Congressional Research Service R46353 (COVID-19: Overview of FY2020 LHHS Supplemental Appropriations)

Summary

A Congressional Research Service report, R46353, by Karen E. Lynch and Jessica Tollestrup, dated May 11, 2020, giving an overview of FY2020 supplemental appropriations for COVID-19. It focuses on discretionary appropriations provided to programs traditionally funded in the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations bill. It explains that the legislative response to the pandemic has included laws providing authorities and supplemental funding to prevent, prepare for and respond to it. It states that LHHS supplemental appropriations had been provided in four separate supplemental acts as of the report's date.

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COVID-19: Overview of FY2020 LHHS
Supplemental Appropriations

Karen E. Lynch
Specialist in Social Policy

Jessica Tollestrup
Specialist in Social Policy

May 11, 2020

Congressional Research Service
7-....
www.crs.gov
R46353
SUMMARY

R46353
Overview of COVID-19 FY2020 LHHS
May 11, 2020
Supplemental Appropriations Karen E. Lynch
The legislative response to the global pandemic of Coronavirus Disease 2019 (COVID-19) has Specialist in Social Policy
included the enactment of laws to provide authorities and supplemental funding to prevent, -re-acte--@crs.loc.gov
prepare for, and respond to the pandemic. This report focuses on supplemental FY2020 Jessica Tollestrup
discretionary appropriations provided to programs and activities traditionally funded by the Specialist in Social Policy
Departments of Labor, Health and Human Services, and Education, and Related Agencies -re-acte--@crs.loc.gov
(LHHS) appropriations bill.
For a copy of the full
As of the date of this report, LHHS supplemental appropriations for COVID-19 response have report, please call 7-....
been provided in four separate supplemental appropriations measures: or visit www.crs.gov.
 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 funds.
 Title V, Division A, of the Families First Coronavirus Response Act (FFCRA, P.L. 116-127), enacted on
March 18, 2020, provided $1.25 billion in supplemental LHHS funds.
 Title VIII, Division B, of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act, P.L. 116-
136), enacted on March 27, 2020, provided $172.1 billion in supplemental LHHS funds.
 Title I, Division B, of the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA,
P.L. 116-139), enacted on April 24, 2020, provided $100 billion in supplemental LHHS funds.
In total, LHHS has received roughly $280 billion in supplemental discretionary appropriations from these COVID-19
response measures. These supplemental funds are in addition to roughly $195 billion in regular FY2020 LHHS discretionary
appropriations provided in Division A of P.L. 116-94, the FY2020 omnibus appropriations act containing full-year LHHS
appropriations that was enacted on December 20, 2019. Unlike the annual discretionary appropriations, however, these
additional funds were designated as an “emergency requirement” and thus were effectively exempted from otherwise
applicable budget enforcement requirements (such as the statutory discretionary spending limits). Overall, the COVID-19
supplemental funds have increased FY2020 LHHS discretionary appropriations by approximately 143%.
The Department of Health and Human Services (HHS) received funding in all four COVID-19 supplemental appropriations
acts, whereas the Department of Labor (DOL), Department of Education (ED), and entities funded under the “Related
Agencies” heading received funding in the third supplemental only. In total, HHS received $248 billion, or 89% of all
COVID-19 LHHS supplemental appropriations. ED received the second-largest share at $31 billion, or 11%. DOL and the
Related Agencies received approximately 0.1% and 0.2% of the LHHS COVID-19 supplemental funds, respectively.
Summary of FY2020 LHHS Supplemental Appropriations for COVID-19 Response
(Dollars in millions)
P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139
(Division A) (Division A) (Division B) (Division B) Total

DOL — — 360 — 360
HHS 6,436 1,250 140,389 100,000 248,075
ED — — 30,925 — 30,925
Related Agencies — — 430 — 430
Total 6,436 1,250 172,104 100,000 279,790

Congressional Research Service
COVID-19: FY2020 LHHS Supplemental Appropriations

Contents
Introduction ..................................................................................................................................... 1
Legislative History .......................................................................................................................... 2
P.L. 116-123 (H.R. 6074), Coronavirus Preparedness and Response Supplemental
Appropriations Act, 2020 ....................................................................................................... 2
P.L. 116-127 (H.R. 6201), Families First Coronavirus Response Act (FFCRA) ...................... 3
P.L. 116-136 (H.R. 748), Coronavirus Aid, Relief, and Economic Security Act
(CARES Act) ......................................................................................................................... 4
P.L. 116-139 (H.R. 266), Paycheck Protection Program and Health Care
Enhancement Act (PPPHCEA) .............................................................................................. 5
Funding Overview ........................................................................................................................... 5
Department of Labor ................................................................................................................. 6
Department of Health and Human Services .............................................................................. 6
PHSSEF .............................................................................................................................. 7
Other HHS Funding ............................................................................................................ 8
Department of Education .......................................................................................................... 9
Related Agencies ..................................................................................................................... 10
Detailed LHHS Programs and Activities Supplemental Amounts .......................................... 10

Tables
Table 1. Summary of FY2020 LHHS Supplemental Appropriations for COVID-19
Response ...................................................................................................................................... 6
Table 2. FY2020 LHHS Supplemental Appropriations for COVID-19 Response .........................11

Contacts
Author Contact Information .......................................................................................................... 16

Congressional Research Service
COVID-19: FY2020 LHHS Supplemental Appropriations

Introduction
The global pandemic of Coronavirus Scope of the LHHS Appropriations Act
Disease 2019 (COVID-19) is affecting  the Department of Labor;
communities around the world and  most agencies at the Department of Health and Human
throughout the United States, with case Services, except for the Food and Drug Administration
counts growing daily. Containment and (FDA, funded through the Agriculture appropriations
mitigation efforts by federal, state, and bill), the Indian Health Service (IHS, funded through the
Interior-Environment appropriations bill), and the
local governments have been undertaken Agency for Toxic Substances and Disease Registry
to flatten the curve—that is, to curb (ATSDR, funded through the Interior-Environment
widespread transmission that could appropriations bill);1
overwhelm the nation’s health care  the Department of Education; and
system. Federal response efforts have  more than a dozen related agencies, including the Social
included the enactment of laws to provide Security Administration, the Corporation for National
authorities and supplemental funding to and Community Service, the Corporation for Public
prevent, prepare for, and respond to the Broadcasting, the Institute of Museum and Library
Services, the National Labor Relations Board, and the
pandemic. This report focuses on Railroad Retirement Board.2
supplemental FY2020 discretionary
appropriations provided to programs and
activities traditionally funded by the Departments of Labor, Health and Human Services, and
Education, and Related Agencies (LHHS) appropriations bill.3
As of the date of this report, LHHS supplemental appropriations for COVID-19 response have
been provided in four separate supplemental appropriations measures:
 Title III, Division A, of the Coronavirus Preparedness and Response
Supplemental Appropriations Act, 2020 (P.L. 116-123), enacted on March 6,
2020.
 Title V, Division A, of the Families First Coronavirus Response Act (FFCRA,
P.L. 116-127), enacted on March 18, 2020.
 Title VIII, Division B, of the Coronavirus Aid, Relief, and Economic Security
Act (CARES Act, P.L. 116-136), enacted on March 27, 2020.
 Title I, Division B, of the Paycheck Protection Program and Health Care
Enhancement Act (PPPHCEA, P.L. 116-139), enacted on April 24, 2020.
In total, LHHS has received roughly $280 billion in supplemental discretionary appropriations
from these COVID-19 response measures.4 These funds are in addition to roughly $195 billion in

1 COVID-19 response-related supplemental funding appropriated to the FDA and IHS is not discussed in this report.

For information on the IHS supplemental funding, see CRS Insight IN11333, COVID-19 and the Indian Health
Service.
2 For a detailed description of the scope of the LHHS appropriations act and a summary of FY2019 appropriations, see

CRS Report R45869, Labor, Health and Human Services, and Education: FY2019 Appropriations.
3 Appropriations acts both provide and control discretionary spending. While appropriations acts may also provide

some mandatory spending (often referred to as appropriated mandatory spending), this spending generally is not the
focus of appropriations decision-making because it is controlled elsewhere (in authorizing laws). Consequently, the
focus of this report is only the discretionary spending provided by the COVID-19 supplemental appropriations acts.
4 This total was calculated by the Congressional Research Service based on amounts specified for supplemental

appropriations in the applicable division of each COVID-19 response measure listed above. This total excludes funds
provided to LHHS agencies and activities in other divisions of these laws. Such funds were commonly provided as

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COVID-19: FY2020 LHHS Supplemental Appropriations

regular FY2020 LHHS discretionary appropriations provided in Division A of P.L. 116-94, the
FY2020 LHHS omnibus appropriations act that was enacted on December 20, 2019.5 Unlike the
annual discretionary appropriations, however, these additional funds were designated as an
“emergency requirement” and thus were effectively exempted from otherwise applicable budget
enforcement requirements (such as the statutory discretionary spending limits).6 Overall, the
COVID-19 supplemental funds have increased FY2020 LHHS discretionary appropriations by
approximately 143%.7

Legislative History
The relevant legislative history of each of the four enacted laws containing LHHS supplemental
appropriations is detailed below.

P.L. 116-123 (H.R. 6074), Coronavirus Preparedness and Response
Supplemental Appropriations Act, 2020
In the weeks leading up to the supplemental appropriations action in Congress, Alex Azar, the
Secretary of the U.S. Department of Health and Human Services (HHS), took administrative steps
to allocate existing funding to COVID-19 response efforts. These included issuing a
determination on January 25, 2020, allowing the allotment of $105 million from the Infectious
Diseases Rapid Response Reserve Fund (IDRRRF).8 He also reportedly informed Congress on
February 2 that he would potentially exercise his authority to transfer $136 million in existing
funds within HHS to increase the budgetary resources of several operating divisions and offices
that were tasked with COVID-19 response.9 In response, the Chair of the House Appropriations
Committee, Representative Nita Lowey, and the Chair of the LHHS Subcommittee,

mandatory appropriations. In addition, this total also excludes a supplemental appropriation of $210 million for the
Department of Labor that was provided in Title IX of the United States-Mexico-Canada Agreement (USMCA)
Supplemental Appropriations Act, 2019 (P.L. 116-113). These are excluded because they were not provided to prevent,
prepare for, or respond to the COVID-19 pandemic.
5 For consistency, this amount (like the amount shown for COVID-19 supplemental appropriations) is based on total

funds provided in the act, not total funds available for the fiscal year. In addition, this amount has not been adjusted for
certain scorekeeping conventions of the Congressional Budget Office. This amount is drawn from the explanatory
statement accompanying the FY2020 LHHS omnibus (P.L. 116-94), available in the Congressional Record, daily
edition, vol. 165, no. 204, Book III (December 17, 2019), p. H11159. Note that in addition to annual discretionary
appropriations, P.L. 116-94 also provided roughly $902 billion in mandatory appropriations. As previously noted,
mandatory appropriations are generally beyond the scope of this report.
6 For further information about the emergency requirements designation, see CRS Report R45778, Exceptions to the

Budget Control Act’s Discretionary Spending Limits.
7 For a summary of congressional actions related to FY2020 regular LHHS appropriations, see CRS Insight IN11114,

FY2020 LHHS Appropriations: Status.
8 See CQ Newsmaker Transcripts, “Health and Human Services Secretary Azar Holds News Conference on

Coronavirus,” January 28, 2020, https://plus.cq.com/doc/newsmakertranscripts-5822133?8&searchId=XGVQS7c5.
Authority for the IDRRRF, administered by the Director of the Centers for Disease Control and Prevention (CDC), is
codified at 42 U.S.C. 247d-4a.
9 Yasmeen Abutaleb and Erica Werner, “HHS Notifies Congress that It May Tap Millions of Additional Dollars for

Coronavirus Response,” Washington Post, February 3, 2020, https://www.washingtonpost.com/health/2020/02/03/hhs-
notifies-congress-it-may-tap-millions-additional-dollars-coronavirus-response/. For additional background on early
funding steps taken by the Administration, see CRS Insight IN11212, Another Coronavirus Emerges: U.S. Domestic
Response to 2019-nCoV; and CRS Report R46219, Overview of U.S. Domestic Response to Coronavirus Disease 2019
(COVID-19).

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Representative Rosa DeLauro, sent the Secretary a letter expressing concern that budgetary
resources available to HHS at that time would not be sufficient.10
On February 24, 2020, the Trump Administration sent Congress a request for supplemental
appropriations of $1.25 billion for the Public Health and Social Services Emergency Fund
(PHSSEF) at HHS.11 The request letter included a number of other proposals, largely but not
exclusively related to re-purposing existing funds toward response efforts. All told, the
Administration estimated needing to allocate approximately $2.5 billion toward COVID-19
response efforts. (For the most part, amounts for other LHHS aspects of the request generally
were unspecified in the publicly released request letter.)12
Several days after the Administration’s request, the Chair of the House Appropriations Committee
introduced H.R. 6074 on March 4, 2020. The measure passed the House that same day by a vote
of 415-2, passed the Senate on March 5 by a vote of 96-1, and was signed into law (P.L. 116-123)
on March 6.13
According to the Congressional Budget Office (CBO), P.L. 116-123 provided a total of $7.8
billion in supplemental appropriations in Division A, of which roughly $6.4 billion (about 83%)
was for LHHS accounts and activities.14 (Division B contained authorization provisions related to
certain LHHS programs and activities—providing the HHS Secretary authority to temporarily
waive or modify the application of certain Medicare requirements with respect to telehealth
services.15 The mandatory spending budgetary effects of these provisions are outside the scope of
this report.)

P.L. 116-127 (H.R. 6201), Families First Coronavirus Response Act
(FFCRA)
A second COVID-19 response measure was developed by Congress and the Administration soon
after the first was enacted. Initially, H.R. 6201 was introduced by the Chair of the House
Appropriations Committee on March 11, 2020.16 The House amended and passed the measure by
a vote of 363-40 on March 14, but further alterations to the final legislative package were
negotiated over the next two days.17 On March 16, the House (by unanimous consent) considered

10 Letter from Representative Nita M. Lowey, Chair, House Appropriations Committee, and Representative Rosa

DeLauro, Chair, LHHS Subcommittee, to Alex Azar, HHS Secretary, February 4, 2020,
https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/Lowey-DeLauro%20Ltr%20-
%20Azar%20-%202.4.20.pdf).
11 The PHSSEF is an account used by the HHS Secretary for one-time or short-term funding such as emergency

supplemental appropriations, and for some ongoing public health preparedness activities.
12 Letter from Russell T. Vought, Acting Director, Office of Management and Budget (OMB), to Vice President

Michael Pence, February 24, 2020, https://www.whitehouse.gov/wp-content/uploads/2020/02/Coronavirus-
Supplemental-Request-Letter-Final.pdf.
13 A summary of provisions is provided in CRS Report R46285, Coronavirus Preparedness and Response

Supplemental Appropriations Act, 2020 (P.L. 116-123): First Coronavirus Supplemental.
14 Congressional Budget Office (CBO), Discretionary Spending Under Division A, the Coronavirus Preparedness and

Response Supplemental Appropriations Act, 2020, March 4, 2020, https://www.cbo.gov/system/files/2020-03/
hr6074.pdf.
15 For further information, see CRS Report R46239, Telehealth and Telemedicine: Frequently Asked Questions.

16 For a summary of the measure, see House Appropriations Committee, H.R. 6201, FAMILIES FIRST

CORONAVIRUS RESPONSE ACT, Title-By-Title Summary, March 11, 2020, https://appropriations.house.gov/sites/
democrats.appropriations.house.gov/files/Families%20First%20Summary%20FINAL.pdf.
17 For background, see John Bresnahan and Marianne Levine, “Senate to take up coronavirus package after House

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and agreed to a resolution (H.Res. 904) that directed the Clerk to make changes to the legislation
when preparing the final, official version of the House-passed bill (engrossment). The engrossed
version was sent to the Senate and ultimately passed without amendment by a vote of 90-8 on
March 18. The President signed the bill into law (P.L. 116-127) the same day.18
Division A of P.L. 116-127 was estimated by CBO to provide a total of $2.5 billion in
supplemental appropriations, of which $1.25 billion (approximately 51%) was for LHHS
accounts and activities.19 (Other divisions of the act contained authorization provisions that in
some cases relate to LHHS programs and activities—for instance, provisions providing a 6.2%
increase to the federal matching assistance percentage for Medicaid and certain other programs.20
The mandatory spending budgetary effects of such provisions are outside scope of this report.)

P.L. 116-136 (H.R. 748), Coronavirus Aid, Relief, and Economic
Security Act (CARES Act)
On March 17, 2020, the Administration released a second request for FY2020 supplemental
appropriations of $45.8 billion for COVID-19 response, of which $11.1 billion was for LHHS
accounts and activities.21
Over the next several days, Congress and the Administration negotiated the scope and scale of
this legislative response, which was expected to involve authorities and additional funding for
numerous programs across the federal government. The legislative vehicle that was ultimately
chosen for this package was H.R. 748, an unrelated measure that had been passed previously by
the House.22 Prior to when a deal was reached between Congress and the Administration, the
Senate voted on March 22 (47-47) and March 23 (49-46) not to invoke cloture on the motion to
proceed to H.R. 748.23 The measure was ultimately laid before the Senate by unanimous consent

passes revised bill,” Politico, March 16, 2020, https://www.politico.com/news/2020/03/16/senate-coronavirus-
emergency-package-131465. See also “DIRECTING THE CLERK OF THE HOUSE OF REPRESENTATIVES TO
MAKE CORRECTIONS IN THE ENGROSSMENT OF H.R. 6201,” Congressional Record, daily edition, vol. 166,
no. 50 (March 16, 2020), pp. H1698-H1707.
18 CRS Reports on FFCRA are available on Congress.gov at https://www.congress.gov/bill/116th-congress/house-bill/

6201.
19 CBO, Preliminary Estimate of the Effects of H.R. 6201, the Families First Coronavirus Response Act, April 2, 2020,

p. 18, https://www.cbo.gov/system/files/2020-04/HR6201.pdf.
20 See Division F, Section 6008 of the Families First Coronavirus Response Act (P.L. 116-127). For background on the

federal matching assistance percentage for Medicaid, see CRS Report R43847, Medicaid’s Federal Medical Assistance
Percentage (FMAP). For information on FMAP increases, see CRS Report R46346, Medicaid Recession-Related
FMAP Increases. See also CRS Insight IN11297, Federal Medical Assistance Percentage (FMAP) Increase Available
for Title IV-E Foster Care and Permanency Payments.
21 With regard to LHHS, the letter also explained that the Administration was seeking to amend its FY2021 budget

request for CDC and NIH to provide them additional budgetary resources and authorities. Letter from Russell T.
Vought, Acting Director, Office of Management and Budget (OMB), to Vice President Michael Pence, March 17,
2020, https://www.whitehouse.gov/wp-content/uploads/2020/03/Letter-regarding-additional-funding-to-support-the-
United-States-response-to-COVID-19-3.17.2020.pdf.
22 Prior to when H.R. 748 was determined to be the vehicle for the third COVID-19 response measure, the Senate

Majority Leader, Senator McConnell, introduced a proposal on March 19, 2020, that did not include supplemental
appropriations (S. 3548). Four days later, on March 23, 2020, the House Appropriations Committee Chair introduced a
proposal (H.R. 6379) that did include supplemental appropriations (including for LHHS).
23 The Senate Appropriations Committee released a summary of the supplemental appropriations in the measure

(Senate Appropriations Committee, $340 Billion Surge in Emergency Funding to Combat Coronavirus Outbreak,
March 25, 2020, https://www.appropriations.senate.gov/imo/media/doc/
Coronavirus%20Supplemental%20Appropriations%20Summary_FINAL.pdf.)

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and passed with a substitute amendment by a vote of 96-0 on March 25. The House subsequently
took up the Senate amendment on March 27, and agreed to it by a voice vote. The bill was signed
into law (P.L. 116-136) by the President that same day.24
According to CBO, P.L. 116-136 provided about $330 billion in supplemental appropriations in
Division B, of which $172.1 billion (approximately 57%) was for LHHS accounts and
activities.25 (Division A contained authorization provisions that in some cases relate to LHHS
programs and activities—for instance, $1.320 billion in mandatory funds for the HRSA health
centers program.26 The mandatory spending budgetary effects of such provisions are outside the
scope of this report.)

P.L. 116-139 (H.R. 266), Paycheck Protection Program and Health
Care Enhancement Act (PPPHCEA)
About three weeks after the enactment of the CARES Act, Congress and the President came to an
agreement that, among other provisions, provided additional supplemental appropriations to HHS
for the Provider Relief Fund and to support COVID-19 testing. The legislative vehicle that was
used for the agreement was H.R. 266, an unrelated appropriations bill that had been passed
previously by the House. On April 21, 2020, the measure was laid before the Senate by
unanimous consent and passed with a substitute amendment by voice vote. The House adopted
the Senate version of the proposal on April 23 by a vote of 388-5.27 The President signed the bill
into law (P.L. 116-139) the following day.28
According to CBO, P.L. 116-139 provided $162.1 billion in supplemental appropriations in
Division B, of which $100 billion (approximately 62%) was for LHHS.29 (Division A contained
no provisions related to LHHS programs and activities. The mandatory spending budgetary
effects of the authorization provisions in Division A are outside the scope of this report.)

Funding Overview
As previously mentioned, LHHS has received in total roughly $280 billion in supplemental
discretionary appropriations from the COVID-19 response measures (Table 1). HHS received
funding in all four supplemental appropriations acts, whereas the Department of Labor (DOL),
the Department of Education (ED), and entities funded under the Related Agencies (RA) heading
received funding in the third supplemental only.

24 CRS reports on the CARES Act are available on Congress.gov at https://www.congress.gov/bill/116th-congress/

house-bill/748 and https://www.congress.gov/bill/116th-congress/senate-bill/3548.
25 The total amount of supplemental appropriations in Division B is from CBO, Preliminary Estimate of the Effects of

H.R. 748, the CARES Act, P.L. 116-136, April 16, 2020, p. 35, https://www.cbo.gov/system/files/2020-04/hr748.pdf.
The total amount of LHHS supplemental appropriations in Division B was calculated by CRS (see Table 2 of this
report).
26 See Title III, Division A, Section 3211 of the CARES Act (P.L. 116-136). For background on the HRSA health

centers program, see CRS Report R43937, Federal Health Centers: An Overview.
27 House Committee on Appropriations, H.R. 622, Paycheck Protection Program and Health Care Enhancement Act

Division B – Additional Emergency Appropriations for Coronavirus Response, April 21, 2020,
https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/
Interim%20Emergency%20Package%20Funds%20Hospitals%2C%20Health%20Workers%20and%20Testing.pdf.
28 See CRS Report R46325, Fourth COVID-19 Relief Package (P.L. 116-139): In Brief.

29 CBO, CBO Estimate for H.R. 266, the Paycheck Protection Program and Health Care Enhancement Act as Passed by

the Senate on April 21, 2020, April 22, 2020, https://www.cbo.gov/system/files/2020-04/hr266.pdf.

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HHS received the vast majority of all LHHS COVID-19 supplemental funds—$248 billion, or
89%. ED received the second-largest share—$31 billion, or 11%. DOL and RA received
approximately 0.1% and 0.2%, respectively.
The remainder of this report provides highlights for HHS, DOL, ED, and RA, and includes a
detailed table (Table 2) organized by department or agency and by account, program, or activity.

Table 1. Summary of FY2020 LHHS Supplemental Appropriations for COVID-19
Response
(Budget authority in millions of dollars)
P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139
(Division A) (Division A) (Division B) (Division B) Total

DOL — — 360 — 360
HHS 6,436a 1,250 140,389 100,000 248,075
ED — — 30,925 — 30,925
Related — — 430 — 430
Total: 6,436 1,250 172,104 100,000 279,790

Department of Labor
The majority of DOL funds ($345 million) in the third measure are for dislocated worker
assistance through activities authorized by the Workforce Innovation and Opportunity Act
(WIOA). Specifically, the DOL funds are for the WIOA National Reserve, which provides
National Dislocated Worker Grants (NDWGs) to states and localities to assist with worker
dislocation resulting from natural disasters and mass layoffs. These funds are generally expected
to address workforce-related effects of the COVID-19 pandemic.30

Department of Health and Human Services
The majority of HHS funds (93%) in the supplemental appropriations measures have been
appropriated to the Public Health and Social Services Emergency Fund (PHSSEF). The PHSSEF
account is used by the HHS Secretary for one-time or short-term funding, such as emergency
supplemental appropriations, and for some ongoing public health preparedness activities in the
Office of the HHS Assistant Secretary for Preparedness and Response (ASPR).
Accounts at the Centers for Disease Control and Prevention (CDC) received approximately 3% of
the supplemental HHS appropriations provided in the COVID-19 response measures. Accounts at
the Administration for Children and Families (ACF) received a similar amount. Remaining funds

30 For additional information on programs and activities authorized by WIOA, see CRS Report R44252, The Workforce

Innovation and Opportunity Act and the One-Stop Delivery System.

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were provided in smaller amounts to the National Institutes of Health (NIH), the Administration
for Community Living (ACL), the Substance Abuse and Mental Health Services Administration
(SAMHSA), and the Centers for Medicare and Medicaid Services (CMS).
While amounts shown in Table 2 are displayed as appropriated, readers should note that the first,
third, and fourth COVID-19 supplemental appropriations acts authorized HHS to transfer funds
made available in these acts, provided the transfers are made to prevent, prepare for, and respond
to the pandemic. (This broad authority giving HHS discretion over certain transfers is in addition
to provisions in these three measures that direct HHS to make specific transfers.) The first
measure broadly allowed for HHS to transfer funds among accounts at CDC, NIH, and PHSSEF.
The third measure allowed for transfers among amounts at CDC, PHSSEF, ACF, ACL, and NIH.
The fourth measure allowed for transfers among accounts at CDC, NIH, PHSSEF, and the Food
and Drug Administration, but limited the amounts available for such transfers (e.g., it excluded
from this authority $75 billion provided to the PHSSEF for the “Provider Relief Fund”). The acts
require HHS to notify the House and the Senate appropriations committees 10 days in advance of
such transfers.

PHSSEF
The PHSSEF received about $232 billion in funding across the four measures. This accounts for
83% of all LHHS funds provided in the acts (and 93% of the HHS funds in the LHHS titles of the
bills).31 These PHSSEF funds may support various activities, including health care surge capacity
and the development and purchase of medical countermeasures, including vaccines. In general,
PHSSEF supplemental funding has been provided for four main sets of activities.
Medical Countermeasures and Surge Capacity: The first and third measures each provided
funding to support the development, and in some cases federal purchase, of COVID-19 medical
countermeasures, such as diagnostic tests, treatments, vaccines, and medical supplies, as well as
for healthcare workforce and other surge capacity activities. In total, approximately $30.4 billion
has been provided for these activities. Note that the bills also specify that some of these funds are
to be transferred elsewhere (e.g., to other federal agencies for the care of persons under federal
quarantine) or reserved for specific purposes or activities (e.g., deposits to the Strategic National
Stockpile). These activities may be carried out by various ASPR components, especially the
Biomedical Advanced Research and Development Authority (BARDA) for countermeasure
development and procurement.32
COVID-19 Testing for the Uninsured: The second supplemental measure included $1 billion to
provide reimbursements for COVID-19 testing and related services for persons who are
uninsured. In addition, the fourth measure specified that up to $1 billion out of the amounts
appropriated for broader COVID-19 testing purposes (discussed below) may be used to cover the
costs of testing for the uninsured. Both measures provide for these payments to be made
according to the National Disaster Medical System (NDMS) definitive care reimbursement
mechanism. However, the program is administered by HRSA.33

31 For further information on PHSSEF funds in the supplemental measures, see CRS Report R46285, Coronavirus

Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116-123): First Coronavirus Supplemental;
CRS Report R46316, Health Care Provisions in the Families First Coronavirus Response Act, P.L. 116-127; and CRS
Report R46325, Fourth COVID-19 Relief Package (P.L. 116-139): In Brief.
32 For information on the ASPR activities, see HHS, ASPR, “COVID-19: 2019 Novel Coronavirus Disease,”

https://www.phe.gov/emergency/events/COVID19/Pages/default.aspx.
33 HRSA, “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the

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Provider Relief Fund: The third and fourth supplemental measures each provided funding for a
“Provider Relief Fund” to assist health care providers and facilities affected by the COVID-19
pandemic.34 These funds are intended to reimburse eligible health care providers for health care-
related expenses or lost revenues that are attributable to COVID-19. The measures define eligible
providers broadly as any that provide “diagnoses, testing, or care for individuals with possible or
actual cases of COVID-19.” In total, $175 billion has been appropriated for the Provider Relief
Fund.35
COVID-19 Testing, Surveillance, and Contact Tracing: The fourth supplemental measure
provided $25 billion to augment national capacity for COVID-19 containment, including
expanded testing capacity, and workforce and technical capacity for disease surveillance and
contact tracing. The bill directed HHS to reserve some of these funds for specific purposes (e.g.,
not less than $11 billion is for states, localities, territories, tribes, tribal organizations, urban
Indian health organizations, or health service providers to tribes). In addition, the bill specified
that certain funds are to be transferred to other agencies and accounts (e.g., $600 million is to be
transferred to the FDA for diagnostic, serological, antigen, and other tests).

In addition to the activities specified above, PHSSEF appropriations in the first, third, and fourth
supplemental measures called for some portion of the funds to be transferred to other agencies or
accounts for particular activities. For instance, some PHSSEF funds are required to be transferred
to the HRSA for health centers, rural health, the Ryan White HIV/AIDS program, and health care
systems.36

Other HHS Funding

Further public health-related funding for preparedness and response was appropriated to the CDC
($6.5 billion) and NIH ($1.8 billion) in the first and third supplemental measures. In addition, the
fourth supplemental explicitly directed certain PHSSEF appropriations to be transferred to CDC
and NIH for COVID-19 response activities. When accounting for these transfers, total funding
directed to the CDC would come to not less than $7.5 billion and total funding directed to NIH
would come to not less than $3.6 billion.37 The CDC funding was intended, among other things,
to support grants, or cooperative agreements with grants to states, localities, tribes and other
entities, for public health activities (e.g., surveillance, infection control, diagnostics, laboratory
support, and epidemiology), as well as for global disease detection and modernization of public
health data collection. The funds may also be used to support public outreach campaigns, and
provide guidance to physicians, health care workers, and others. Most of the NIH funding was

Uninsured,” https://www.hrsa.gov/CovidUninsuredClaim.
34 For more information on the new fund, see HHS, “CARES Act Provider Relief Fund” (the name given to this fund

by HHS), April 22, 2020, https://www.hhs.gov/provider-relief/index.html.
35 For further information about these appropriations, see CRS Report R46325, Fourth COVID-19 Relief Package (P.L.

116-139): In Brief, and HHS news releases at https://www.hhs.gov/about/news/index.html.
36 For further background on HRSA and these activities, see, for example, CRS Report R44054, Health Resources and

Services Administration (HRSA) Funding: Fact Sheet; CRS Report R46239, Telehealth and Telemedicine: Frequently
Asked Questions; and CRS Insight IN11238, Coronavirus Disease 2019 (COVID-19) Poses Challenges for the U.S.
Blood Supply.
37 P.L. 116-139 directed HHS to transfer $1 billion to the CDC-Wide Activities and Program Support account for

various activities including workforce supports necessary to expand and improve COVID-19 testing. In addition, P.L.
116-139 directed HHS to transfer not less than $1.8 billion to NIH to support activities related to COVID-19 testing.
This includes at least $306 million for the National Cancer Institute, at least $500 million for the National Institute of
Biomedical Imaging and Bioengineering, and at least $1 billion for the Office of the Director, for specified activities.

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provided to several institutes to support basic scientific research as well as research on potential
vaccines, therapeutics, and diagnostics related to COVID-19.38

ACL received a total of $1.2 billion in the second and third response measures. The majority of
this funding ($750 million) was spread across a variety of activities that the agency undertakes to
help provide meals to low-income seniors.39

SAMHSA received $425 million in the third measure, with $250 million for Certified
Community Behavioral Health Clinics, $50 million for suicide prevention programs, and not less
than $15 million for Indian Tribes. The measure specified that not less than $100 million be made
available as emergency response grants for state governments for crisis intervention services,
mental health and substance use disorder treatment, and recovery supports for individuals
affected by the pandemic.40

CMS received $200 million in the third measure. At least half of this appropriation was to be
spent on additional infection control surveys for federally certified facilities with populations
vulnerable to severe illness from COVID-19.41

ACF received $6.3 billion in the third measure. These funds were directed to a number of human
services programs. For instance, the Child Care and Development Block Grant received $3.5
billion to provide continued assistance to child care providers in the event of decreased
enrollment or program closures. These funds may also be used to support child care facilities that
are open and operating, including those providing care for the children of essential workers.42
Several other ACF programs received funding, including the Community Services Block Grant
($1 billion), Head Start ($750 million), and the Low Income Home Energy Assistance Program
($225 million).43

Department of Education
Almost all of the $30.925 billion in supplemental ED appropriations provided in the third
measure are for the Education Stabilization Fund (ESF). The ESF is composed of three
emergency relief funds: (1) a Governor’s Emergency Education Relief (GEER) Fund (§18002),
(2) an Elementary and Secondary School Emergency Relief Fund (ESSERF; §18003),44 and (3) a

38 For background on NIH funding, see CRS Report R43341, National Institutes of Health (NIH) Funding: FY1994-

FY2020. For further information on the NIH, see CRS Report R41705, The National Institutes of Health (NIH):
Background and Congressional Issues.
39 For more information, see CRS Insight IN11266, Senior Nutrition Programs’ Response to COVID-19.

40 SAMHSA ultimately allocated $110 million for these emergency response grants. HHS, SAMHSA, Grants/Grant

Announcements/Emergency Grants to Address Mental and Substance Use Disorders During COVID-19, April 1, 2020,
https://www.samhsa.gov/grants/grant-announcements/fg-20-006.
41 For background, see CMS, “Coronavirus: Updates for State Surveyors and Accrediting Organizations,”

https://www.cms.gov/medicare/quality-safety-oversight-general-information/coronavirus.
42 For further information, see CRS Report R46324, COVID-19: Child Care and Development Block Grant (CCDBG)

Supplemental Appropriations in the CARES Act.
43 For background on these programs, see CRS Report RL32872, Community Services Block Grants (CSBG):

Background and Funding; CRS In Focus IF11008, Head Start: Overview and Current Issues; and CRS Report
RL31865, LIHEAP: Program and Funding.
44 For more information about emergency assistance for elementary and secondary education related to COVID-19, see

CRS In Focus IF11509, CARES Act Elementary and Secondary Education Provisions.

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Higher Education Emergency Relief (HEER) Fund (§18004).45 The third measure provided a total
of $30.750 billion for the ESF and specified that these funds are to remain available through
September 30, 2021.
The GEER Fund may be used to provide emergency support through grants to local educational
agencies (LEAs) that the state educational agency (SEA) or governor determines to have been the
most significantly impacted by COVID-19. Emergency support may also be provided through
grants to institutions of higher education (IHEs) serving students within the state that the
governor determines to have been the most significantly impacted by COVID-19. A governor
may also choose to provide emergency support to any other IHE, LEA, or education-related entity
within the state that he or she deems “essential for carrying out emergency educational services”
to students for a broad array of purposes ranging from any activity authorized under various
federal education laws to the provision of child care and early childhood education, social and
emotional support, and the protection of education-related jobs.
Funds from the ESSERF are to be awarded to states based on their relative shares of grants
awarded under Title I-A of the Elementary and Secondary Education Act (ESEA), as amended.
SEAs are required to provide at least 90% of the funds to LEAs to be used for myriad purposes
such as any activity authorized under various federal education laws (e.g., ESEA), coordination
of preparedness and response to the COVID-19 pandemic, technology acquisition, mental health,
and activities related to summer learning. Funds retained by the SEA must be used for emergency
needs, as determined by the SEA, to address issues in response to the COVID-19 pandemic and
for administration.
The HEER Fund is to distribute funds to IHEs to address needs directly related to the COVID-19
pandemic, including, but not limited to, transitioning courses to distance education and grant aid
to students for their educational costs such as food, housing, course materials, health care, and
child care.

Related Agencies
The Social Security Administration (SSA) received the largest amount ($300 million) among the
related agencies. These funds were provided to the SSA Limitation on Administrative Expenses
account to support the salaries and benefits of all SSA employees affected as a result of office
closures. The funds are also to be used for costs associated with telework, phone, and
communication services for employees; for overtime costs and supplies; and for processing
disability and retirement benefit workloads and backlogs.

Detailed LHHS Programs and Activities Supplemental Amounts
Table 2 displays funding directed to LHHS programs and activities, as enacted, across the four
COVID-19 supplemental appropriations acts. It is organized by department or agency and by
account, program, or activity. The table also indicates a number of cases in which appropriations
language reserved funds within a particular account for specific programs or activities, or directed
that funds be transferred to other accounts. It makes note of instances in which these reservations
are for not less than (NLT) or not more than (NMT) a certain dollar amount. In cases where the
bill text calls for transfers, funds are shown in the account to which they were appropriated, not
in the account to which they are to be transferred.

45 For more information about emergency assistance related to COVID-19 for IHEs, see CRS In Focus IF11497,

CARES Act Higher Education Provisions.

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Table 2. FY2020 LHHS Supplemental Appropriations for COVID-19 Response
(Budget authority in millions of dollars)
Department and P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139
Agency, Account, or Program (Division A)a (Division A) (Division B) (Division B)b Total

DOL Subtotal — — 360 — 360
Training and Employment Services: — — 345 — 345
Dislocated Worker Assistance National
Reserve
Departmental Management — — 15c — 15
Transfer to OIG — — (1) — (1)
HHS Subtotal 6,436d 1,250 140,389e 100,000f 248,075
Centers for Disease Control and 2,200 — 4,300 — 6,500
Prevention (CDC)
CDC-Wide Program Activities and 2,200 — 4,300 — 6,500
Support
NLT for states, territories, localities, or (950)g — (1,500)h — (2,450)
tribal entities to carry out core public
health functions (e.g., infection control,
epidemiology, laboratory capacity,
mitigation)
NLT transfer to Infectious Disease (300) — (300) — (600)
Rapid Response Reserve Fund
(IDRRRF)
NLT for global disease detection and (300) — (500) — (800)
response
NLT for health data surveillance — — (500) — (500)
modernization
National Institutes of Health 836 — 945 — 1,781
(NIH)
National Heart, Lung, and Blood — — 103 — 103
Institute
National Institute of Allergy and 836 — 706 — 1,542
Infectious Diseases
NLT transfer to National Institute of (10) — — — (10)
Environmental Sciences
NLT for vaccine and infectious disease — — (156) — (156)
research facilities
National Institute of Biomedical Imaging — — 60 — 60
and Bioengineering
National Library of Medicine — — 10 — 10
National Center for Advancing — — 36 — 36
Translational Sciences
Office of the Director — — 30 — 30
Substance Abuse and Mental — — 425 — 425
Health Services Administration
(SAMHSA)

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Department and P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139
Agency, Account, or Program (Division A)a (Division A) (Division B) (Division B)b Total

Health Surveillance and Program — — 425i — 425
Support
NLT for Certified Community — — (250) — (250)
Behavioral Health Clinics
NLT for suicide prevention — — (50) — (50)
NLT for emergency response grants — — (100)j — (100)
for substance abuse and mental
health
Centers for Medicare & Medicaid — — 200 — 200
Services (CMS)
Program Management — — 200 — 200
NLT for survey and certification for — — (100) — (100)
infection control
Administration for Children and — — 6,274 — 6,274
Families (ACF)
Low Income Home Energy Assistance — — 900 — 900
Program
Child Care and Development Block — — 3,500 — 3,500
Grant
Children and Families Services — — 1,874 — 1,874
Programs
Community Services Block Grant — — (1,000) — (1,000)
Head Start — — (750) — (750)
Domestic Violence Hotline — — (2) — (2)
Family Violence Prevention and — — (45) — (45)
Services Grants
Runaway and Homeless Youth — — (25) — (25)
Child Welfare Services — — (45) — (45)
Federal Administration — — (7) — (7)
Administration for Community — 250 955 — 1,205
Living (ACL)
Aging and Disabilities Services — 250 955 — 1,205
Supportive Services — — (200) — (200)
Congregate and Home-Delivered — (240)k (480) — (720)
Nutrition Services
Nutrition Services to Native Americans — (10) (20) — (30)
Family Caregivers — — (100) — (100)
Elder Rights Protection Activities — — (20) — (20)
Aging and Disability Resource Centers — — (50) — (50)
Centers for Independent Living — — (85) — (85)
Office of the Secretary 3,400l 1,000m 127,290n 100,000o 231,690

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Department and P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139
Agency, Account, or Program (Division A)a (Division A) (Division B) (Division B)b Total

PHSSEF 3,400l 1,000m 127,290n 100,000o 231,690
NMT transfer to HHS OIG (2)p — (4)p (6)p (12)
Testing for the Uninsured — (1,000) — —q (1,000)
Transfers to HRSA (Ryan White, Rural — — (275)r — (275)
Health, and Health Care Systems)
Provider Relief Fund — — (100,000) (75,000) (175,000)
Medical Countermeasures and Surge (3,400)l — (27,015) — (30,415)
Capacity
Transfer to HRSA (Health (100) — — — (100)
Centers)
NMT for Strategic National — — (16,000)s — (16,000)
Stockpile
NLT for Hospital Preparedness — — (250) — (250)
Program grantees or subgrantees
for public health emergency needs
NLT for Biomedical Advanced — — (3,500) — (3,500)
Research & Development
Authority (BARDA)
NMT transfer to other federal — — (289) — (289)
agencies for care of persons under
federal quarantine
National Academies Study — — (2) — (2)
COVID-19 Testing, Surveillance, and — — —t (25,000) (25,000)
Contact Tracing
NLT for grants to states, localities, — — — (11,000)u (11,000)
territories, and tribal entities
NLT transfer to CDC-Wide — — — (1,000) (1,000)
Activities and Program Support
NLT transfer to NIH National — — — (306) (306)
Cancer Institute
NLT transfer to NIH National — — — (500) (500)
Institute of Biomedical Imaging
and Bioengineering
NLT transfer to NIH Office of the — — — (1,000) (1,000)
Director
NLT for BARDA — — — (1,000) (1,000)
Transfer to Food and Drug — — — (22) (22)
Administration (Salaries and
Expenses)
Transfer to HRSA (Health — — — (600)v (600)
Centers)
Rural Health Clinics — — — (225) (225)
NMT Testing for the Uninsured — — — (1,000)q (1,000)
ED Subtotal — — 30,925 — 30,925

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COVID-19: FY2020 LHHS Supplemental Appropriations

Department and P.L. 116-123 P.L. 116-127 P.L. 116-136 P.L. 116-139
Agency, Account, or Program (Division A)a (Division A) (Division B) (Division B)b Total

Education Stabilization Fund — — 30,750 — 30,750
Safe Schools and Citizenship — — 100 — 100
Gallaudet University — — 7 — 7
Student Aid Administration — — 40 — 40
Howard University — — 13 — 13
Program Administration — — 8 — 8
OIG — — 7 — 7
Related Agencies Subtotal — — 430 — 430
Corporation for Public Broadcasting — — 75 — 75
Institute of Museum and Library — — 50 — 50
Services
Railroad Retirement Board — — 5 — 5
Social Security Administration — — 300 — 300
LHHS Total 6,436 1,250 172,104 100,000 279,790

Source: Compiled by CRS from amounts specified in P.L. 116-123 (Title III, Division A), P.L. 116-127 (Title V,
Division A), P.L. 116-136 (Title VIII, Division B), and P.L. 116-139 (Title I, Division B). Funds provided in other
titles and divisions of these laws are beyond the scope of this report and are excluded from the table. (For
instance, the table does not include the $1.320 billion in mandatory funds for the HRSA health centers program
provided in Title III, Division A, Section 3211 of P.L. 116-136).
Notes: OIG = Office of the Inspector General. NLT = Not Less Than. NMT = Not More Than. All funds are
designated as an emergency requirement. Amounts in parenthesis and italics are non-adds. The table displays
funds in the accounts in which they were appropriated. The table makes note of a number of cases in which the
appropriations language reserved funds within a particular account for specific programs or activities, or directed
that funds be transferred to other accounts. When the bill text calls for transfers, funds are shown in the account to
which they were appropriated, not in the account to which they are to be transferred.
a. For further information, see CRS Report R46285, Coronavirus Preparedness and Response Supplemental
Appropriations Act, 2020 (P.L. 116-123): First Coronavirus Supplemental.
b. For further information, see CRS Report R46325, Fourth COVID-19 Relief Package (P.L. 116-139): In Brief.
c. DOL may transfer funds from this appropriation to the accounts for Employee Benefits Security
Administration, Wage and Hour Division, Occupational Safety and Health Administration, and Employment
and Training Administration—Program Administration.
d. HHS may transfer nearly all the funds appropriated to it in Title III, Division A of P.L. 116-123 among
accounts at CDC, NIH, or PHSSEF, provided the transfers are made to prevent, prepare for, and respond
to the COVID-19 pandemic, domestically or internationally (see §304). HHS is to notify the House and the
Senate appropriations committees 10 days in advance of such a transfer.
e. HHS may transfer nearly all the funds appropriated to it in Title VIII, Division B of P.L. 116-136 among
accounts at CDC, PHSSEF, ACF, ACL, and NIH, provided the transfers are made to prevent, prepare for,
and respond to the COVID-19 pandemic, domestically or internationally (see §18111). HHS is to notify the
House and the Senate appropriations committees 10 days in advance of such a transfer.
f. HHS may transfer certain funds appropriated to it in Title I, Division B of P.L. 116-139 among accounts at
CDC, NIH, PHSSEF, and the Food and Drug Administration, provided the transfers are made to prevent,
prepare for, and respond to the COVID-19 pandemic (see §102). (This transfer authority does not apply to
the $75 billion for the Provider Relief Fund or to the $11 billion in COVID-19 testing capabilities funds for
grants to states, localities, territories, tribes, tribal organizations, urban Indian health organizations, or
related providers.) HHS is to notify the House and the Senate appropriations committees 10 days in
advance of such a transfer.

Congressional Research Service 14
COVID-19: FY2020 LHHS Supplemental Appropriations

g. Of the total appropriated, not less than $40 million shall be allocated to tribes, tribal organizations, urban
Indian health organizations, or health service providers to tribes.
h. Of the total appropriated, not less than $125 million shall be allocated to tribes, tribal organizations, urban
Indian health organizations, or health service providers to tribes.
i. Of the total appropriated, not less than $15 million shall be allocated to tribes, tribal organizations, urban
Indian health organizations, or health or behavioral health service providers to tribes.
j. SAMHSA ultimately allocated $110 million for these emergency response grants. HHS, SAMHSA,
Grants/Grant Announcements/Emergency Grants to Address Mental and Substance Use Disorders During COVID-19,
April 1, 2020, https://www.samhsa.gov/grants/grant-announcements/fg-20-006.
k. Of this total, $80 million is for congregate nutrition and $160 million is for home-delivered nutrition.
l. The total shown in this table includes $300 million in appropriations contingent upon future HHS actions.
Of the total appropriated to the PHSSEF, up to $2 million is to be transferred to the HHS OIG.
m. To provide reimbursements for COVID-19 testing and related services for persons who are uninsured.
n. Provided in distinct appropriations broadly focused on medical countermeasures and surge capacity ($27
billion), health care provider reimbursement (the Provider Relief Fund, $100 billion), and HRSA transfers
($275 million). Of the total appropriated to the PHSSEF, up to $4 million is to be transferred to the HHS
OIG.
o. Provided in distinct appropriations broadly focused on health care provider reimbursement (the Provider
Relief Fund, $75 billion) and COVID-19 testing, surveillance, and contact tracing ($25 billion). Of the total
appropriated to the PHSSEF, up to $6 million is to be transferred to the HHS OIG.
p. The transfers to the HHS OIG are specified in general provisions (not more than $2 million per Title III,
Division A, Section 306 of P.L. 116-123, not more than $4 million per Title VIII, Division B, Section 8113 of
P.L. 116-136, and not more than $6 million per Title I , Division B, Section 103 of P.L. 116-139). The
amounts transferred to the HHS OIG may come from any funds appropriated to the PHSSEF in the
respective appropriations acts. The HHS OIG funds are for oversight of all activities supported with funds
appropriated to HHS to prevent, prepare for, and respond to the COVID-19 pandemic (not just funds
appropriated to the PHSSEF).
q. P.L. 116-123 did not provide a distinct appropriation for testing for the uninsured, but it specified that up to
$1 billion out of the $25 billion appropriated for COVID-19 testing, surveillance, and contact tracing may be
used for this purpose.
r. Of the total to be transferred to HRSA, $90 million is for the Ryan White HIV/AIDS program, $180 million
is for rural health programs (of which not less than $15 million is for tribes, tribal organizations, urban
Indian health organizations, or health service providers to tribes), and $5 million is for health care systems.
s. HHS may transfer certain additional funds from the PHSSEF to the Strategic National Stockpile for
countermeasures purchases.
t. P.L. 116-136 did not provide a distinct appropriation for these activities, but it did allow for PHSSEF
appropriations to be used for “other preparedness and response activities.” At the HHS Secretary’s
discretion, this may include testing, surveillance, and/or contact tracing, among other things.
u. From this total, not less than $750 million shall be allocated, in coordination with the Director of the Indian
Health Service (IHS), to tribes, tribal organizations, urban Indian health organizations, or related entities.
v. P.L. 116-139 specified that these funds may be awarded to Federally Qualified Health Centers under Section
330 of the Public Health Service Act and to entities that are eligible for but not currently receiving such
funds (i.e., Federally Qualified Health Center “look-alikes”).

Congressional Research Service 15
COVID-19: FY2020 LHHS Supplemental Appropriations

Author Contact Information

Karen E. Lynch Jessica Tollestrup
Specialist in Social Policy Specialist in Social Policy
/redacted/@crs.loc.gov
, 7-.... /redacted/@crs.loc.gov , 7-....

Acknowledgments
The analysis in this report benefitted from subject-matter expertise provided by David H. Bradley, Kirsten
J. Colello, Christopher M. Davis, Johnathan H. Duff, Elayne J. Heisler, Sarah A. Lister, William R.
Morton, Angela Napili, Kavya Sekar, Kyle D. Shohfi, Rebecca R. Skinner, and Phoenix Voorhies.

Congressional Research Service R46353 · VERSION 2 · NEW 16
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