to support
communities disproportionately affected by COVID-19. CDC did not require or recommend recipients
of funds from the Epidemiology and Laboratory Capacity Reopening Schools program to do so.
Page 19
GAO-23-105500 Pandemic Relief Funds
State officials said they sometimes chose to allocate funds more broadly
rather than target funds to support disproportionately affected
communities. For example, Arizona and Louisiana officials said they
made Epidemiology and Laboratory Capacity Reopening Schools funds
available statewide in order to give all schools the opportunity to take part
in their voluntary school-based COVID-19 testing programs. Michigan
officials said they decided to allocate an equal amount of COVID-19
Crisis Response funds to each of the state’s 45 local health departments;
this decision was informed by input from and coordination with local
health department officials.
Our five selected states reported a variety of challenges allocating and
using funds from the five CDC programs we reviewed. First, some states
reported being unable to readily allocate CDC funding due to delays in
their state’s required acceptance or approval of the funds, which required
action by different entities, such as the legislature, depending on the
state.18 Specifically, officials from three state health departments—
Louisiana, Michigan, and New Hampshire—reported that their state
governments had not accepted certain CDC funds until between 3 and 9
months after CDC awarded the funding (see text box). Officials from New
Hampshire explained that certain CDC funds were awarded after the
state’s emergency declaration had expired and normal processes for
approving funds were required.
18State governments have established a variety of processes to accept federal funding
awarded to them. In some cases, the state legislature or an executive government entity
must accept or approve federal funding before state officials may begin working on such
programs. CDC officials told us that, with the significant influx of COVID-19 relief funding,
many states implemented new processes requiring additional approvals prior to health
departments being able to access the funds.
Louisiana Officials’ Observations on
Allocating Funds from CDC’s
Epidemiology and Laboratory Capacity
Reopening Schools Program
CDC’s Epidemiology and Laboratory Capacity
Reopening Schools program provided funds
for COVID-19 testing and other efforts to
support school reopening. Louisiana officials
said they did not allocate these funds to
particular schools serving disproportionately
affected communities. Officials noted that
many Louisiana schools are in rural or
underserved areas. They had the resources to
support every school that wanted to
participate in testing, so they encouraged all
schools to do so.
Source: GAO summary of information from state officials and
the Centers for Disease Control and Prevention (CDC). |
GAO-23-105500
State-Reported
Challenges Allocating and
Using CDC Funding
Included Delays in
Accepting Funds and
Capacity Issues
Page 20
GAO-23-105500 Pandemic Relief Funds
Source: GAO analysis of state and CDC documents and interviews. I GAO-23-105500
CDC officials told us that many other states were also affected by their
states’ delayed acceptance or approval of certain CDC funds. For
example, CDC officials told us that over half of the recipients of funding
from the two Epidemiology and Laboratory Capacity programs we
reviewed, which include all 50 states, faced delays obtaining required
state approvals to spend the funding.19 CDC officials also told us that
three states opted not to accept certain CDC funds and another state
opted to accept only partial CDC funding.
Health department officials from the five selected states also reported
capacity issues that affected their ability to allocate and use the CDC
funds, according to our interviews with state officials and review of state
documents. Specifically, the capacity issues included the following:
•
Heavy workloads. Officials from two states (Arizona and
Louisiana) told us it was challenging to allocate and use funds
19CDC awarded $29.4 billion through its Epidemiology and Laboratory Capacity
Enhancing Detection program and $10 billion through its Epidemiology and Laboratory
Capacity Reopening Schools program to 64 recipients, including state, local, and territorial
health departments.
Example of Michigan’s Delayed Acceptance of CDC Program Funds
March 11, 2021: The American Rescue Plan Act of 2021 was enacted.
April 8, 2021: The Centers for Disease Control and Prevention (CDC) awarded about
$301 million in funding from the American Rescue Plan Act of 2021 to Michigan
through its Epidemiology and Laboratory Capacity Reopening Schools program. This
program was to support school-based COVID-19 testing for the 2021-2022 school
year. Funds were initially set to expire in July 2022, but were later extended for one
year.
December 21, 2021: Michigan’s state legislature accepted the funding 8 months after
it was awarded by CDC.
State funding allocation: Officials from Michigan’s health department told us in May
2022 they had not yet allocated funding for this program, because they received the
funding too late in the school year to take action on it. Instead, they planned to use the
funding to support school-based COVID-19 testing for the 2022-2023 school year. In
November 2022, officials said they had allocated funds for several efforts, such as
providing testing support for schools experiencing outbreaks and purchasing tests to
send home with students.
Page 21
GAO-23-105500 Pandemic Relief Funds
from multiple, large programs while simultaneously addressing the
emergent and dynamic health needs of the pandemic.20
•
Hiring challenges. Although the CDC funding awarded to states
provided additional resources—including funding they could use to
hire staff—officials from all five selected states told us they
experienced challenges finding qualified personnel to fill these
positions. Officials from three states said this was due to
increased competition in hiring from a limited workforce and the
time-limited nature of positions supported by these funds.21 Two
states also reported facing delays recruiting for new positions due
to the length of time it took to obtain state approval to create new
positions, according to our interviews with state officials and
review of state documents.
•
Difficulties in executing contracts. Officials from all five
selected states described challenges preparing and executing
contracts with other organizations to implement programs
supported by the CDC funding. These officials cited factors such
as the amount of time required for state contracting processes,
and the need to ensure that organizations meet contract
requirements.
•
Limited capacity of local organizations. Officials from two
states (Michigan and Washington) told us that in some cases the
limited capacity of local community based organizations directly
serving those disproportionately affected by COVID-19 made it
difficult to obtain their participation. This constrained state and
local health departments’ ability to award the CDC funds. For
example, Washington state officials planned to partner with seven
health clinics serving certain disproportionately affected
communities, but found that several of these clinics did not have
the capacity to take on the workload related to managing or
implementing the CDC funds during the program’s 2-year grant
period.
•
Supply challenges. Three states (Arizona, Louisiana, and
Washington) reported experiencing challenges related to the lack
of availability of COVID-19 testing supplies, according to our
review of state documents. Reports from one state noted that this
20Officials from these two states also noted that some local health departments faced
similar challenges allocating or using CDC funding, which in one state was exacerbated
by having been understaffed prior to the pandemic.
21Because certain CDC funds were available for a 2-year period, officials from three states
told us that their hiring efforts were similarly time-limited.
Page 22
GAO-23-105500 Pandemic Relief Funds
challenge related to a surge in the demand for testing while the
Delta and Omicron variants were spreading. This challenge
affected the ability of two of these states to use the CDC funds.
CDC officials told us that many state and local health departments faced
significant capacity challenges during the pandemic that affected their
ability to allocate or use CDC funds. These capacity challenges are not
unique to the CDC funding; our prior work has noted similar challenges
among states as they have worked on other COVID-19 response
efforts.22
In some cases, our selected states reported taking action to mitigate the
impact of these challenges. For example, to address hiring challenges,
Arizona officials reported that they were working to streamline some of
their state’s hiring processes and modify employment requirements,
including by opening up certain public health career opportunities to those
living outside the state, according to a state document. To address issues
related to the limited capacity of local organizations, Washington officials
told us they worked with CDC to obtain approval to redirect funds that the
state was unable to allocate as planned, and instead, partner with other
local organizations to support community-based outreach and related
activities. CDC officials also told us that they took steps to help mitigate
challenges that states were experiencing, including by offering training
and technical assistance, facilitating information-sharing among states,
and for the COVID-19 health disparities program, offering an extension to
the period of performance to allow states more time to complete their
work.
We provided a draft of this report to HHS for review and comment. HHS
provided technical comments from CDC and HRSA, which we
incorporated as appropriate.
We are sending copies of this report to the appropriate congressional
committees, the Secretary of Health and Human Services, and other
interested parties. In addition, the report will be available at no charge on
the GAO website at http://www.gao.gov.
22For more information on these and other related challenges, see for example,
GAO-22-105397, 116 and 249; and GAO, COVID-19: Efforts to Increase Vaccine
Availability and Perspectives on Initial Implementation, GAO-21-443 (Washington, D.C.:
Apr. 14, 2021), 33.
Agency Comments
Page 23
GAO-23-105500 Pandemic Relief Funds
If you or your staff have any questions about this report, please contact
me at (202) 512-7114 or yocomc@gao.gov. Contact points for our Offices
of Congressional Relations and Public Affairs may be found on the last
page of this report. GAO staff who made key contributions to this report
are listed in appendix II.
Carolyn L. Yocom
Director, Health Care
Page 24
GAO-23-105500 Pandemic Relief Funds
List of Addressees
Chairman
Vice Chairman
Committee on Appropriations
United States Senate
Chairman
Ranking Member
Committee on Finance
United States Senate
Chair
Ranking Member
Committee on Health, Education, Labor, and Pensions
United States Senate
Chairman
Ranking Member
Committee on Homeland Security and Governmental Affairs
United States Senate
The Honorable Kay Granger
Chair
The Honorable Rosa L. DeLauro
Ranking Member
Committee on Appropriations
House of Representatives
The Honorable Cathy McMorris Rodgers
Chair
The Honorable Frank Pallone, Jr.
Ranking Member
Committee on Energy and Commerce
House of Representatives
The Honorable Mark Green
Chairman
The Honorable Bennie G. Thompson
Ranking Member
Committee on Homeland Security
House of Representatives
Page 25
GAO-23-105500 Pandemic Relief Funds
The Honorable James Comer
Chair
The Honorable Jamie Raskin
Ranking Member
Committee on Oversight and Accountability
House of Representatives
The Honorable Jason Smith
Chairman
The Honorable Richard E. Neal
Ranking Member
Committee on Ways and Means
House of Representatives
The Honorable Elizabeth Warren
United States Senate
The Honorable Ayanna Pressley
House of Representatives
Appendix I: Programs Specifically Supporting
Communities Disproportionately Affected by
COVID-19 with Selected Pandemic Relief
Funds
Page 26
GAO-23-105500 Pandemic Relief Funds
The Department of Health and Human Services (HHS) reported that its
Public Health and Social Services Emergency Fund received $349 billion
in appropriations from the six COVID-19 relief laws. According to HHS,
$75 billion of this amount went to the Centers for Disease Control and
Prevention, Health Resources and Services Administration, Indian Health
Service, and Office of Minority Health to support their COVID-19 relief
efforts. These agencies allocated $29 billion, or over 35 percent, of these
selected pandemic relief funds to programs specifically supporting
communities disproportionately affected by COVID-19. Table 7 lists the
programs supported by these funds.
Table 7: HHS Agencies’ Allocations of Selected Pandemic Relief Funds to Programs Specifically Supporting Communities
Disproportionately Affected by COVID-19
Agency
Program Name
Amount
Centers for
Disease Control
and Prevention
(CDC)
Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems
$3,107,000,000
National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk
and Underserved Communities
2,250,000,000
Long Term Care Facility Infection Prevention and Control
1,620,000,000
Increasing Community Access to Testing
875,200,000
Epidemiology and Laboratory Capacity: Detection and Mitigation of COVID-19 in
Confinement Facilities, Homeless Service Sites, and Other Congregate Living Facilities
808,500,000
Public Health Americorps
400,000,000
Community Health Workers for COVID Response and Resilient Communities
49,000,000
High Risk and Underserved Partner Awards
45,000,000
Undergraduate Public Health Scholars Program
35,000,000
Subtotal
9,189,700,000
Health Resources
and Services
Administration
(HRSA)
Rural Payments
8,500,000,000
Uninsured Program Fund
6,800,000,000
Health Centers
700,015,150
Rural Health Clinics
688,800,000
Small Rural Hospital Improvement Program
546,780,531
Community-Based Workforce for COVID-19 Vaccine Outreach Program
330,000,000
Community Health Worker Program
239,500,000
Ryan White/HIV AIDS Program
90,000,000
Rural Public Health Workforce Training Network Program
51,995,000
Telehealth Programs
42,667,137
Rural Tribal COVID-19 Response Program
16,305,246
Telehealth Broadband Pilot Program
8,284,571
Subtotal
18,014,347,635
Appendix I: Programs Specifically
Supporting Communities Disproportionately
Affected by COVID-19 with Selected
Pandemic Relief Funds
Appendix I: Programs Specifically Supporting
Communities Disproportionately Affected by
COVID-19 with Selected Pandemic Relief
Funds
Page 27
GAO-23-105500 Pandemic Relief Funds
Agency
Program Name
Amount
Indian Health
Service (IHS)
COVID-19 testing and federally operated and tribally operated health care facilities and
urban Indian organizations, including the purchase and provision of test kits and related
supplies
763,000,000
Public health workforce activities
210,000,000
COVID-19 testing and federally operated and tribally operated health care facilities and
urban Indian organizations, including the purchase and provision of personal protective
equipment
70,000,000
Vaccine distribution
20,100,000
Subtotal
1,063,100,000
Office of Minority
Health (OMH)
Advancing Health Literacy to Enhance Equitable Community Responses to COVID-19
250,000,000
National Infrastructure for Mitigating the Impact of COVID-19 within Racial and Ethnic
Minority Communities
39,990,337
National Hypertension Control Initiative: Addressing Disparities among Racial and Ethnic
Minority Populations
25,009,662
Subtotal
315,000,000
Total
$28,582,147,635
Source: GAO analysis of information from Department of Health and Human Services (HHS) agencies. | GAO-23-105500
Notes: Selected pandemic relief funds refers to $75 billion that was appropriated in six COVID-19
relief laws through the Public Health and Social Services Emergency Fund and provided to four HHS
agencies (CDC, HRSA, IHS, and OMH). It does not include funds for the Provider Relief Fund
administered by HRSA, which reimburses eligible health care providers for health care-related
expenses or lost revenues attributable to COVID-19. Amounts include funds allocated for program
administration.
Appendix II: GAO Contact and Staff
Acknowledgments
Page 28
GAO-23-105500 Pandemic Relief Funds
Carolyn L. Yocom, (202) 512-7114 or YocomC@gao.gov
In addition to the contact named above, Susan Barnidge (Assistant
Director), Patricia Roy (Analyst-in-Charge), Robin Burke, Carmen Rivera-
Lowitt, and Martha Elbaum Williamson made key contributions to this
report. Also contributing were Drew Long, Ethiene Salgado-Rodriguez,
and Emily Wilson Schwark.
Appendix II: GAO Contact and Staff
Acknowledgments
GAO Contact
Staff
Acknowledgments
(105500)
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