# Labor, Health and Human Services, and Education: FY2019 Appropriations

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URL: https://www.frixlaw.com/law-library/documents/crs%3AR45869

## Record

- **Collection:** Congressional research report
- **Document type:** CRS Report
- **Published:** August 5, 2019
- **Citation:** R45869

## Text

Labor, Health and Human Services, and
Education: FY2019 Appropriations
Karen E. Lynch, Coordinator
Specialist in Social Policy
Jessica Tollestrup, Coordinator
Specialist in Social Policy
David H. Bradley
Specialist in Labor Economics
Ada S. Cornell
Senior Research Librarian
William R. Morton
Analyst in Income Security
Angela Napili
Senior Research Librarian
Kyle D. Shohfi
Analyst in Education Policy
August 5, 2019

Congressional Research Service
7-....
www.crs.gov
R45869

SUMMARY

Labor, Health and Human Services, and
Education: FY2019 Appropriations
This report offers an overview of actions taken by Congress and the President to provide
FY2019 appropriations for accounts funded by the Departments of Labor, Health and
Human Services, and Education, and Related Agencies (LHHS) appropriations bill. This
bill includes all accounts funded through the annual appropriations process at the
Department of Labor (DOL) and Department of Education (ED). It also provides annual
appropriations for most agencies within the Department of Health and Human Services
(HHS), with certain exceptions (e.g., the Food and Drug Administration is funded via
the Agriculture bill). Finally, the LHHS bill provides funds for more than a dozen related
agencies, including the Social Security Administration (SSA).
FY2019 Supplemental Appropriations for the Southern Border: During the 116th
Congress, on July 1, 2019, the President signed into law P.L. 116-26, a supplemental
appropriations act for FY2019 focusing primarily on the provision of humanitarian
assistance and security at the southern border. The bill was passed by the House on June
27 and by the Senate on June 26. (An earlier version of the bill had passed the House on
June 25. A related bill, S. 1900, had passed the Senate on June 19; this bill was
substantially similar to the final version of P.L. 116-26.) As enacted, the bill contained
nearly $2.9 billion in emergency-designated LHHS appropriations for the Refugee and
Entrant Assistance account at HHS. The FY2019 enacted levels presented throughout
this report are based on amounts provided by the FY2019 LHHS omnibus (P.L. 115-245,
see below) and do not include these supplemental funds, which were provided in
addition to the annual appropriations.

R45869
August 5, 2019
Karen E. Lynch,
Coordinator
Specialist in Social Policy
-redacted-@crs.loc.gov
Jessica Tollestrup,
Coordinator
Specialist in Social Policy
-redacted-@crs.loc.gov
David H. Bradley
Specialist in Labor
Economics
-redacted-@crs.loc.gov
Ada S. Cornell
Senior Research Librarian
-redacted-@crs.loc.gov
William R. Morton
Analyst in Income Security
-redacted-@crs.loc.gov
Angela Napili
Senior Research Librarian
-redacted-@crs.loc.gov
Kyle D. Shohfi
Analyst in Education Policy
-redacted-@crs.loc.gov

FY2019 Supplemental Appropriations for Disaster Relief: During the 116th Congress,
on June 6, 2019, the President signed into law P.L. 116-20, a supplemental
For a copy of the full report,
appropriations act for FY2019 focusing primarily on certain expenses arising from
please call 7-.... or visit
hurricanes, typhoons, wildfires, earthquakes, tornadoes, floods, and other natural
www.crs.gov.
disasters or emergencies. The bill was passed by the House on June 3 and by the Senate
on May 23. (An earlier version of the bill had passed the House on May 10.) As enacted, the bill included roughly
$611 million in emergency-designated LHHS appropriations for accounts at DOL, HHS, and ED. The FY2019
enacted levels presented throughout this report are based on amounts provided by the FY2019 LHHS omnibus
(P.L. 115-245) and do not include these supplemental funds, which were provided in addition to the annual
appropriations.
FY2019 LHHS Omnibus: During the 115th Congress, on September 28, 2018, the President signed into law the
Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and
Continuing Appropriations Act, 2019 (H.R. 6157, P.L. 115-245). This law contained full-year LHHS
appropriations in Division B. This is the first occasion since the FY1997 appropriations cycle that full-year LHHS
appropriations were enacted on or before the start of the fiscal year (October 1). The FY2019 LHHS omnibus
contained discretionary appropriations totaling $189.4 billion. This amount is 1.5% more than FY2018 enacted
levels and 8.9% more than the FY2019 President’s budget request. The omnibus also provided $869.8 billion in
mandatory funding, for a combined LHHS total of $1.059 trillion. The distribution of discretionary funding was
as follows:
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


DOL: $12.1 billion, 0.8% less than FY2018.
HHS: $90.5 billion, 2.6% more than FY2018.
ED: $71.4 billion, 0.8% more than FY2018.
Related Agencies: $15.3 billion, 0.1% more than FY2018.

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Labor, Health and Human Services, and Education: FY2019 Appropriations

FY2019 LHHS Senate Action: The Senate Appropriations Committee reported its version of the FY2018 LHHS
appropriations bill on June 28, 2018, by a vote of 30-1 (S. 3158). Instead of taking up the committee-reported
vehicle, the Senate chose to take up a different appropriations vehicle (H.R. 6157) and amend it to contain
FY2019 LHHS appropriations as well. (Those LHHS appropriations, which were added as Division B of H.R.
6157, were substantially the same as S. 3158.) During floor consideration of H.R. 6157, the Senate also adopted
31 amendments to the new LHHS division of the bill (see Appendix B for a summary of these amendments). The
Senate passed an amended H.R. 6157 by a vote of 85-7 on August 23, 2018.
The Senate-passed bill would have provided $189.4 billion in discretionary LHHS funds. This would have been
1.5% more than FY2018, and 8.9% more than the FY2019 President’s request. In addition, the Senate-passed bill
would have provided an estimated $869.8 billion in mandatory funding, for a combined total of $1.059 trillion for
LHHS as a whole. The distribution of discretionary funding would have been as follows:





DOL: $12.1 billion, 0.8% less than FY2018.
HHS: $90.5 billion, 2.7% more than FY2018.
ED: $71.4 billion, 0.8% more than FY2018.
Related Agencies: $15.4 billion, 0.5% more than FY2018.

FY2019 LHHS House Action: The House Appropriations Committee’s version of the FY2019 LHHS
appropriations bill was ordered reported by the full committee on July 11, 2018, by a vote of 30-22, and reported
to the House on July 23 (H.R. 6470). This bill would have provided $187.2 billion in discretionary LHHS funds, a
0.3% increase from FY2018 enacted levels. This amount would have been 7.6% more than the FY2019
President’s request. In addition, the House committee bill would have provided an estimated $869.8 billion in
mandatory funding, for a combined total of $1.057 trillion for LHHS as a whole. The distribution of discretionary
funding would have been as follows:





DOL: $11.9 billion, 2.4% less than FY2018.
HHS: $89.3 billion, 1.3% more than FY2018.
ED: $71.0 billion, 0.2% more than FY2018.
Related Agencies: $15.0 billion, 2.2% less than FY2018.

The House committee-reported version of the LHHS bill did not receive floor consideration.
FY2019 President’s Budget Request: On February 12, 2018, the Trump Administration released the FY2019
President’s budget. The President requested $173.9 billion in discretionary funding for accounts funded by the
LHHS bill, which would have been a decrease of 6.8% from FY2018 levels. In addition, the President requested
$869.8 billion in annually appropriated mandatory funding, for a total of $1.044 trillion for LHHS as a whole. The
distribution of discretionary funding was as follows:





DOL: $10.9 billion, 11.1% less than FY2018.
HHS: $86.7 billion, 1.6% less than FY2018.
ED: $63.2 billion, 10.8% less than FY2018.
Related Agencies: $13.2 billion, 14.0% less than FY2018.

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Labor, Health and Human Services, and Education: FY2019 Appropriations

Contents
Introduction ..................................................................................................................................... 1
Report Roadmap and Useful Terminology ...................................................................................... 1
Scope of the Report ................................................................................................................... 2
Important Budget Concepts....................................................................................................... 2
Mandatory vs. Discretionary Budget Authority .................................................................. 2
Total Budget Authority Provided in the Bill vs. Total Budget Authority Available
in the Fiscal Year.............................................................................................................. 3
Status of FY2019 LHHS Appropriations ........................................................................................ 4
FY2019 Supplemental Appropriations for the Southern Border ............................................... 4
FY2019 Supplemental Appropriations for Disaster Relief ....................................................... 6
FY2019 LHHS Omnibus........................................................................................................... 7
Earlier Congressional Action on an LHHS Bill ........................................................................ 8
FY2019 LHHS Action in the House ................................................................................... 8
FY2019 LHHS Action in the Senate ................................................................................... 8
FY2019 President’s Budget Request......................................................................................... 9
Conclusion of the FY2018 Appropriations Process .................................................................. 9
Summary of FY2019 LHHS Appropriations ................................................................................. 10
Department of Labor (DOL) ......................................................................................................... 13
About DOL ............................................................................................................................. 13
FY2019 DOL Appropriations Overview ................................................................................. 13
Selected DOL Highlights ........................................................................................................ 14
Employment and Training Administration (ETA)............................................................. 14
Bureau of International Labor Affairs (ILAB) .................................................................. 15
Labor-Related General Provisions .................................................................................... 15
Department of Health and Human Services (HHS)....................................................................... 18
About HHS .............................................................................................................................. 19
FY2019 HHS Appropriations Overview ................................................................................. 20
Special Public Health Funding Mechanisms ........................................................................... 21
Public Health Service Evaluation Tap............................................................................... 21
Prevention and Public Health Fund .................................................................................. 23
Selected HHS Highlights by Agency ...................................................................................... 23
HRSA ................................................................................................................................ 24
CDC .................................................................................................................................. 24
NIH ................................................................................................................................... 25
SAMHSA .......................................................................................................................... 26
CMS .................................................................................................................................. 26
ACF ................................................................................................................................... 27
AHRQ ............................................................................................................................... 28
ACL .................................................................................................................................. 28
Restrictions Related to Certain Controversial Issues .............................................................. 29
Department of Education (ED) ...................................................................................................... 36
About ED ................................................................................................................................ 36
FY2019 ED Appropriations Overview .................................................................................... 37
Selected ED Highlights ........................................................................................................... 37
Career and Technical Education........................................................................................ 38

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Student Financial Assistance............................................................................................. 38
Free Application for Federal Student Aid (FAFSA) ......................................................... 39
Related Agencies ........................................................................................................................... 41
FY2019 Related Agencies Appropriations Overview ............................................................. 41
Selected Related Agencies Highlights..................................................................................... 42
SSA Limitation on Administrative Expenses (LAE) ........................................................ 42
Corporation for National and Community Service ........................................................... 43
National Labor Relations Board (NLRB) ......................................................................... 43

Figures
Figure 1. FY2019 Enacted LHHS Appropriations .......................................................................... 8
Figure 2. FY2019 Enacted LHHS Appropriations by Title ........................................................... 12
Figure 3. FY2019 Enacted HHS Appropriations by Agency......................................................... 21

Tables
Table 1. Status of Full-Year LHHS Appropriations Legislation, FY2019 ....................................... 4
Table 2. LHHS Appropriations Overview by Bill Title, FY2018-FY2019 .................................... 11
Table 3. DOL Appropriations Overview ....................................................................................... 14
Table 4. Detailed DOL Appropriations .......................................................................................... 16
Table 5. HHS Appropriations Overview........................................................................................ 20
Table 6. HHS Appropriations Totals by Agency ........................................................................... 30
Table 7. HHS Discretionary Appropriations for Selected Programs or Activities,
by Agency .................................................................................................................................. 33
Table 8. ED Appropriations Overview .......................................................................................... 37
Table 9. Detailed ED Appropriations ............................................................................................ 39
Table 10. Related Agencies Appropriations Overview .................................................................. 42
Table 11. Detailed Related Agencies Appropriations .................................................................... 44
Table A-1. FY2019 LHHS Discretionary House and Senate Initial 302(b) Suballocations,
FY2019 Enacted Levels, and FY2018 Enacted Levels .............................................................. 49
Table A-2. LHHS Appropriations Overview, by Bill Title: FY2018-FY2019............................... 50
Table B-1. Senate Floor Amendments Offered to H.R. 6157 ........................................................ 52

Appendixes
Appendix A. Budget Enforcement Activities ................................................................................ 46
Appendix B. Senate Floor Amendments Offered to H.R. 6157 .................................................... 52

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Contacts
Author Contact Information .......................................................................................................... 55

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Introduction
This report provides an overview of FY2019 appropriations actions for accounts traditionally
funded in the appropriations bill for the Departments of Labor, Health and Human Services, and
Education, and Related Agencies (LHHS). This bill provides discretionary and mandatory
appropriations to three federal departments: the Department of Labor (DOL), the Department of
Health and Human Services (HHS), and the Department of Education (ED). In addition, the bill
provides annual appropriations for more than a dozen related agencies, including the Social
Security Administration (SSA).
Discretionary funds represent less than one-fifth of the total funds appropriated in the LHHS bill.
Nevertheless, the LHHS bill is typically the largest single source of discretionary funds for
domestic nondefense federal programs among the various appropriations bills. (The Department
of Defense bill is the largest source of discretionary funds among all federal programs.) The bulk
of this report is focused on discretionary appropriations because these funds receive the most
attention during the appropriations process.
The LHHS bill typically is one of the more controversial of the regular appropriations bills
because of the size of its funding total and the scope of its programs, as well as various related
social policy issues addressed in the bill, such as restrictions on the use of federal funds for
abortion and for research on human embryos and stem cells.
Congressional clients may consult the LHHS experts list in CRS Report R42638, Appropriations:
CRS Experts, for information on which analysts to contact at the Congressional Research Service
(CRS) with questions on specific agencies and programs funded in the LHHS bill.

Report Roadmap and Useful Terminology
This report is divided into several sections. The opening section provides an explanation of the
scope of the LHHS bill (and hence, the scope of this report) and an introduction to important
terminology and concepts that carry throughout the report. Next is a series of sections describing
major congressional actions on FY2019 appropriations and (for context) a review of the
conclusion of the FY2018 appropriations process. This is followed by a high-level summary and
analysis of enacted and proposed appropriations for FY2019, compared to FY2018 funding
levels. The body of the report concludes with overview sections for each of the major titles of the
bill: DOL, HHS, ED, and Related Agencies. These sections provide selected highlights from
FY2019 enacted and proposed funding levels compared to FY2018. (Note that the distribution of
funds is sometimes illustrated by figures, which in all cases are based on the FY2019 enacted
version of the LHHS bill.1)
Finally, Appendix A provides a summary of budget enforcement activities for FY2019. This
includes information on the Budget Control Act of 2011 (BCA; P.L. 112-25) and sequestration,
budget enforcement in the absence of an FY2019 budget resolution, provisional subcommittee
spending allocations, and current-year spending levels. This is followed by Appendix B, which
provides an overview of the LHHS-related floor amendments that were offered in the Senate
during its consideration of H.R. 6157, an appropriations measure that was amended to contain
LHHS appropriations for FY2019.
1 The dollars and percentages in each figure also are generally illustrative, except as noted, of the parallel distribution

of funds enacted in FY2018 and proposed by the FY2019 President’s budget, and the House committee-reported and
the Senate-passed bills.

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Scope of the Report
In general, this report is focused strictly on appropriations to agencies and accounts that are
subject to the jurisdiction of the Labor, Health and Human Services, Education, and Related
Agencies subcommittees of the House and Senate appropriations committees (i.e., accounts
traditionally funded via the LHHS bill). Department “totals” provided in this report do not
include funding for accounts or agencies that are traditionally funded by appropriations bills
under the jurisdiction of other subcommittees.
The LHHS bill provides appropriations for the following federal departments and agencies:






the Department of Labor;
most agencies at the Department of Health and Human Services, except for the
Food and Drug Administration (funded through the Agriculture appropriations
bill), the Indian Health Service (funded through the Interior-Environment
appropriations bill), and the Agency for Toxic Substances and Disease Registry
(also funded through the Interior-Environment appropriations bill);
the Department of Education; and
more than a dozen related agencies, including the Social Security Administration,
the Corporation for National and Community Service, the Corporation for Public
Broadcasting, the Institute of Museum and Library Services, the National Labor
Relations Board, and the Railroad Retirement Board.

Note also that funding totals displayed in this report do not reflect amounts provided outside of
the annual appropriations process. Certain direct spending programs, such as Social Security and
parts of Medicare, receive funding directly from their authorizing statutes; such funds are not
reflected in the totals provided in this report because they are not provided through the annual
appropriations process (see related discussion in the “Important Budget Concepts” section).

Important Budget Concepts
Mandatory vs. Discretionary Budget Authority2
The LHHS bill includes both discretionary and mandatory budget authority. While all
discretionary spending is subject to the annual appropriations process, only a portion of
mandatory spending is provided in appropriations measures.
Mandatory programs funded through the annual appropriations process are commonly referred to
as appropriated entitlements. In general, appropriators have little control over the amounts
provided for appropriated entitlements; rather, the authorizing statute controls the program
parameters (e.g., eligibility rules, benefit levels) that entitle certain recipients to payments. If
Congress does not appropriate the money necessary to meet these commitments, entitled
recipients (e.g., individuals, states, or other entities) may have legal recourse.3

2 For definitions of these and other budget terms, see U.S. Government Accountability Office (GAO), A Glossary of

Terms Used in the Federal Budget Process, GAO-05-734SP, September 1, 2005, http://www.gao.gov/products/GAO05-734SP. (Terms of interest may include appropriated entitlement, direct spending, discretionary, entitlement
authority, and mandatory.)
3 Sometimes appropriations measures include amendments to laws authorizing mandatory spending programs and
thereby change the amount of mandatory appropriations needed. Because such amendments are legislative in nature,

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Most mandatory spending is not provided through the annual appropriations process, but rather
through budget authority provided by the program’s authorizing statute (e.g., Social Security
benefits payments). The funding amounts in this report do not include budget authority provided
outside of the appropriations process. Instead, the amounts reflect only those funds, discretionary
and mandatory, that are provided through appropriations acts.
Note that, as displayed in this report, mandatory amounts for the Trump Administration’s budget
submission reflect current-law (or current services) estimates; they generally do not include the
President’s proposed changes to a mandatory spending program’s authorizing statute that might
affect total spending. (In general, such proposals are excluded from this report, as they typically
would be enacted in authorizing legislation.)
Note also that the report focuses most closely on discretionary funding. This is because
discretionary funding receives the bulk of attention during the appropriations process. (As noted
earlier, although the LHHS bill includes more mandatory funding than discretionary funding, the
appropriators generally have less flexibility in adjusting mandatory funding levels than
discretionary funding levels.)
Mandatory and discretionary spending is subject to budget enforcement processes that include
sequestration. In general, sequestration involves largely across-the-board reductions that are made
to certain categories of discretionary or mandatory spending. However, the conditions that trigger
sequestration, and how it is carried out, differ for each type of spending. This is discussed further
in Appendix A.

Total Budget Authority Provided in the Bill vs. Total Budget Authority
Available in the Fiscal Year
Budget authority is the amount of money a federal agency is legally authorized to commit or
spend. Appropriations bills may include budget authority that becomes available in the current
fiscal year, in future fiscal years, or some combination. Amounts that become available in future
fiscal years are typically referred to as advance appropriations.
Unless otherwise specified, appropriations levels displayed in this report refer to the total amount
of budget authority provided in an appropriations bill (i.e., “total in the bill”), regardless of the
year in which the funding becomes available.4 In some cases, the report breaks out “current-year”
appropriations (i.e., the amount of budget authority available for obligation in a given fiscal year,
regardless of the year in which it was first appropriated).5
As the annual appropriations process unfolds, the amount of current-year budget authority is
measured against 302(b) allocation ceilings (budget enforcement caps for appropriations
subcommittees that traditionally emerge following the budget resolution process). The process of
measuring appropriations against these spending ceilings takes into account scorekeeping
adjustments, which are made by the Congressional Budget Office (CBO) to reflect conventions

they may violate parliamentary rules separating authorizations and appropriations. For more information, see CRS
Report R42388, The Congressional Appropriations Process: An Introduction.
4 Such figures include advance appropriations provided in the bill for future fiscal years, but do not include advance
appropriations provided in prior years’ appropriations bills that become available in the current year.
5 Such figures exclude advance appropriations for future years, but include advance appropriations from prior years that
become available in the given fiscal year.

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and special instructions of Congress.6 Unless otherwise specified, appropriations levels displayed
in this report do not reflect additional scorekeeping adjustments.

Status of FY2019 LHHS Appropriations
Table 1 provides a timeline of major legislative actions for full-year LHHS proposals, which are
discussed in greater detail below.
Table 1. Status of Full-Year LHHS Appropriations Legislation, FY2019
Subcommittee
Approval

Resolution of House and
Senate Differences

Full Committee
Approval

House

Senate

House

Senate

6/15/18
voice
vote

6/26/18
voice
vote

H.R. 6470
H.Rept.
115-862
7/11/18
30-22

S. 3158
S.Rept.
115-289
6/28/18
30-1

House
Initial
Passage

Senate
Initial
Passage

Conf.
Report

House
Final
Passage

Senate
Final
Passage

H.R. 6157, H.Rept.
Division B 115-952
8/23/18
85-7

H.R. 6157,
Division B
9/26/18
361-61

H.R. 6157,
Division B
9/18/18
93-7

Public
Law
P.L. 115245
9/28/18

Source: CRS Appropriations Status Table.

FY2019 Supplemental Appropriations for the Southern Border
On July 1, the President signed into law P.L. 116-26, an FY2019 supplemental appropriations act
focused primarily on humanitarian assistance and security needs at the southern border. The bill
was passed by the House on June 27 and by the Senate on June 26. (An earlier version of the bill
had passed the House on June 25. A related bill, S. 1900, had been reported by the Senate
Appropriations Committee on June 19; this bill was substantially similar to the final version of
P.L. 116-26.)
As enacted, the FY2019 border supplemental contained nearly $2.9 billion in emergencydesignated LHHS appropriations for the Refugee and Entrant Assistance account at HHS. These
funds were primarily intended to support the Unaccompanied Alien Children (UAC) program,
which provides for the shelter, care, and placement of unaccompanied alien children who have
been apprehended in the United States. According to a letter to Congress from the Office of
Management and Budget (OMB), as of May 1 the number of apprehensions referred to HHS had
increased by almost 50% from the prior year.7 In this same letter, OMB requested about $2.9
billion in supplemental funds for the UAC program, noting that these funds would provide

6 For more information on scorekeeping, see CRS Report 98-560, Baselines and Scorekeeping in the Federal Budget

Process. See also a discussion of key scorekeeping guidelines included in the joint explanatory statement
accompanying the conference report to the Balanced Budget Act of 1997 (H.Rept. 105-217, pp. 1007-1014).
7 Letter from Russell T. Vought, Acting Director, Office of Management and Budget, to Michael R. Pence, Nancy
Pelosi, Mitch McConnell, Charles E. Schumer, Kevin McCarthy, Richard C. Shelby, Nita Lowey, Patrick J. Leahy,
Kay Granger, May 1, 2019, https://www.whitehouse.gov/wp-content/uploads/2019/05/Pence.pdf. (This letter requested
$2.8 billion in supplemental funds for the UAC program, but a subsequent letter clarified that the actual request level
was $2.88 billion. See letter from Russell T. Vought, Acting Director, Office of Management and Budget, to Nancy
Pelosi et al., May 17, 2019, https://www.whitehouse.gov/wp-content/uploads/2019/05/Report-and-Notice-ofAnticipated-Deficiency.pdf.)

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“critical child welfare services and high-quality shelter care.” The letter estimated that these funds
would allow HHS to increase shelter capacity to approximately 23,600 beds.
Of the $2.9 billion appropriated to the UAC account, some funds were set aside for designated
activities or purposes, such as state-licensed shelters (not less than $866 million); postrelease
services, child advocates, and legal services (not less than $100 million); additional federal field
specialists and increased case management and coordination services intended to place children
with sponsors more expeditiously and reduce the length of stay in HHS custody (not less than $8
million); project officers/program staff and the development of a discharge rate improvement plan
(not less than $1 million); and oversight activities conducted by the HHS Office of the Inspector
General ($5 million).
In addition to these reservations, the bill also placed a number of conditions on the use of the
supplemental funds. For instance, the bill













directed HHS to prioritize community-based residential care, state-licensed
facilities, hard-sided dormitories, and shelter care other than large-scale
institutional facilities (§401);
prohibited funds from being used for unlicensed facilities, except in limited
circumstances (e.g., on a temporary basis due to a large influx of children) when
specified conditions are met (e.g., comprehensive monitoring for an unlicensed
facility operating for more than three consecutive months) (§404);
required HHS to ensure, when feasible, that certain types of children (e.g.,
children under age 13, children with special needs, pregnant or parenting teens)
are not placed in unlicensed facilities (§406);
required HHS to reverse any reprogramming within the account that had been
carried out pursuant to a notification submitted to the appropriations committees
on May 16 (proviso within UAC appropriation);
prohibited funds from being used to prevent a Member of Congress from visiting
a UAC facility for oversight purposes (§407);
prohibited funds from being used by the Department of Homeland Security
(DHS) to detain or remove sponsors (or potential sponsors) of unaccompanied
children based on information provided by HHS as part of the sponsor’s
application, except when specified criteria are met (§409); and
prohibited funds from being used to reverse or change certain operational
directives previously issued by HHS, except in limited circumstances (§403).

The bill also included a number of notification and reporting requirements associated with these
funds. For instance, the bill required HHS to







notify the appropriations committees within 72 hours of conducting a formal
assessment of a facility for possible lease/acquisition and within seven days of
any acquisition/lease of real property (proviso within UAC appropriation);
submit to the appropriations committees a discharge rate improvement plan
within 120 days of enactment (proviso within UAC appropriation);
provide specific information to the appropriations committees at least 15 days
before opening an unlicensed facility and provide the committees with monthly
reports on the children placed at such facilities (§405);
submit to the appropriations committees (and make public) a monthly report on
the number and ages of unaccompanied alien children transferred into HHS care

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

after being separated from parents or legal guardians by DHS, along with the
reasons for the separations (§408); and
submit to the appropriations committees a detailed spending plan of anticipated
uses of funds within 30 days of enactment (§410).

FY2019 Supplemental Appropriations for Disaster Relief
Over the course of FY2019, the 115th and 116th Congresses considered supplemental
appropriations to several federal departments and agencies for expenses related to various recent
wildfires, hurricanes, volcanic eruptions, earthquakes, typhoons, and other natural disasters or
emergencies (e.g., H.R. 695 in the 115th Congress; H.R. 268, S.Amdt. 201 to H.R. 268, and H.R.
2157 in the 116th Congress). Each of these bills included appropriations for several accounts
typically funded in the LHHS bill.
Ultimately, on June 6, the President signed into law P.L. 116-20, a supplemental appropriations
act for FY2019. The bill was passed by the House on June 3 and by the Senate on May 23. (An
earlier version of the bill had passed the House on May 10.)
As enacted, the bill included roughly $611 million in emergency-designated LHHS appropriations
for accounts at DOL, HHS, and ED. With limited exceptions, the bill explicitly directed the
LHHS funds toward necessary expenses directly related to Hurricane Florence, Hurricane
Michael, Typhoon Mangkhut, Super Typhoon Yutu, wildfires and earthquakes occurring in
calendar year 2018, and tornadoes and floods occurring in calendar year 2019.
The FY2019 supplemental provided the following definite LHHS appropriations:







$50 million for the dislocated worker assistance national reserve at DOL, of
which up to $1 million may be transferred to other DOL accounts for
reconstruction and recovery needs and up to $500,000 is to be transferred to the
DOL Office of the Inspector General for oversight activities.
$30 million to the Child Care and Development Block Grant at HHS to support
the costs of renovating, repairing, or rebuilding child care facilities.
$90 million to the Children and Families Services Programs account at HHS for
necessary expenses related to the disasters and emergencies referenced by the
law. Of the total, $55 million is directed to Head Start programs, $25 million is
directed to the Community Services Block Grant, $5 million is directed to the
Stephanie Tubbs Jones Child Welfare Services program, and up to $5 million
may be used for federal administrative expenses.
$201 million for the Public Health and Social Services Emergency Fund at HHS
for necessary expenses directly related to the disasters and emergencies
referenced by the law. Of this amount, HHS is directed to transfer
 not less than $100 million to the Substance Abuse and Mental Health
Services Administration (SAMHSA) Health Surveillance and Program
Support account for grants, contracts, and cooperative agreements for
behavioral health treatment, treatment of substance use disorders, crisis
counseling and related helplines, and other similar programs to support
impacted individuals;
 $80 million to the Health Resources and Services Administration
(HRSA) federal health centers program for alteration, renovation,

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

construction, equipment, and other capital improvements to meet the
needs of affected areas;
 not less than $20 million to the Centers for Disease Control and
Prevention (CDC) for CDC-Wide Activities and Program Support for
response, recovery, mitigation, and other expenses; and
 up to $1 million to the Office of the Inspector General for oversight
activities.
$165 million for Hurricane Education Recovery at ED to assist in meeting the
educational needs of affected individuals. Of the total, $2 million is to be
transferred to the Office of the Inspector General for oversight activities and up
to $1 million may be used for program administration.

In addition, the supplemental provided a combination of definite and indefinite appropriations to
the Medicaid program at HHS to support program costs in the Northern Mariana Islands, Guam,
and American Samoa.8

FY2019 LHHS Omnibus
During the 115th Congress, on September 28, 2018, the President signed into law the Department
of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and
Continuing Appropriations Act, 2019 (H.R. 6157, P.L. 115-245). This was the first occasion since
the FY1997 appropriations cycle that full-year LHHS appropriations were enacted on or before
the start of the fiscal year (October 1). The House and Senate had previously agreed to resolve
differences on the measure via a conference committee. (Conferees on the bill were named in the
House on September 4 and in the Senate on September 6.) The conference report (H.Rept. 115952) was adopted by the Senate on September 18, and the House on September 26.
LHHS discretionary appropriations in the FY2019 omnibus totaled $189.4 billion. This amount is
1.5% more than FY2018 enacted and 8.9% more than the FY2019 President’s budget request.
The omnibus also provided $869.8 billion in mandatory funding, for a combined LHHS total of
$1.059 trillion. (Note that these totals are based only on amounts provided by the FY2019 LHHS
omnibus and do not include the supplemental funds, which were provided in addition to the
annual appropriations.)
See Figure 1 for a breakdown of FY2019 discretionary and mandatory LHHS appropriations.9

8 The Congressional Budget Office estimated total LHHS budget authority in the FY2019 supplemental to be $611

million. Of that amount, $536 million is outlined in the bulleted list above, and the remaining amount, a portion of
which is unspecified in the law, is presumably for the Medicaid funding in Section 802.
9 While the percentages in this figure were calculated based on amounts in the FY2019 LHHS omnibus, they are
generally also illustrative—within a few percentage points—of the share of mandatory and discretionary funds in
FY2018 and under the various FY2019 proposals (e.g., President’s budget and the House-committee and Senate-passed
bills).

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Figure 1. FY2019 Enacted LHHS Appropriations

Source: Amounts in this figure are generally drawn from or calculated based on data contained in the
conference report (H.Rept. 115-952) on the FY2019 LHHS omnibus (P.L. 115-245). For consistency with source
materials, amounts in this figure generally do not reflect mandatory spending sequestration.
Notes: Details may not add to totals due to rounding. Amounts in this figure (1) reflect all budget authority
appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided for agencies
and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations
committees; and (4) do not include appropriations that occur outside of appropriations bills.

Earlier Congressional Action on an LHHS Bill
FY2019 LHHS Action in the House
The House Appropriations Committee’s LHHS subcommittee approved its draft bill on June 15,
2018. The full committee markup was held on July 11, 2018, and the bill was ordered to be
reported that same day (30-22). The bill was subsequently reported to the House on July 23 (H.R.
6470, H.Rept. 115-862). It did not receive floor consideration in the House.
As reported by the full committee, the bill would have provided $187.2 billion in discretionary
LHHS funds, a 0.3% increase from FY2018 enacted levels. This amount would have been 7.6%
more than the FY2019 President’s request. In addition, the House committee bill would have
provided an estimated $869.8 billion in mandatory funding, for a combined total of $1.057 trillion
for LHHS as a whole.

FY2019 LHHS Action in the Senate
The Senate Appropriations Committee’s LHHS subcommittee approved its draft bill on June 26,
2018. The full committee markup was held on June 28, 2018. The committee approved the bill
(30-1) and reported it that same day (S. 3158, S.Rept. 115-289).
Instead of taking up S. 3158, the Senate chose to consider and pass H.R. 6157 on August 23,
2018, by a vote of 85-7. The bill was amended on the Senate floor to contain FY2019 LHHS
appropriations in Division B. (Division A contained the appropriations act for the Department of
Defense.) The text of Division B that was considered for amendment was the same as S. 3158

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(with minor alterations). During floor consideration, the Senate also adopted 31 amendments to
the new LHHS division of the bill (see Appendix B for a summary of these amendments).
The Senate-passed bill would have provided $189.4 billion in discretionary LHHS funds. This
would have been 1.5% more than FY2018, and 8.9% more than the FY2019 President’s request.
In addition, the Senate bill would have provided an estimated $869.8 billion in mandatory
funding, for a combined total of $1.059 trillion for LHHS as a whole.

FY2019 President’s Budget Request
On February 12, 2018, the Trump Administration released the FY2019 President’s budget. The
President requested $173.9 billion in discretionary funding for accounts funded by the LHHS bill,
which would have been a decrease of 6.8% from FY2018 levels. In addition, the President
requested $869.8 billion in annually appropriated mandatory funding, for a total of $1.044 trillion
for LHHS as a whole.

Conclusion of the FY2018 Appropriations Process
On March 23, 2018, President Trump signed into law the Consolidated Appropriations Act, 2018
(H.R. 1625, P.L. 115-141). The bill was agreed to in the House on March 22 and in the Senate on
March 23. The bill provided regular, full-year appropriations for all 12 annual appropriations acts,
including LHHS (Division H).
LHHS discretionary appropriations in the FY2018 omnibus totaled $186.5 billion (this total does
not include emergency funding provided by an earlier supplemental appropriations act for
FY2018, P.L. 115-123). This amount was 7.6% more than FY2017 levels and 25.3% more than
the FY2018 budget request from the Trump Administration. The omnibus also provided $817.5
billion in mandatory funding, for a combined FY2018 LHHS total of $1.004 trillion.

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Summary of FY2019 LHHS Appropriations
Dollars and Percentages in this Report
Amounts displayed in this report are typically rounded to the nearest million or billion (as labeled). Dollar and
percentage changes discussed in the text are based on unrounded amounts.
Unless otherwise specified, appropriations levels displayed in this report refer to the total amount of budget
authority provided in an appropriations bill (i.e., “total in the bill”), regardless of the year in which the funding
becomes available.
Funding levels are generally drawn from (or estimated based on) data contained in the conference report (H.Rept.
115-952) on the FY2019 LHHS omnibus (P.L. 115-245).
Throughout this report, the FY2019 House Appropriations Committee-reported LHHS bill and Senate
Appropriations Committee-reported LHHS bill are commonly referred to as the House and Senate “committee
bills.” The version of H.R. 6157 that passed the Senate is referred to as “Senate-passed” or “Senate Floor.”
Amounts for the FY2019 Senate Floor version integrate the budgetary effects of the LHHS-related floor
amendments that were adopted in the Senate during its consideration of H.R. 6157.
Enacted totals for FY2018 do not include emergency-designated appropriations provided by the supplemental
appropriations act in P.L. 115-123. (For informational purposes, and per the convention of source materials,
FY2018 supplemental amounts are displayed separately in tables throughout the report.) Also per the convention
of source materials, enacted totals for FY2019 do not include the emergency-designated supplemental
appropriations provided in P.L. 116-20 or P.L. 116-26, nor are these amounts shown separately in the tables. (One
exception to this rule is made in Table A-1, which includes FY2018 and FY2019 supplemental funds in the
“Adjusted Appropriations” totals, as scored by the Congressional Budget Office.)
For consistency with source materials, the FY2018 and FY2019 numbers in this report generally do not reflect
actual or anticipated postenactment budgetary adjustments, except as noted.10

Table 2 displays FY2019 discretionary and mandatory LHHS budget authority provided or
proposed, by bill title, along with FY2018 enacted levels. The amounts shown in this table reflect
total budget authority provided in the bill (i.e., all funds appropriated in the bill, regardless of the
fiscal year in which the funds become available), not total budget authority available for the
current fiscal year. (For a comparable table showing current-year budget authority, see Table A-2
in Appendix A.)

10 The general practice for CRS reports on the LHHS bill has been to reflect conventions used in source materials.

These conventions have varied over the years. For instance, CRS reports on LHHS appropriations for FY2012-FY2015
generally relied on source materials that adjusted appropriations amounts in the prior-year column to reflect
sequestration, reestimates of mandatory spending, transfers, reprogramming, and other adjustments for comparability.
However, the FY2016 version of this report broke from that practice due to differing display conventions in source
documents, and did not reflect any such adjustments (except sequestration for the Prevention and Public Health Fund
(PPHF)). The FY2017 version of this report differed from both of these prior practices, in that it reflected a smaller
subset of transfers (generally concentrated at the National Institutes of Health) and other adjustments for comparability
(e.g., program moves from one account to another), but not reprogramming of funds or mandatory sequestration
(except sequestration of the PPHF). Due to the display conventions in the FY2018 and FY2019 source materials, the
current version of this report generally does not reflect any transfers or other budgetary adjustments except PPHF
sequestration.

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Table 2. LHHS Appropriations Overview by Bill Title, FY2018-FY2019
(Total budget authority provided in the bill, in billions of dollars)

Bill Title
Title I: Labor

FY2018
Enacted

FY2019
Request

FY2019
Senate
Floor
(H.R.
6157)

FY2019
House
Cmte.
(H.R.
6470)

FY2019
Enacted
(P.L.
115-245)

13.8

12.3

13.6

13.4

13.6

Discretionary

12.2

10.9

12.1

11.9

12.1

Mandatory

1.6

1.4

1.4

1.4

1.4

Title II: HHS

847.6

895.4

899.2

898.0

899.2

Discretionary

88.2

86.7

90.5

89.3

90.5

Mandatory

759.5

808.7

808.7

808.7

808.7

Title III: Education

74.3

66.7

74.9

74.5

75.0

Discretionary

70.9

63.2

71.4

71.0

71.4

Mandatory

3.5

3.5

3.5

3.5

3.5

Title IV: Related Agencies

68.3

69.3

71.5

71.1

71.5

Discretionary

15.3

13.2

15.4

15.0

15.3

Mandatory

53.0

56.2

56.2

56.2

56.2

Total BA in the Bill

1,004.0

1,043.7

1,059.2

1,057.0

1,059.2

Discretionary

186.5

173.9

189.4

187.2

189.4

Mandatory

817.5

869.8

869.8

869.8

869.8

4.0

—

—

—

—

Advances for Future Years
(provided in current bill)a

183.3

186.1

186.7

186.7

186.7

Advances from Prior Years
(for use in current year)a

168.9

183.3

183.3

183.3

183.3

-7.5

-5.2

-8.2

-8.2

-9.4

P.L. 115-123 (emergency)
Memoranda:

Additional Scorekeeping Adjustmentsb

Source: Amounts in this table are generally drawn from or calculated based on data contained in the conference
report (H.Rept. 115-952) on the FY2019 LHHS omnibus (P.L. 115-245). Enacted totals for FY2018 do not
include emergency-designated appropriations provided by P.L. 115-123. For consistency with source materials,
amounts in this table generally do not reflect mandatory spending sequestration, where applicable, nor do they
reflect any transfers or reprogramming of funds pursuant to executive authorities.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. No
amounts are shown for Title V, because this title consists solely of general provisions.
a. Totals in this table are based on budget authority provided in the bill (i.e., they exclude advance
appropriations from prior bills and include advance appropriations from this bill made available in future
years). The calculation for total budget authority available in the current year is as follows: Total BA in the
Bill, minus Advances for Future Years, plus Advances from Prior Years.

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b.

Totals in this table have generally not been adjusted for further scorekeeping. (To adjust for scorekeeping,
add this line to the total budget authority.)

Figure 2 displays the FY2019 enacted discretionary and mandatory LHHS funding levels, by bill
title. (While the dollars and percentages discussed in this section were calculated based on the
FY2019 enacted amounts, they are generally also illustrative—within several percentage points—
of the share of funds directed to each bill title in FY2018 and under the other FY2019 proposals.)
As this figure demonstrates, HHS accounts for the largest share of total FY2019 LHHS
appropriations: $899 billion, or 84.9%. This is due to the large amount of mandatory funding
included in the HHS appropriation, the majority of which is for Medicaid grants to states and
payments to health care trust funds. After HHS, ED and the Related Agencies represent the nextlargest shares of total LHHS funding, accounting for 7.1% and 6.7%, respectively. (The majority
of the ED appropriations each year are discretionary, while the bulk of funding for the Related
Agencies goes toward mandatory payments and administrative costs of the Supplemental Security
Income program at the Social Security Administration.) Finally, DOL accounts for the smallest
share of total LHHS funds, 1.3%.
However, the overall composition of LHHS funding is noticeably different when comparing only
discretionary appropriations. HHS accounts for a comparatively smaller share of total
discretionary appropriations (47.8%), while ED accounts for a relatively larger share (37.7%).
Together, these two departments represent the majority (85.5%) of discretionary LHHS
appropriations. DOL and the Related Agencies account for a roughly even split of the remaining
14.5% of discretionary LHHS funds.
Figure 2. FY2019 Enacted LHHS Appropriations by Title

Source: Amounts in this figure are generally drawn from or calculated based on data contained in the
conference report (H.Rept. 115-952) on the FY2019 LHHS omnibus (P.L. 115-245). For consistency with source
materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable,
nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities.
Notes: Details may not add to totals due to rounding. Amounts in this figure (1) reflect all BA appropriated in
the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prioryear appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not
been adjusted to reflect scorekeeping; (3) comprise only those funds provided for agencies and accounts subject
to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do
not include appropriations that occur outside of appropriations bills.

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Department of Labor (DOL)
Note that all amounts in this section are based on regular LHHS appropriations only. Amounts in
this section do not include mandatory funds provided outside of the annual appropriations process
(e.g., direct appropriations for Unemployment Insurance benefits payments). All amounts in this
section are rounded to the nearest million or billion (as labeled). The dollar changes and
percentage changes discussed in the text are based on unrounded amounts. For consistency with
source materials, amounts do not reflect sequestration or reestimates of mandatory spending
programs, where applicable.

About DOL
DOL is a federal department comprised of multiple entities that provide services related to
employment and training, worker protection, income security, and contract enforcement. Annual
LHHS appropriations laws direct funding to all DOL entities (see the text box).12 The DOL
entities fall primarily into two main functional areas—workforce development and worker
protection. First, there are several DOL
entities that administer workforce employment
DOL Entities Funded via the
and training programs—such as the Workforce
LHHS Appropriations Process
Innovation and Opportunity Act (WIOA) state
Employment and Training Administration (ETA)
formula grant programs, Job Corps, and the
Employee Benefits Security Administration (EBSA)
Employment Service—that provide direct
Wage and Hour Division (WHD)
funding for employment activities or
Office of Federal Contract Compliance Programs
administration of income security programs
(OFCCP)
(e.g., for the Unemployment Insurance
Office of Labor-Management Standards (OLMS)
benefits program). Also included in this area is Office of Workers’ Compensation Programs (OWCP)
the Veterans’ Employment and Training
Occupational Safety and Health Administration (OSHA)
Service (VETS), which provides employment
Mine Safety and Health Administration (MSHA)
services specifically for the veteran
Bureau of Labor Statistics (BLS)
population. Second, there are several agencies
Office of Disability Employment Policy (ODEP)
that provide various worker protection
Departmental Management (DM)11
services. For example, the Occupational
Safety and Health Administration (OSHA),
the Mine Safety and Health Administration (MSHA), and the Wage and Hour Division (WHD)
provide different types of regulation and oversight of working conditions. DOL entities focused
on worker protection provide services to ensure worker safety, adherence to wage and overtime
laws, and contract compliance, among other duties. In addition to these two main functional
areas, DOL’s Bureau of Labor Statistics (BLS) collects data and provides analysis on the labor
market and related labor issues.

FY2019 DOL Appropriations Overview
Table 3 generally displays FY2019 discretionary and mandatory DOL budget authority provided
or proposed, along with FY2018 enacted levels. The FY2019 LHHS omnibus decreased
discretionary appropriations for DOL by 0.8% compared to the FY2018 enacted levels. Similarly,
11 Departmental Management includes the DOL salaries and expenses, Veterans Employment and Training Service

(VETS), IT Modernization, and the Office of the Inspector General.
12 The Pension Benefit Guaranty Corporation (PBGC) is funded primarily through insurance premiums and related fees
from companies covered by the PBGC.

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discretionary DOL appropriations would have decreased, compared to FY2018, under the
FY2019 President’s budget request (-11.1%), as well as the FY2019 House committee bill (2.4%) and Senate-passed bill (-0.8%). Of the total funding provided in the bill for DOL, roughly
89% is discretionary.
Table 3. DOL Appropriations Overview
(Dollars in billions)

Funding

FY2018
Enacted

FY2019
Request

FY2019
Senate
Floor
(H.R. 6157)

FY2019
House
Cmte.
(H.R. 6470)

FY2019
Enacted
(P.L.
115-245)

Discretionary

12.2

10.9

12.1

11.9

12.1

Mandatory

1.6

1.4

1.4

1.4

1.4

13.8

12.3

13.6

13.4

13.6

0.1

—

—

—

—

Total BA in the
Bill
P.L. 115-123
(emergency)

Source: Amounts in this table are generally drawn from or calculated based on data contained in the conference
report (H.Rept. 115-952) on the FY2019 LHHS omnibus (P.L. 115-245). Enacted totals for FY2018 do not
include emergency-designated appropriations provided by P.L. 115-123. For consistency with source materials,
amounts in this table generally do not reflect mandatory spending sequestration, where applicable, nor do they
reflect any transfers or reprogramming of funds pursuant to executive authorities.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills.

Selected DOL Highlights
The following sections present highlights from FY2019 enacted and proposed appropriations
compared to FY2018 enacted appropriations for selected DOL accounts and programs.13
Table 4 displays funding for DOL programs and activities discussed in this section.

Employment and Training Administration (ETA)
ETA administers the primary federal workforce development law, the Workforce Innovation and
Opportunity Act (WIOA, P.L. 113-128). The WIOA, which replaced the Workforce Investment
Act, was signed into law in July 2014 and authorizes appropriations for its programs through
FY2020. WIOA’s provisions went into effect in FY2015 and FY2016.
Title I of WIOA, which authorizes more than half of all funding for the programs authorized by
the four titles of WIOA, includes three state formula grant programs serving Adults, Youth, and
Dislocated Workers. While the FY2019 LHHS omnibus provided the same funding for the three
WIOA state formula grant programs compared to FY2018, the President’s budget would have

13 DOL budget materials can be found at https://www.dol.gov/general/aboutdol#budget.

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reduced funding for all three of the state formula grant programs by $80 million (-2.9%),
compared to FY2018 enacted levels.
The FY2019 LHHS omnibus provided $221 million for the Dislocated Workers Activities
National Reserve (DWA National Reserve), which was the same level enacted in FY2018. The
FY2019 President’s budget and the House committee bill would have reduced funding for the
DWA National Reserve by $75 million (-34.0%) and $21 million (-9.4%), respectively, while the
Senate would have kept DWA National Reserve funding the same as FY2018. Finally, the
FY2019 LHHS omnibus maintained a provision in that account (which had originated in the
FY2018 omnibus) directing $30 million from the DWA National Reserve toward training and
employment assistance for workers dislocated in both the Appalachian and lower Mississippi
regions.
The FY2019 LHHS omnibus provided $160 million for the Apprenticeship Grant program, which
is $15 million (+10.3%) more than the level enacted in FY2018. The FY2019 President’s budget
would have increased funding for the Apprenticeship Grant program by $55 million (+37.9%)
compared to the FY2018 enacted level.
Finally, four ETA programs for which the FY2019 President’s budget proposed no funding—the
Native Americans program, the Migrant and Seasonal Farmworkers program, the Community
Service Employment for Older Americans (CSEOA) program, and the Workforce Data Quality
Initiative—received FY2019 appropriations at roughly the same level as FY2018.

Bureau of International Labor Affairs (ILAB)
The FY2019 LHHS omnibus provided the same funding, $86 million, for ILAB as was provided
in FY2018. The Senate-passed bill would also have provided $86 million for ILAB. The FY2019
President’s budget and the House committee bill each would have decreased funding by $68
million (-78.5%) for ILAB, which provides research, advocacy, technical assistance, and grants to
promote workers’ rights in different parts of the world. Language in the FY2019 President’s
budget indicated that the proposed reduction reflected a “workload decrease associated with the
elimination of new grants as well as ILAB’s refocusing of its efforts and resources on ensuring
that U.S. trade agreements are fair for U.S. workers by monitoring and enforcing the labor
provisions of Free Trade Agreements (FTAs) and trade preference programs.”14

Labor-Related General Provisions
Annual LHHS appropriations acts regularly contain general provisions related to certain labor
issues. This section highlights selected DOL general provisions in the FY2019 LHHS omnibus.
The FY2019 LHHS omnibus continued several provisions that have been included in at least one
previous LHHS appropriations act, including provisions that


direct the Secretary of Labor to accept private wage surveys as part of the process
of determining prevailing wages in the H-2B program, even in instances in which
relevant wage data are available from the Bureau of Labor Statistics (included
since FY2016);15

14 See https://www.dol.gov/sites/dolgov/files/legacy-files/budget/2019/CBJ-2019-V3-02.pdf, DM-36.
15 See Division B, Title I, §111 of P.L. 115-245. The H-2B program allows for the temporary employment of foreign

workers in nonagricultural sectors and requires these workers to be paid the “prevailing wage” (i.e., the average wage
paid to similar workers in the local area). Under DOL regulations, private employer surveys may be considered only if

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






exempt certain insurance claims adjusters from overtime protection for two years
following a “major disaster” (included since FY2016);16
authorize the Secretary of Labor to provide up to $2 million in “excess personal
property” to apprenticeship programs to assist training apprentices (included
since FY2018);17
authorize the Secretary of Labor to employ law enforcement officers or special
agents to provide protection to the Secretary of Labor and certain other
employees and family members at public events and in situations in which there
is a “unique and articulable” threat of physical harm (included since FY2018);18
and
authorize the Secretary of Labor to dispose of or divest “by any means the
Secretary determines appropriate” all or part of the real property on which the
Treasure Island Job Corps Center is located (included since FY2018).19
Table 4. Detailed DOL Appropriations
(Dollars in millions)

Agency or Selected Program

FY2018
Enacted

FY2019
Request

FY2019
Senate
Floor
(H.R.
6157)

FY2019
House
Cmte.
(H.R.
6470)

FY2019
Enacted
(P.L. 115245)

ETA—Mandatorya

790

790

790

790

790

ETA—Discretionary

9,228

7,997

9,118

9,012

9,116

Training and Employment Services:

3,486

3,221

3,501

3,474

3,503

State Formula Grants:

2,790

2,710

2,790

2,790

2,790

Adult Activities Grants to States

846

816

846

846

846

Youth Activities Grants to States

903

873

903

903

903

1,041

1,021

1,041

1,041

1,041

696

511

711

685

713

DWA National Reserve

221

146

221

200

221

Native Americans

54

0

54

55

55

Migrant and Seasonal Farmworkers

88

0

88

88

89

YouthBuild

90

85

90

93

90

Technical Assistance

0

2

0

0

0

Reintegration of Ex-Offenders

93

78

93

93

93

Workforce Data Quality Initiative

6

0

6

6

6

Discretionary ETA Programs:

Dislocated Worker Activities (DWA)
Grants to States
National Activities:

the employer meets certain conditions.
16 See Division B, Title I, §108 of P.L. 115-245.
17 See Division B, Title I, §113 of P.L. 115-245.
18 See Division B, Title I, §115 of P.L. 115-245.
19 See Division B, Title I, §116 of P.L. 115-245.

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FY2019
Request

FY2019
Senate
Floor
(H.R.
6157)

FY2019
House
Cmte.
(H.R.
6470)

FY2019
Enacted
(P.L. 115245)

145

200

160

150

160

1,719

1,297

1,719

1,719

1,719

400

0

400

400

400

3,465

3,325

3,339

3,260

3,336

2,653

2,505

2,528

2,530

2,528

Employment Service

686

691

686

606

683

Foreign Labor Certification

62

62

62

62

62

One-Stop Career Centers

63

67

63

63

63

ETA Program Administration

159

154

159

159

159

Employee Benefits Security Administration

181

190

187

181

181

Pension Benefit Guaranty Corp, (PBGC) program
level (non-add)b

(424)

(445)

(445)

(445)

(445)

Wage and Hour Division

228

230

229

226

229

Office of Labor-Management Standards

40

47

40

42

41

Office of Federal Contract Compliance
Programs

103

91

103

99

103

Office of Workers’ Compensation Programs—
Mandatoryc

766

642

642

642

642

Office of Workers’ Compensation Programs—
Discretionary

118

115

118

118

118

Occupational Safety & Health Administration

553

549

557

545

558

Mine Safety & Health Administration

374

376

374

368

374

Bureau of Labor Statistics

612

609

615

612

615

Office of Disability Employment Policy

38

27

38

38

38

Departmental Management

743

630

748

688

751

Salaries and Expenses

338

261

338

270

338

86

19

86

19

86

Veterans Employment and Training

295

282

300

300

300

IT Modernization

21

0

21

29

23

Office of the Inspector General

89

88

89

89

89

Total, DOL BA in the Bill

13,773

12,293

13,557

13,360

13,555

Subtotal, Mandatory

1,556

1,432

1,432

1,432

1,432

Subtotal, Discretionary

12,218

10,861

12,126

11,929

12,123

130

-

-

-

-

Agency or Selected Program
Apprenticeship Grants
Job Corps
Community Service Employment for Older Americans
State Unemployment Insurance and Employment
Service Operations (SUI/ESO):
Unemployment Compensation

International Labor Affairs (non-addd)

P.L. 115-123 (emergency)

FY2018
Enacted

Memoranda

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Agency or Selected Program

FY2018
Enacted

FY2019
Request

FY2019
Senate
Floor
(H.R.
6157)

FY2019
House
Cmte.
(H.R.
6470)

FY2019
Enacted
(P.L. 115245)

Total, BA Available in Fiscal Year (current year from
any bill)

13,774

12,369

13,558

13,561

13,556

Total, BA Advances for Future Years (provided in
current bill)

1,787

1,711

1,786

1,586

1,786

Total, BA Advances from Prior Years (for use in
current year)

1,788

1,787

1,787

1,787

1,787

Source: Amounts in this table are generally drawn from or calculated based on data contained in the conference
report (H.Rept. 115-952) on the FY2019 LHHS omnibus (P.L. 115-245). Enacted totals for FY2018 do not
include emergency-designated appropriations provided by P.L. 115-123. For consistency with source materials,
amounts in this table generally do not reflect mandatory spending sequestration, where applicable, nor do they
reflect any transfers or reprogramming of funds pursuant to executive authorities.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills.
a. Mandatory funding within ETA goes to Federal Unemployment Benefits and Allowances (FUBA) and
Advances to the Unemployment Trust Fund (UTF), if any. FUBA funds Trade Adjustment Assistance for
Workers (TAA).
b. PBGC funding is provided outside the LHHS Appropriations Act.
c. Mandatory programs in the Office of Workers’ Compensation Programs include Special Benefits
(comprising the Federal Employees’ Compensation Benefits and the Longshore and Harbor Workers’
Benefits), Special Benefits for Disabled Coal Miners, Energy Employees Occupational Illness Compensation
(Administrative Expenses), and the Black Lung Disability Trust Fund.
d. The funding for International Labor Affairs is included in the Salaries and Expenses total.

Department of Health and Human Services (HHS)
Note that all amounts in this section are based on regular LHHS appropriations only; they do not
include funds for HHS agencies provided through other appropriations bills (e.g., funding for the
Food and Drug Administration) or outside of the annual appropriations process (e.g., direct
appropriations for Medicare or mandatory funds provided by authorizing laws, such as the Patient
Protection and Affordable Care Act [ACA, P.L. 111-148]).20 All amounts in this section are
rounded to the nearest million or billion (as labeled). The dollar changes and percentage changes
discussed in the text are based on unrounded amounts. For consistency with source materials,
amounts do not reflect sequestration or reestimates of mandatory spending programs, where
applicable.

20 The ACA was subsequently amended by the Health Care and Education Reconciliation Act (P.L. 111-152). These

two laws are collectively referred to as the ACA in this report. (Previous CRS reports on the Patient Protection and
Affordable Care Act used the acronym PPACA to refer to the statute, but newer reports will use “ACA,” in
conformance with the more widely used acronym for the law.) For information on funding directly appropriated by the
ACA, see the tables in CRS Report R41301, Appropriations and Fund Transfers in the Affordable Care Act (ACA).

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About HHS
HHS is a large federal department composed
HHS Agencies Funded via the
of multiple agencies working to enhance the
LHHS Appropriations Process
health and well-being of Americans. Annual
Health Resources and Services Administration (HRSA)
LHHS appropriations laws direct funding to
Centers for Disease Control and Prevention (CDC)
most (but not all) HHS agencies (see text box
National Institutes of Health (NIH)
for HHS agencies supported by the LHHS
Substance Abuse and Mental Health Services
bill).21 For instance, the LHHS bill directs
Administration (SAMHSA)
funding to five Public Health Service (PHS)
Agency for Healthcare Research and Quality (AHRQ)
agencies: the Health Resources and Services
Centers for Medicare & Medicaid Services (CMS)
Administration (HRSA), Centers for Disease
Administration for Children and Families (ACF)
Control and Prevention (CDC), National
Administration for Community Living (ACL)
Institutes of Health (NIH), Substance Abuse
and Mental Health Services Administration
Office of the Secretary (OS)
(SAMHSA), and Agency for Healthcare
Research and Quality (AHRQ).22 These public
health agencies support diverse missions, ranging from the provision of health care services and
supports (e.g., HRSA, SAMHSA), to the advancement of health care quality and medical research
(e.g., AHRQ, NIH), to the prevention and control of infectious and chronic diseases (e.g., CDC).
In addition, the LHHS bill provides funding for annually appropriated components of CMS,23
which is the HHS agency responsible for the administration of Medicare, Medicaid, the State
Children’s Health Insurance Program (CHIP), and consumer protections and private health
insurance provisions of the ACA.
The LHHS bill also provides funding for two HHS agencies focused primarily on the provision of
social services: the Administration for Children and Families (ACF) and the Administration for
Community Living (ACL). ACF’s mission is to promote the economic and social well-being of
vulnerable children, youth, families, and communities. ACL was formed with a goal of increasing
access to community supports for older Americans and people with disabilities.24 Finally, the
LHHS bill also provides funding for the HHS Office of the Secretary (OS), which encompasses a
broad array of management, research, oversight, and emergency preparedness functions in
support of the entire department.

21 Three HHS public health agencies receive annual funding from appropriations bills other than the LHHS bill: the

Food and Drug Administration (funded through the Agriculture appropriations bill), the Indian Health Service (funded
through the Interior-Environment appropriations bill), and the Agency for Toxic Substances and Disease Registry
(funded through the Interior-Environment appropriations bill). In addition, while the National Institutes of Health
(NIH) receive the majority of their appropriations from the LHHS bill, one NIH institute (the National Institute of
Environmental Health Sciences) receives appropriations from two bills: LHHS and the Interior-Environment bill.
22 For more information on HHS PHS agencies, see CRS Report R44916, Public Health Service Agencies: Overview
and Funding (FY2016-FY2018).
23 Much of the funding for CMS activities is provided through mandatory appropriations in authorizing legislation, and
thus is not subject to the annual appropriations process.
24 ACL is a relatively new agency within HHS—it was established in April 2012 by consolidating the Administration
on Aging, the Office of Disability, and the Administration on Developmental Disabilities (renamed the Administration
on Intellectual and Developmental Disabilities) into one agency. See the HHS Secretary’s press release from April 16,
2012: http://www.hhs.gov/news/press/2012pres/04/20120416a.html. For more information on the ACL, see
http://www.hhs.gov/acl/.

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FY2019 HHS Appropriations Overview
Table 5 displays enacted and proposed FY2019 funding levels for HHS, along with FY2018
levels. In general, discretionary funds account for about 10% of HHS appropriations in the LHHS
bill. Compared to the FY2018 funding levels, the FY2019 LHHS omnibus increased HHS
discretionary appropriations by 2.6%. The House committee bill would have increased HHS
discretionary appropriations to a lesser degree, by 1.3%, whereas the Senate proposed a more
substantial increase of 2.7%. In contrast, the President requested a 1.6% decrease in discretionary
HHS funding.
Table 5. HHS Appropriations Overview
(Dollars in billions)
FY2019
House Cmte.
(H.R. 6470)

FY2019
Enacted
(P.L.
115-245)

FY2018
Enacted

FY2019
Request

FY2019
Senate Floor
(H.R. 6157)

Discretionary

88.2

86.7

90.5

89.3

90.5

Mandatory

759.5

808.7

808.7

808.7

808.7

Total BA in the Bill

847.6

895.4

899.2

898.0

899.2

1.1

-

-

-

-

Funding

P.L. 115-123 (emergency)

Source: Amounts in this table are generally drawn from or calculated based on data contained in the conference
report (H.Rept. 115-952) on the FY2019 LHHS omnibus (P.L. 115-245). Enacted totals for FY2018 do not
include emergency-designated appropriations provided by P.L. 115-123. For consistency with source materials,
amounts in this table generally do not reflect mandatory spending sequestration, where applicable, nor do they
reflect any transfers or reprogramming of funds pursuant to executive authorities.
Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect
all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include
advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2)
have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested)
for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate
appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills.

Figure 3 provides an HHS agency-level breakdown of FY2019 enacted appropriations. As this
figure demonstrates, annual HHS appropriations are dominated by mandatory funding, the
majority of which goes to CMS to provide Medicaid benefits and payments to health care trust
funds. When taking into account both mandatory and discretionary funding, CMS accounts for
$796.9 billion, which is 88.6% of all enacted appropriations for HHS. ACF and NIH account for
the next-largest shares of total HHS appropriations, receiving about 4.2% apiece.
By contrast, when looking exclusively at discretionary appropriations, funding for CMS
constitutes about 4.9% of FY2019 enacted HHS appropriations. Instead, the bulk of discretionary
appropriations went to the PHS agencies, which account for 63.5% of discretionary
appropriations provided for HHS.25 NIH typically receives the largest share of all discretionary
funding among HHS agencies (41.9% in FY2019), with ACF accounting for the second-largest
share (25.6% in FY2019).

25 For further information about PHS agency funding, see CRS Report R44916, Public Health Service Agencies:

Overview and Funding (FY2016-FY2018).

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Figure 3. FY2019 Enacted HHS Appropriations by Agency

Source: Amounts in this figure are generally drawn from or calculated based on data contained in the
conference report (H.Rept. 115-952) on the FY2019 LHHS omnibus (P.L. 115-245). For consistency with source
materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable,
nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities.
Notes: Details may not add to totals due to rounding. The bar representing the combined mandatory and
discretionary total for CMS has been abbreviated due to space constraints. When taking into account both
mandatory and discretionary funding, CMS receives over 20 times the funding appropriated to either ACF or
NIH in the FY2019 LHHS omnibus. Amounts in this table (1) reflect all BA appropriated in the bill, regardless of
the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but
do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect
scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the
jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not
include appropriations that occur outside of appropriations bills.

Special Public Health Funding Mechanisms
Annual appropriations for HHS public health service agencies are best understood in the context
of certain HHS-specific funding mechanisms: the Public Health Service (PHS) Evaluation SetAside and the Prevention and Public Health Fund (PPHF). In recent years, LHHS appropriations
have used these funding mechanisms to direct additional support to certain programs and
activities.

Public Health Service Evaluation Tap
The PHS Evaluation Set-Aside, also known as the PHS Evaluation Tap, is a unique feature of
HHS appropriations. It is authorized by Section 241 of the Public Health Service Act (PHSA),
and allows the Secretary of HHS, with the approval of appropriators, to redistribute a portion of
eligible PHS agency appropriations across HHS for program evaluation purposes.

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The PHSA limits the set-aside to not less than 0.2% and not more than 1% of eligible program
appropriations. However, LHHS appropriations acts have commonly established a higher
maximum percentage for the set-aside and have distributed specific amounts of “tap” funding to
selected HHS programs. Since FY2010, and including in FY2019, this higher maximum set-aside
level has been 2.5% of eligible appropriations.26 (While the House committee bill would also
have maintained the set-aside at 2.5%, the Senate-passed bill and the President’s budget each
proposed to increase the set-aside to 2.6% and 2.9%, respectively.)
Display of Evaluation Tap Transfers
Before FY2015, the PHS tap traditionally
provided more than a dozen HHS programs
Readers should note that, by convention, tables in this
report show only the amount of PHS Evaluation Tap
with funding beyond their annual
funds received by an agency (i.e., tables do not subtract
appropriations and, in some cases, was the
the amount of the evaluation tap from donor agencies’
sole source of funding for a program or
appropriations). That is to say, tap amounts shown in
activity. However, since FY2015 and
the following tables are in addition to amounts shown
including in FY2019, LHHS appropriations
for budget authority, but the amounts shown for
budget authority have not been adjusted to reflect
laws have directed tap funds to a smaller
potential “transfer-out” of funds to the tap.
number of programs or activities within three
HHS agencies (NIH, SAMHSA, and OS) and
have not provided any tap transfers to AHRQ, CDC, and HRSA. This has been particularly
notable for AHRQ, which had been funded primarily through tap transfers from FY2003 to
FY2014, but has received discretionary appropriations since then.27 The House committee bill
and the Senate-passed bill generally would have maintained the current distributional practice for
FY2019. However, the President’s budget proposed to expand the activities and agencies funded
by the PHS tap to include the Public Health Scientific Services at the CDC, while simultaneously
proposing to eliminate tap transfers to some other activities.
Since FY2015, LHHS appropriations laws have directed the largest share of tap transfers to
NIH.28 The FY2019 omnibus provided $1.1 billion in tap transfers to NIH, a $224 million
(+24.3%) increase over the FY2018 level. The FY2019 House committee bill proposed that the
NIH transfers be continued at FY2018 levels ($923 million), whereas the Senate-passed bill
would have increased the transfer by $95 million (+10.3%). In contrast, the President’s request
proposed that the transfer be reduced by $182 million (-19.7%).

26 See §204 of P.L. 115-245 for the FY2019 maximum set-aside level. The last time that an appropriations act set the

PHS tap percentage at a level other than 2.5% was in FY2009, when it was 2.4% (see P.L. 111-8). The FY2019
omnibus also retained a change to this provision, first included in the FY2014 omnibus, allowing tap transfers to be
used for the “evaluation and the implementation” of programs funded in the HHS title of the LHHS appropriations act.
Prior to FY2014, such provisions had restricted tap funds to the “evaluation of the implementation” of programs
authorized under the Public Health Service Act.
27 Until FY2015, AHRQ had not received a discretionary appropriation in an annual appropriations act in more than a
decade. FY2009 was the exception to this general pattern, as AHRQ received a supplemental appropriation from the
American Recovery and Reinvestment Act that year. In recent years, AHRQ has also received some transfers from the
Prevention and Public Health Fund and the Patient-Centered Outcomes Research Trust Fund, though these transfers
were generally much smaller than the transfers AHRQ received from the tap. For more information, see CRS Report
R44136, The Agency for Healthcare Research and Quality (AHRQ) Budget: Fact Sheet.
28 Prior to FY2015, NIH had traditionally been by far the largest net donor of tap funds, rather than a net recipient. The
joint explanatory statement accompanying the FY2015 omnibus explained this shift as being intended to ensure that tap
transfers are a “net benefit to NIH rather than a liability” and noted that this change was in response to a growing
concern at the loss of NIH funds to the tap. Joint Explanatory Statement, Proceedings and Debates of the 113 th
Congress, Second Session, Congressional Record, vol. 160, no. 151, Book II, December 11, 2014, p. H9832.

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Prevention and Public Health Fund
The ACA both authorized and appropriated mandatory funding to three funds to support programs
and activities within the PHS agencies.29 One of these, the Prevention and Public Health Fund
(PPHF, ACA §4002, as amended), was given a permanent, annual appropriation that was intended
to provide support each year to prevention, wellness, and related public health programs funded
through HHS accounts.
The ACA had appropriated $2 billion in mandatory funds to the PPHF for FY2019, but this
amount has been reduced by subsequent laws that decreased PPHF funding for FY2019 and other
fiscal years. Under current law, the FY2019 appropriation was $900 million.30 In addition, this
appropriation was subject to a 6.2% reduction due to sequestration of nonexempt mandatory
spending. (For more information on sequestration, see the budget enforcement discussion in
Appendix A.) After sequestration, the total PPHF appropriation available for FY2019 was $844
million, an increase of $4 million relative to FY2018. Of this amount, the LHHS omnibus
allocated $805 million to CDC, $12 million to SAMHSA, and $28 million to ACL.31
PPHF funds are intended to supplement
(sometimes quite substantially) the funding
that selected programs receive through regular
appropriations. Although the PPHF authority
instructs the HHS Secretary to transfer
amounts from the fund to HHS agencies, since
FY2014 provisions in annual appropriations
acts and accompanying reports have explicitly
directed the distribution of PPHF funds and
prohibited the Secretary from making further
transfers for those years.32

Display of PPHF Transfers
Readers should note that the PPHF transfer amounts
displayed in the HHS tables in this report are in
addition to amounts shown for budget authority
provided in the bill. For consistency with source
materials, the amounts shown for PPHF transfers in
these tables reflect the estimated effects of mandatory
spending sequestration; this is not the case for other
mandatory spending shown in this report (also for
consistency with source materials).

The CDC commonly receives the largest share of annual PPHF funds. The amount provided to
the CDC for FY2019, $805 million, was a $4 million (+0.4%) increase relative to FY2018. The
House committee bill and the Senate-passed bill each proposed increases to the CDC allocation
(to $848 million and $808 million, respectively), while the President’s request proposed
eliminating the mandatory PPHF appropriation entirely.

Selected HHS Highlights by Agency
This section begins with a limited selection of FY2019 discretionary funding highlights by HHS
agency. The discussion is largely based on the enacted and proposed appropriations levels for
FY2019, compared to FY2018 enacted levels.33 These summaries are followed by a brief
overview of significant provisions from annual HHS appropriations laws that restrict spending in
certain controversial areas, such as abortion and stem cell research. The section concludes with
two tables (Table 6 and Table 7) presenting more detailed information on FY2018 enacted and
FY2019 proposed and enacted funding levels for HHS.
29 For more information, see CRS Report R41301, Appropriations and Fund Transfers in the Affordable Care Act

(ACA).
30 42 U.S.C. 300u-11.
31 See H.Rept. 115-952, p. 542, for allocations to specific agency programs and activities.
32 See Section 222, Division B, P.L. 115-245.
33 HHS budget materials can be found at http://www.hhs.gov/budget/.

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HRSA
The FY2019 LHHS omnibus provided $6.9 billion in discretionary budget authority for HRSA.
This was $107 million (+1.6%) more than HRSA’s FY2018 discretionary funding level and $2.7
billion (-28.4%) less than the FY2019 President’s budget request.
In several cases, the FY2019 President’s budget proposed new or increased discretionary budget
authority for HRSA programs that had previously been funded exclusively or jointly with
mandatory appropriations from authorizing laws, such as the health centers program, the National
Health Service Corps, and the Maternal, Infant, and Early Childhood Home Visiting program. 34
Simultaneously, the President’s budget proposed to eliminate mandatory funding for these
programs. However, authorizing law ultimately provided FY2019 mandatory appropriations for
each of these programs and the FY2019 LHHS omnibus maintained discretionary appropriations
for them at their FY2018 levels, where applicable.35
The FY2019 LHHS omnibus provided $286 million for Title X Family Planning, the same as
FY2018. For the fourth year in a row, the House committee bill had proposed eliminating funding
for Title X of the PHSA and also prohibiting the use of other HHS funds to carry out Title X. In
contrast, the FY2019 Senate-passed bill and the FY2019 President’s budget had proposed a flat
funding level for Title X from FY2018, and no prohibition on the use of other HHS funds.
The FY2019 LHHS omnibus also continued to fund the Rural Communities Opioids Response
program within HRSA’s Rural Health account. The program was created in FY2018 to support
treatment and prevention of substance use disorders in high-risk rural communities. The omnibus
appropriated $120 million for the program, an increase of $20 million (+20.0%) from FY2018.
HRSA is directed to use this increase to establish three Rural Centers of Excellence on substance
use disorders. The LHHS omnibus provided Healthy Start an increase of $12 million (+10.9%)
from FY2018 as part of a new initiative to reduce maternal mortality and increased funding to
support maternal mortality reduction efforts under the Maternal and Child Health Block Grant by
$26 million (+4.0%).

CDC
The FY2019 LHHS omnibus provided $7.1 billion in discretionary budget authority for CDC.
This was $117 million (-1.6%) less than CDC’s FY2018 funding level and $1.6 billion (+28.3%)
more than the FY2019 President’s budget request. The FY2019 LHHS omnibus did not direct any
PHS tap funds to the CDC, continuing the practice started in FY2015. (The FY2019 President’s
budget had requested $136 million in tap funds.) However, the FY2019 LHHS omnibus did
supplement discretionary CDC appropriations with $805 million in PPHF transfers to the CDC,

34 These proposals had the effect of making the FY2019 President’s request for discretionary HRSA budget authority

significantly larger than the FY2018 enacted discretionary funding level for HRSA. However, when taking into account
total budgetary resources requested, the FY2019 President’s budget proposed a lower overall funding level for HRSA
than had been provided in FY2018. This was driven by President’s budget proposals to reduce or eliminate funds for a
number of health care workforce, maternal and child health, and rural health programs. Taking into account all
budgetary resources (mandatory and discretionary), the FY2019 President’s request proposed a total funding level of
$9.9 billion for HRSA, which is about $1.1 billion (-15%) less than the comparable FY2018 HRSA funding level. For
more information, see CRS Report R45245, Health Resources and Services Administration (HRSA) FY2019 Budget
Request and Funding History: Fact Sheet.
35 For further discussion, see CRS Report R45245, Health Resources and Services Administration (HRSA) FY2019
Budget Request and Funding History: Fact Sheet.

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which was $4 million (+0.4%) more than FY2018.36 (Unlike FY2018, the FY2019 LHHS
omnibus did not direct any transfers from the HHS Nonrecurring Expenses Fund (NEF) to the
CDC.)37
A number of CDC accounts contained funding set aside to address the opioid crisis. For example,
the HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention
account received an increase of $5 million (+0.4%) from FY2018; the conference report specified
that the increase be used for a new initiative targeting infectious disease consequences of the
opioid epidemic.38 With regard to the Injury Prevention and Control account, which was
maintained at the FY2018 level of $649 million, the conference report directed HHS to reserve
$476 million from this total for the CDC’s Prescription Drug Overdose (PDO) activities, noting
that these funds should be used to “advance the understanding of the opioid overdose epidemic
and scale up prevention activities.”39 In addition, $10 million in PDO funding was to be dedicated
to a nationwide opioid awareness and education campaign. The Birth Defects and Developmental
Disabilities account received an increase of $15 million (+10.7%), of which $10 million was to
support monitoring of mothers and babies affected by the Zika virus as well as other emerging
health threats, such as opioid use during pregnancy, and $2 million was reserved specifically for
activities related to neonatal abstinence syndrome.

NIH
The FY2019 LHHS omnibus provided $37.9 billion in discretionary budget authority for NIH.
This was $1.8 billion (+4.9%) more than FY2018 and $4.1 billion (+12.3%) more than the
President’s FY2019 budget request. In addition, the FY2019 LHHS omnibus directed $1.1 billion
in PHS tap transfers to NIH, an increase of $224 million (+24.3%) from FY2018. The entirety of
the tap transfer was provided to the National Institute of General Medical Sciences (NIGMS), and
was paired with a discretionary appropriation of $1.7 billion. The discretionary appropriation was
$137 million (-7.3%) less than FY2018, but when combined with the tap transfer, total funding
for NIGMS increased by $87 million (+3.1%) from FY2018.
When accounting for discretionary appropriations and PHS tap transfers, each of the NIH
accounts in the LHHS bill received an increase from FY2018 levels. Compared to FY2018, the
largest percentage increases went to the National Institute on Aging, which received a total of
$3.1 billion (+19.8%), and the Buildings and Facilities account, which received $200 million
(+55.2%).40 In line with recent practice, the conference report on the FY2019 LHHS omnibus
directed NIH to reserve a specific amount ($2.34 billion) for Alzheimer’s disease research,
referring to it as an increase of $425 million from FY2018.41 Reserving a specific dollar amount

36 H.Rept. 115-952, p. 542.
37 The $250 million NEF transfer to the CDC Buildings and Facilities account in the FY2018 omnibus was to support

the construction of a new Biosafety Level 4 laboratory. (That omnibus paired the NEF transfer with a dedicated
discretionary appropriation of $240 million, for a combined funding level of $480 million for this construction project.)
The FY2019 appropriation of $30 million for the CDC Buildings and Facilities account represented flat funding from
FY2018, when excluding all the funds that were reserved for the biosafety laboratory construction project.
38 H.Rept. 115-952, p. 523.
39 Ibid, p 527.
40 The House committee report explained that this increase was to support the buildings on the main NIH campus in
Bethesda, MD; the Animal Center in Poolesville, MD; the NIEHS facility in Research Triangle Park, NC; and other
smaller facilities throughout the United States. (H.Rept. 115-862, p. 77.)
41 H.Rept. 115-952, p. 529.

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for a particular disease or area of research at NIH is a relatively new practice and constitutes a
significant departure from past precedent.42
The FY2019 LHHS omnibus appropriated $711 million to the NIH Innovation Account pursuant
to the 21st Century Cures Act (P.L. 114-255), which was equal to the amount authorized to be
appropriated in that act.43 The conference report also reiterated the purposes authorized in the act,
directing that NIH transfer $400 million to the National Cancer Institute to support cancer
research, and $57.5 million each to the National Institute of Neurological Disorders and Stroke
and the National Institute of Mental Health to support the Brain Research through Advancing
Innovative Neurotechnologies (BRAIN) Initiative. The remaining $196 million was divided
between the Precision Medicine Initiative ($186 million) and regenerative medicine research ($10
million).44

SAMHSA
The FY2019 LHHS omnibus provided $5.6 billion in discretionary budget authority for
SAMHSA. This amount was $584 million (+11.6%) more than SAMHSA’s FY2018 funding
level and $2.2 billion (+63.4%) more than the President’s FY2019 budget request. In addition, the
FY2019 LHHS omnibus also directed $134 million in PHS evaluation tap funding and $12
million in PPHF funding to SAMHSA, which was the same amount as FY2018.
State Opioid Response Grants received $1.5 billion in FY2019, a $500 million (+50%) increase
from FY2018, which was the first year in which funding was provided for this program.
However, the State Targeted Response to the Opioid Crisis (STR) grants that were appropriated
$500 million in each of FY2017 and FY2018 did not receive appropriations in FY2019.45 The
FY2019 LHHS omnibus also included an increase of $50 million (+50.0%) from FY2018 for
Certified Community Behavioral Health Centers. Mental Health Programs of Regional and
National Significance (PRNS) and Substance Abuse Prevention PRNS each had a reduction of
$43 million (-10.1% and -17.2%, respectively) from FY2018, while Substance Abuse Treatment
PRNS had an increase of $55 million (+13.7) from FY2018.

CMS
The FY2019 LHHS omnibus provided $4.4 billion in discretionary budget authority for CMS.
This was $20 million (+0.5%) more than FY2018 and $121 million (+2.8%) more than the
42 As recently as December 2014, the explanatory statement on the FY2015 omnibus stipulated, “In keeping with

longstanding practice, the agreement does not recommend a specific amount of NIH funding for this purpose
[Alzheimer’s disease] or for any other individual disease. Doing so would establish a dangerous precedent that could
politicize the NIH peer review system. Nevertheless, in recognition that Alzheimer’s disease poses a serious threat to
the Nation’s long-term health and economic stability, the agreement expects that a significant portion of the
recommended increase for NIA should be directed to research on Alzheimer’s. The exact amount should be determined
by scientific opportunity of additional research on this disease and the quality of grant applications that are submitted
for Alzheimer’s relative to those submitted for other diseases.” See Congressional Record, daily edition, vol. 160, no.
151, Book II (December 11, 2014), p. H9832.
43 The Cures Act created the NIH Innovation Account and specified that funds in the account must be appropriated in
order to be available for expenditure. Projects authorized by the Cures Act are the Precision Medicine Initiative (funded
at $186 million in FY2019), the BRAIN Initiative (funded at $115 million in FY2019), cancer research (funded at $400
million), and regenerative medicine using adult stem cells (funded at $10 million).
44 H.Rept. 115-952, p. 529.
45 The STR funds were appropriated to the HHS Office of the Secretary, but SAMHSA ultimately received the funds
and administered the program. The grants were initially authorized by the Cures Act for FY2017 and FY2018. They
were reauthorized by the SUPPORT Act (P.L. 115-271) through FY2021, after the FY2019 LHHS omnibus was
enacted.

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FY2019 President’s budget request. The LHHS omnibus appropriated $765 million for the CMS
Health Care Fraud and Abuse Control (HCFAC) account, 2.7% more than FY2018, and slightly
less (-0.6%) than the FY2019 President’s request. Of the total amount appropriated for HCFAC,
$454 million was effectively exempt from the discretionary budget caps. (See Appendix A for an
explanation of the LHHS budget cap exemptions.)
The LHHS omnibus provided the CMS Program Management account with a flat funding level of
$3.7 billion. This account supports CMS program operations (e.g., claims processing, information
technology investments, provider and beneficiary outreach and education, and program
implementation), in addition to federal administration and other activities related to the
administration of Medicare, Medicaid, the State Children’s Health Insurance Program, and
private health insurance provisions established by the ACA. The FY2019 appropriation was the
same amount that was proposed by the Senate-passed bill, but more than the amounts proposed
by the President’s budget (+3.6%) and the House committee bill (+4.8%). The omnibus
maintained a general provision (§227), included in LHHS appropriations acts since FY2014,
authorizing HHS to transfer additional funds into this account from Medicare trust funds. The
terms of the provision required that such funds be used to support activities specific to the
Medicare program, limited the amount of the transfers to $305 million, and explicitly prohibited
such transfers from being used to support or supplant funding for ACA implementation. The
House committee bill would have eliminated this provision.

ACF
The FY2019 LHHS omnibus provided $23.2 billion in discretionary budget authority for ACF.
This was $357 million (+1.6%) more than FY2018 and $7.8 billion (+50.6%) more than the
FY2019 President’s budget request. The President’s budget would have decreased ACF
discretionary funding by roughly one-third relative to the prior year (-32.5%). The President’s
budget would have achieved much of its proposed reduction by eliminating certain programs
within ACF, such as the Low Income Home Energy Assistance Program (LIHEAP), Preschool
Development Grants (PDG), and the Community Services Block Grant (CSBG). Funding for
these three programs was sustained or increased in the FY2019 LHHS omnibus: LIHEAP
received $3.7 billion, PDG $250 million, and CSBG $725 million.
The LHHS omnibus provided $1.9 billion for the Refugee and Entrant Assistance programs
account, an increase of $40 million (+2.2%) relative to FY2018. The LHHS omnibus retained a
provision, included in LHHS appropriations since FY2015, authorizing HHS to augment
appropriations for the Refugee and Entrant Assistance account by up to 10% via transfers from
other discretionary HHS funds.
The conference report on the omnibus directed the majority of the appropriation for Refugee and
Entrant Assistance programs toward the Unaccompanied Alien Children (UAC) program ($1.3
billion, the same as FY2018). The UAC program provides for the shelter, care, and placement of
unaccompanied alien children who have been apprehended in the United States. The LHHS
omnibus also included several new general provisions related to the UAC program. For instance,
the law authorized HHS to accept donations for the care of UACs (§232), required HHS to submit
a report on reunification of children with parents who are no longer in the United States (§233),
and prohibited HHS appropriations from being used to prevent a Member of Congress from
visiting a UAC facility for oversight purposes (§234). In addition, the conference report on the
LHHS omnibus expressed an expectation that HHS would adhere to certain general provisions
that had been included in the House committee bill (H.R. 6470), specifically provisions relating
to sibling placement (§235), monthly reporting (§236), a report on preliterate children in custody
(§541), a report on the mental health needs of children separated from their parents (§542), and a

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sense of the Congress that immigrant children should not be separated from their parents and
should be reunited immediately (§539).
A number of new directives and reporting requirements on the UAC program were also included
in the conference report itself, as well as reports on the earlier committee-reported FY2019 LHHS
bills. The conferees noted that HHS was expected to adhere to the requirements laid out in all
three reports (unless a particular requirement in a committee report had been superseded by the
LHHS omnibus or its conference report). These requirements addressed a range of topics related
to, for instance, the administration of medication, questioning children about religion, sharing
information on the whereabouts of children and parents, protecting genetic material, the provision
of qualified and independent legal counsel, and expectations for communication with
appropriations committees on various UAC issues.

AHRQ
The FY2019 LHHS omnibus provided $338 million in discretionary budget authority to AHRQ.
This was 1.2% more than the FY2018 level of $334 million. The FY2019 LHHS omnibus did not
direct any PHS tap transfers to AHRQ, which is in keeping with practices since FY2015 but
contrasts with earlier years (FY2003-FY2014) in which AHRQ had been funded primarily with
tap transfers.46 The FY2019 omnibus continued to fund AHRQ as its own operating division,
declining the President’s proposal to consolidate AHRQ into NIH. The FY2019 President’s
request had proposed zero funding for AHRQ, proposing instead to continue funding many of
AHRQ’s activities through a new National Institute for Research on Safety and Quality (NIRSQ)
in the NIH.47

ACL
The FY2019 LHHS omnibus provided $2.2 billion in discretionary budget authority for ACL.
This was $25 million (+1.2%) more than FY2018. In addition, the FY2019 LHHS omnibus
directed $28 million in PPHF transfers to ACL, the same as FY2018. The FY2019 LHHS
omnibus specified that the PPHF transfers were for the Alzheimer’s Disease Program, Chronic
Disease Self-Management, and Elder Falls Prevention.
The FY2019 LHHS omnibus did not adopt the President’s budget proposals to consolidate
Chronic Disease Self-Management and Elder Falls Prevention into the Preventive Health Services
Program, or to eliminate funding for the State Health Insurance Program, the Paralysis Resource
Center, and the Limb Loss Resource Center.
The conference report on the FY2019 LHHS omnibus called on ACL to use a portion of the $181
million reserved for Family Caregiver Support Services to establish and carry out activities for
46 In addition to funds provided through the annual appropriations process, AHRQ is also scheduled in FY2019 to

receive a transfer of certain mandatory funds that were authorized and appropriated to the Patient-Centered Outcomes
Research Trust Fund (PCORTF) by ACA Section 6301(e) (26 U.S.C. §9511). Transfers to AHRQ from the PCORTF
are to be used to disseminate the results of patient-centered outcomes research. (PCORTF funds are generally not
displayed in this report, as they are not provided by or modified through annual LHHS appropriations bills.) For more
information on the PCORTF, see Appendix D of CRS Report R44916, Public Health Service Agencies: Overview and
Funding (FY2016-FY2018).
47 HHS, NIH, National Institute for Research on Safety and Quality, FY2019 Congressional Justification,
https://www.ahrq.gov/sites/default/files/wysiwyg/cpi/about/mission/budget/2019/NIRSQ.pdf. The President’s request
would have funded NIRSQ at $255 million for FY2019 (not counting transfers from the PCORTF). A similar proposal
was made in the President’s FY2018 request; see HHS, NIH, National Institute for Research on Safety and Quality, FY
2018 Congressional Justification—Budget Estimates for Appropriations Committees, May 23, 2017,
https://www.ahrq.gov/sites/default/files/wysiwyg/cpi/about/mission/budget/2018/NIRSQ.pdf.

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two newly authorized advisory councils. Specifically, the report recommended that ACL dedicate
$300,000 to the Family Caregiving Advisory Council authorized under the RAISE Family
Caregivers Act (P.L. 115-119) and $300,000 to the Advisory Council to Support Grandparents
Raising Grandchildren authorized under the Supporting Grandparents Raising Grandchildren Act
(P.L. 115-196). In addition, the conference report on the FY2019 LHHS omnibus called for a $5
million (+40.1%) increase under Aging Network Support Activities for a new Care Corps grants
program. Care Corps grants are intended to support public agencies and nonprofits in placing
volunteers to provide nonmedical care to help family caregivers, seniors, and individuals with
disabilities to maintain independence.

Restrictions Related to Certain Controversial Issues
Annual LHHS appropriations measures regularly contain broad restrictions related to certain
controversial issues. For instance, annual LHHS appropriations acts commonly include provisions
limiting the use of federal funds for abortions, the use of human embryos for research, needle
exchange programs, and gun control advocacy.
Abortions: Since FY1977, annual LHHS appropriations acts have included provisions limiting
the circumstances under which LHHS funds (including Medicaid funds) may be used to pay for
abortions. Early versions of these provisions applied only to HHS, but since FY1994 most
provisions have applied to the entire LHHS bill. Under current provisions, (1) abortions may be
funded only when the life of the mother is endangered or in cases of rape or incest; (2) funds may
not be used to buy a managed care package that includes abortion coverage, except in cases of
rape, incest, or endangerment; and (3) federal programs and state and local governments that
receive LHHS funding are prohibited from discriminating against health care entities that do not
provide or pay for abortions or abortion services. The FY2019 omnibus retained these existing
restrictions (§§506 and 507).48 In addition, the House committee bill proposed a new provision
that was not enacted (§534) based on the Conscience Protection Act (H.R. 644, 115th Congress).49
Among other things, this provision would have amended the Public Health Service Act to
generally prevent federal, state, and local governments from penalizing or discriminating against
health care providers who choose not to perform, pay for, or sponsor coverage of abortions.50
However, the provision was not included in the LHHS omnibus.
Human Embryo Research: Since FY1996, annual LHHS appropriations have included a
provision prohibiting any LHHS funds (including NIH funds) from being used to create human
embryos for research purposes or for research in which human embryos are destroyed. The
FY2019 omnibus retained these existing restrictions (§508).51
Needle Exchange Programs: Since FY1990, annual LHHS appropriations have generally
included a provision prohibiting any LHHS funds from being used for needle exchange programs
(i.e., programs in which sterile needles or syringes are made available to injection drug users in
exchange for used needles or syringes to mitigate the spread of related infections, such as
48 The current provisions are commonly referred to as the Hyde and Weldon Amendments. For additional information,

see CRS Report RL33467, Abortion: Judicial History and Legislative Response.
49 The Senate companion measure to H.R. 644 was S. 301.
50 Section 534 of H.R. 6470 would have also established a private right of action for qualified parties who were
penalized or otherwise discriminated against as a result of violations of the Public Health Service Act’s conscience
provisions, including those that would have been added by Section 534.
51 The current provision is commonly referred to as the Dickey Amendment. For additional information, see CRS
Report RL33540, Stem Cell Research: Science, Federal Research Funding, and Regulatory Oversight.

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Hepatitis and HIV/AIDS).52 Starting in FY2016, the provision was modified to allow funds to be
used for needle exchange programs under the following conditions: (1) federal funds may not be
used to purchase the needles, but may be used for other aspects of such programs; (2) the state or
local jurisdiction must demonstrate, in consultation with CDC, that they are experiencing, or at
risk for, a significant increase in hepatitis infections or an HIV outbreak due to injection drug use;
and (3) the program must be operating in accordance with state and local law. The FY2019
omnibus retained these existing restrictions and conditions (§529).53
Gun Control: Since FY1997, annual LHHS appropriations have included provisions prohibiting
the use of certain funds for activities that advocate or promote gun control. Early versions of
these provisions applied only to CDC; since FY2012, annual appropriations acts also have
included HHS-specific restrictions, in addition to restrictions that apply to all LHHS funds
(including funds transferred from the PPHF). The FY2019 omnibus retained these existing
restrictions (§210 [HHS] and §503(c) [all LHHS, plus PPHF transfers]).
Restrictions on ACA Implementation: Since FY2011, annual LHHS appropriations have
included provisions limiting or altering the ability of HHS to implement various aspects of the
ACA.54 The content and scope of these provisions has evolved over time. The FY2019 House
committee bill contained two provisions related to this topic that were not included in the FY2018
omnibus. First, the FY2019 House committee bill (§528) would have prohibited any funds
appropriated in the bill from being used for health insurance “navigator” programs required by
Section 1311 of the ACA. (Navigators conduct public education activities to help consumers and
small businesses make informed decisions about insurance.)55 Further, the House committee bill
would have prohibited LHHS appropriations from being used to “implement, administer, enforce,
or further” any provision of the ACA, with limited exceptions (§527). The Senate bill did not
include comparable provisions.
Table 6. HHS Appropriations Totals by Agency
(Dollars in millions)
FY2019
House
Cmte.
(H.R.
6470)

FY2019
Request

FY2019
Senate
Floor
(H.R. 6157)

7,014

9,877

7,134

6,858

7,161

Mandatory BA

268

308

308

308

308

Discretionary BA

6,746

9,569

6,826

6,550

6,853

HHS Agency
HRSA

FY2018
Enacted

FY2019
Enacted
(P.L. 115245)

52 The one exception is the FY1992 LHHS appropriations act (P.L. 102-170), which appears to have included no such

provision. Since the provision’s inception in FY1990, there has been variation in its scope and application during
certain fiscal years. For example, the LHHS appropriations act for FY1998 (P.L. 105-78) made the ban subject to
action by the HHS Secretary. The LHHS appropriations acts for FY2010 (P.L. 111-117, Division D) and FY2011 (P.L.
112-10, Division B) applied the ban only in locations that local authorities determined to be inappropriate.
53 The FY2019 House committee bill proposed modifying this provision by adding new language prohibiting funds
from being used for the operation of a supervised drug consumption facility that permits the consumption onsite of any
substance listed in the Schedule I of Section 202 of the Controlled Substances Act. However, this additional language
was not included in the FY2019 LHHS omnibus.
54 F

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Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/crs%3AR45869. Public record. Not legal advice.