# Labor, Health and Human Services, and Education: FY2023 Appropriations > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/crs%3AR47345 ## Record - **Collection:** Congressional research report - **Document type:** CRS Report - **Published:** May 22, 2023 - **Citation:** R47345 ## Text Labor, Health and Human Services, and Education: FY2023 Appropriations Updated May 22, 2023 Congressional Research Service https://crsreports.congress.gov R47345 SUMMARY Labor, Health and Human Services, and Education: FY2023 Appropriations This report offers an overview of actions taken by Congress and the President to provide FY2023 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). The LHHS bill also provides funds for more than a dozen related agencies, including the Social Security Administration (SSA). R47345 May 22, 2023 Karen E. Lynch, Coordinator Specialist in Social Policy Jessica Tollestrup, Coordinator Specialist in Social Policy This report primarily focuses on regular FY2023 LHHS discretionary funding enacted during the annual appropriations process. Totals in the report tables do not include emergency-designated funds. Regular Appropriations FY2023 LHHS Omnibus: On December 29, 2022, the Consolidated Appropriations Act, 2023 (FY2023 LHHS omnibus; H.R. 2617) was signed into law by the President (P.L. 117-328). The FY2023 LHHS omnibus provided full-year appropriations for all 12 annual appropriations acts in Divisions A-L. Annual discretionary LHHS appropriations totaled about $225.9 billion. This amount is 5.6% more than FY2022 enacted and 7.8% less than the FY2023 President’s budget request. The omnibus also provided $1.196 trillion in mandatory funding, for a combined LHHS total of $1.422 trillion. The distribution of discretionary funding was as follows: • • • • DOL: $13.8 billion, 4.9% more than FY2022. HHS: $115.4 billion, 6.6% more than FY2022. ED: $79.6 billion, 4.1% more than FY2022. Related Agencies: $17.0 billion, 6.7% more than FY2022. FY2023 LHHS Senate Action: The FY2023 LHHS bill did not receive subcommittee, full committee, or initial floor action in the Senate. Senator Leahy, chair of the Senate Appropriations Committee, released a majority draft of the LHHS bill and accompanying draft report language on July 28, 2022. These draft numbers are not presented in this report. Also on July 28, 2022, Senator Patty Murray, chair of the Senate Appropriations LHHS Subcommittee, introduced an FY2023 LHHS bill (S. 4659). This bill was referred to the Senate Appropriations Committee. Because S. 4659 did not receive any congressional action, this report does not discuss this measure. FY2023 LHHS House Action: On June 30 2022, the House Appropriations Committee voted to report the FY2023 LHHS bill, 32-24; the measure was subsequently reported to the House on July 5 (H.R. 8295; H.Rept. 117-403). Previously, the measure was approved in subcommittee, via a voice vote, on June 23, 2022. As reported by the full committee, the bill would have provided $243.3 billion in discretionary LHHS funds, a 13.8% increase from FY2022 enacted levels. This amount was 0.6% less than the FY2023 President’s request. In addition, the House committee bill would have provided an estimated $1.196 trillion in mandatory funding, for a combined total of $1.439 trillion for LHHS as a whole. The distribution of proposed discretionary funding was as follows: • • • • DOL: $15.0 billion, 14.0% more than FY2022. HHS: $124.2 billion, 14.7% more than FY2022. ED: $86.7 billion, 13.5% more than FY2022. Related Agencies: $17.4 billion, 8.8% more than FY2022. FY2023 President’s Budget Request: The President’s budget request was submitted to Congress on March 28, 2022. The President requested $244.9 billion in discretionary funding for accounts funded by the LHHS bill, which is an increase of Congressional Research Service Labor, Health and Human Services, and Education: FY2023 Appropriations 14.5% from FY2022 levels. In addition, the President requested $1.196 trillion in annually appropriated mandatory funding, for a total of $1.441 trillion for LHHS as a whole. The distribution of requested discretionary funding was as follows: • • • • DOL: $14.9 billion, 13.0% more than FY2022. HHS: $123.9 billion, 14.4% more than FY2022. ED: $88.3 billion, 15.6% more than FY2022. Related Agencies: $17.7 billion, 11.1% more than FY2022. Emergency-Designated Appropriations Three acts have been signed into law providing LHHS emergency-designated appropriations for FY2023: • Division A of the Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023 (H.R. 6833; P.L. 117-180, September 30, 2022) provided emergency-designated appropriations for two accounts at the HHS Administration for Children and Families (ACF): $1.0 billion for the Low Income Home Energy Assistance Program (§146) and $1.8 billion for expenses to carry out the Unaccompanied Children Program and for certain refugee and entrant assistance activities (§147). • Division M of H.R. 2617 (P.L. 117-328, December 29, 2022), the Additional Ukraine Supplemental Appropriations Act, 2023, provided $2.4 billion in emergency-designated appropriations for the Refugee and Entrant Assistance Account at ACF. • Division N of H.R. 2617 (P.L. 117-328, December 29, 2022), the Disaster Relief Supplemental Appropriations Act, 2023, provided a total of $4.25 billion in emergency-designated appropriations to several HHS accounts and programs within the Centers for Disease Control and Prevention, the National Institutes of Health, ACF, and the Public Health and Social Sciences Emergency Fund. Congressional Research Service Labor, Health and Human Services, and Education: FY2023 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 FY2023 LHHS Appropriations ........................................................................................ 4 FY2023 Emergency-Designated Appropriations ...................................................................... 4 FY2023 Annual LHHS Appropriations ..................................................................................... 5 FY2023 Consolidated Appropriations Act ................................................................................ 5 FY2023 Continuing Appropriations .......................................................................................... 6 Prior Congressional Action on an LHHS Bill ..................................................................... 7 FY2023 President’s Budget Request ......................................................................................... 8 FY2022 LHHS Omnibus (Division H, Consolidated Appropriations Act, 2022, H.R. 2471, P.L. 117-103) ................................................................................................................ 8 Summary of FY2023 LHHS Appropriations ................................................................................... 9 Department of Labor (DOL) ......................................................................................................... 12 About DOL ............................................................................................................................. 13 FY2023 DOL Appropriations Overview ................................................................................. 13 Selected DOL Highlights ........................................................................................................ 14 Employment and Training Administration (ETA)............................................................. 14 Employment Service ......................................................................................................... 15 Wage and Hour Division (WHD)...................................................................................... 15 Bureau of Labor Statistics (BLS) ...................................................................................... 15 Bureau of International Labor Affairs (ILAB) .................................................................. 16 Labor-Related General Provisions .................................................................................... 16 Department of Health and Human Services (HHS)....................................................................... 19 About HHS .............................................................................................................................. 19 FY2023 HHS Appropriations Overview ................................................................................. 20 Special Public Health Funding Mechanisms ........................................................................... 23 Public Health Service Evaluation Tap............................................................................... 23 Prevention and Public Health Fund .................................................................................. 24 Selected HHS Highlights by Agency ...................................................................................... 25 Health Resources and Services Administration (HRSA) .................................................. 25 Centers for Disease Control and Prevention (CDC) ......................................................... 26 National Institutes of Health (NIH) .................................................................................. 27 Substance Abuse and Mental Health Services Administration (SAMHSA) ..................... 28 Agency for Healthcare Research and Quality (AHRQ) .................................................... 29 Centers for Medicare & Medicaid Services (CMS) .......................................................... 29 Administration for Children and Families (ACF) ............................................................. 30 Administration for Community Living (ACL) ................................................................. 31 Restrictions Related to Certain Controversial Issues .............................................................. 32 Department of Education (ED) ...................................................................................................... 40 About ED ................................................................................................................................ 40 Congressional Research Service Labor, Health and Human Services, and Education: FY2023 Appropriations FY2023 ED Appropriations Overview.................................................................................... 41 Selected ED Highlights ........................................................................................................... 42 Education for the Disadvantaged ...................................................................................... 42 Safe Schools and Citizenship Education........................................................................... 43 Student Financial Assistance............................................................................................. 43 Related Agencies ........................................................................................................................... 46 FY2023 Related Agencies Appropriations Overview ............................................................. 46 Selected Related Agencies Highlights..................................................................................... 47 SSA Limitation on Administrative Expenses (LAE) ........................................................ 48 Corporation for National and Community Service ........................................................... 48 National Labor Relations Board (NLRB) ......................................................................... 48 Figures Figure 1. FY2023 Enacted LHHS Appropriations .......................................................................... 6 Figure 2. FY2023 Enacted LHHS Appropriations by Title ........................................................... 12 Figure 3. FY2023 Enacted HHS Appropriations by Agency......................................................... 22 Tables Table 1. Status of Full-Year LHHS Appropriations Legislation, FY2023 ....................................... 5 Table 2. LHHS Appropriations Overview by Bill Title, FY2022-FY2023 ................................... 10 Table 3. DOL Appropriations Overview ....................................................................................... 14 Table 4. Detailed DOL Appropriations .......................................................................................... 17 Table 5. HHS Appropriations Overview........................................................................................ 21 Table 6. HHS Appropriations Totals and Directed Transfers by Agency ...................................... 34 Table 7. HHS Discretionary Appropriations and Directed Transfers for Selected Programs or Activities, by Agency ............................................................................................................. 36 Table 8. ED Appropriations Overview .......................................................................................... 41 Table 9. Detailed ED Appropriations ............................................................................................ 44 Table 10. Related Agencies Appropriations Overview .................................................................. 47 Table 11. Detailed Related Agencies Appropriations .................................................................... 49 Table A-1. LHHS Discretionary FY2022 and FY2023 Enacted Levels and FY2023 House 302(b) Suballocations ................................................................................................................. 55 Table A-2. LHHS Appropriations Overview, by Bill Title: FY2022-FY2023............................... 56 Appendixes Appendix. Budget Enforcement Activities .................................................................................... 51 Congressional Research Service Labor, Health and Human Services, and Education: FY2023 Appropriations Contacts Author Information........................................................................................................................ 58 Congressional Research Service Labor, Health and Human Services, and Education: FY2023 Appropriations Introduction This report provides an overview of FY2023 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). Scope of the Report: Emergency-Designated and Mandatory Funding This report primarily focuses on regular FY2023 LHHS discretionary funding enacted during the annual appropriations process. The emergency discretionary funding that was enacted for FY2022 or FY2023 is generally not included in the budgetary figures discussed or table totals presented in the main body of the report. (Such spending is presented below the table totals and is in addition to regular appropriations.) In addition, during FY2022, mandatory appropriations were enacted for certain LHHS-related accounts, including in the Inflation Reduction Act of 2022 (P.L. 117-169). These mandatory funds are also not included in this report. Discretionary funds represent less than one-fifth of the total funds appropriated in the annual 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.) Because the appropriations process both provides and controls discretionary funding (concepts discussed further in “Mandatory vs. Discretionary Budget Authority”), the bulk of this report is focused on these funds. The LHHS bill typically is one of the more controversial of the regular appropriations bills because of the size of its funding and the scope of its programs, as well as various related social policy issues addressed in the bill, such as restrictions on the use of federal funds for abortion and for research on human embryos, stem cells, and gun violence. Congressional clients may consult the LHHS experts list in CRS Report R42638, Appropriations: CRS Experts, for information on which analysts to contact at the Congressional Research Service (CRS) with questions on specific agencies and programs funded in the LHHS bill. Report Roadmap and Useful Terminology This report is divided into several sections. The opening section provides an explanation of the scope of the LHHS bill (and hence, the scope of this report) and an introduction to important terminology and concepts that carry throughout the report. Next is a series of sections describing major congressional actions on FY2023 appropriations and (for context) a review of the conclusion of the FY2022 appropriations process. This is followed by a high-level summary and analysis of proposed and enacted appropriations for FY2023, compared to FY2022 funding levels. The body of the report concludes with overview sections for each of the major titles of the bill: DOL, HHS, ED, and Related Agencies (RA). These sections provide selected highlights from FY2023 proposed and enacted funding levels compared to FY2022. (Note that the Congressional Research Service 1 Labor, Health and Human Services, and Education: FY2023 Appropriations distribution of funds is sometimes illustrated by figures, which in all cases are based on the FY2023 enacted version of the LHHS bill.1) The Appendix provides a summary of budget enforcement activities for FY2023. This includes information on mandatory spending sequestration pursuant to the Budget Control Act of 2011 (BCA; P.L. 112-25), discretionary spending budget enforcement in the absence of a FY2023 budget resolution, the House LHHS subcommittee spending allocation, and current-year spending levels. Scope of the Report This report focuses on appropriations to agencies and accounts that are subject to the jurisdiction of the Labor, Health and Human Services, Education, and Related Agencies subcommittees of the House and Senate appropriations committees (i.e., accounts traditionally funded via the LHHS bill). Department “totals” provided in this report do not include funding for accounts or agencies that are traditionally funded by appropriations bills under the jurisdiction of other subcommittees. The LHHS bill provides appropriations for the following federal departments and agencies: • • • • the Department of Labor; most agencies at the Department of Health and Human Services, except for the Food and Drug Administration (funded through the Agriculture appropriations bill), the Indian Health Service (funded through the Interior-Environment appropriations bill), and the Agency for Toxic Substances and Disease Registry (also funded through the Interior-Environment appropriations bill); the Department of Education; and more than a dozen related agencies, including the Social Security Administration, the Corporation for National and Community Service, the Corporation for Public Broadcasting, the Institute of Museum and Library Services, the National Labor Relations Board, and the Railroad Retirement Board. Note also that funding totals displayed in this report do not reflect amounts provided outside of the annual appropriations process. Certain direct spending programs, such as Social Security and parts of Medicare, receive funding directly from their authorizing statutes; such funds are not reflected in the totals provided in this report because they are not provided through the annual appropriations process (see related discussion in the “Mandatory vs. Discretionary Budget Authority” 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 budget authority is provided in appropriations measures. 1 The figures reflect FY2023 enacted, but the distribution of funds (as measured by the relative share of funds going toward a particular department or agency) is generally illustrative of FY2022 enacted and as proposed by the FY2023 President’s budget and the House committee bill. 2 For definitions of these and other budget terms, see U.S. Government Accountability Office (GAO), A Glossary of (continued...) Congressional Research Service 2 Labor, Health and Human Services, and Education: FY2023 Appropriations Mandatory programs funded through the annual appropriations process are commonly referred to as appropriated entitlements. In general, appropriators have little control over the amounts provided for appropriated entitlements; rather, the authorizing statute controls the program parameters (e.g., eligibility rules, benefit levels) that entitle certain recipients to payments. If Congress does not appropriate the money necessary to meet these commitments, entitled recipients (e.g., individuals, states, or other entities) may have legal recourse.3 Most mandatory spending is not provided through the annual appropriations process, but rather through budget authority provided by the program’s authorizing statute (e.g., Social Security benefits payments). The funding amounts in this report do not include budget authority provided outside of the appropriations process. Instead, the amounts reflect only those funds, discretionary and mandatory, that are provided through appropriations acts. As displayed in this report, mandatory amounts for the FY2023 President’s budget submission reflect current-law (or current services) estimates; they generally do not include the President’s proposed changes to a mandatory spending program’s authorizing statute that might affect total spending. (In general, such proposals are excluded from this report, as they typically would be enacted in authorizing legislation.) The report focuses most closely on discretionary funding because discretionary funding receives the bulk of attention during the appropriations process. (While the LHHS bill includes more mandatory funding than discretionary funding, the appropriators generally have less flexibility in adjusting mandatory funding levels than discretionary funding levels.) Mandatory and discretionary spending is subject to budget enforcement processes that include sequestration. In general, sequestration involves largely across-the-board reductions that are made to certain categories of discretionary or mandatory spending. However, the conditions that trigger sequestration, and how it is carried out, differ for each type of spending. This is discussed further in the Appendix. 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 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, 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. Congressional Research Service 3 Labor, Health and Human Services, and Education: FY2023 Appropriations 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, see the Appendix).6 The process of measuring appropriations against these spending ceilings takes into account scorekeeping adjustments, which are made by the Congressional Budget Office (CBO) to reflect conventions and special instructions of Congress.7 Unless otherwise specified, appropriations levels displayed in this report do not reflect additional scorekeeping adjustments. (Those scorekeeping adjustments are displayed at the bottom of Table 2.) Status of FY2023 LHHS Appropriations FY2023 Emergency-Designated Appropriations Three acts have been signed into law providing LHHS emergency-designated appropriations for FY2023: • • Division A of the Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023 (H.R. 6833; P.L. 117-180, September 30, 2022) provided emergency-designated appropriations for two accounts at the HHS Administration for Children and Families (ACF): $1.0 billion for the Low Income Home Energy Assistance Program (§146) and $1.8 billion for expenses to carry out the Unaccompanied Children Program and for certain refugee and entrant assistance activities (§147).8 Division M of H.R. 2617 (P.L. 117-328, December 29, 2022), the Additional Ukraine Supplemental Appropriations Act, 2023, provided $2.4 billion in emergency-designated appropriations for the Refugee and Entrant Assistance Account at ACF.9 5 Such figures exclude advance appropriations for future years, but include advance appropriations from prior years that become available in the given fiscal year. 6 As of the cover date of this report, the House and Senate have not adopted a budget resolution for FY2023. In its absence, on June 8, 2022, the House adopted a resolution (H.Res. 1151) to provide for House Appropriations Committee allocations and related purposes. For further information, see the Appendix. 7 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). 8 The budgetary effects of Section 149 related to Afghan parolee eligibility for certain benefits also were emergencydesignated. These budgetary effects are not included in this report because no definite dollar amount was specified. For further information, see CBO, Estimated Discretionary Appropriations Under Division A of Senate Amendment Number 5745 to H.R. 6833, the Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023, September 28, 2022, https://www.cbo.gov/system/files/2022-09/hr6833-CA.pdf. 9 The budgetary effects of Section 1501 related to Afghan parolee eligibility for certain benefits also were emergencydesignated. These budgetary effects are not included in this report because no definite dollar amount was specified. For further information, see CBO, Discretionary Spending in Fiscal Year 2023 Under Divisions A Through L of H.R. 2617 (as modified by Senate Amendment 6552), the Consolidated Appropriations Act, 2023, December 21, 2022, https://www.cbo.gov/system/files/2022-12/HR-2617_div-A%E2%80%93N.pdf. Congressional Research Service 4 Labor, Health and Human Services, and Education: FY2023 Appropriations • Division N of H.R. 2617 (P.L. 117-328, December 29, 2022), the Disaster Relief Supplemental Appropriations Act, 2023, provided a total of $4.25 billion in emergency-designated appropriations to several HHS accounts and programs: • $86 million for CDC-wide Activities and Program Support Account (Centers for Disease Control and Prevention); • $3 million to the National Institute of Environmental and Health Sciences (National Institutes of Health; NIH); • • • • $25 million to the Office of the Director (NIH); • $129 million to the Public Health and Social Services Emergency Fund. $3.5 billion to the Low Income Home Energy Assistance Program (ACF); $100 million to the Child Care and Development Block Grant (ACF); $408 million to the Children and Families Services Programs Account (ACF) for several programs, including $345 million to the Head Start program; and FY2023 Annual LHHS Appropriations Table 1 provides a timeline of major legislative actions for full-year LHHS proposals, which are discussed in greater detail below. Table 1. Status of Full-Year LHHS Appropriations Legislation, FY2023 Subcommittee Approval House Senate 6/23/22 voice vote — Full Committee Approval House H.R. 8295 (H.Rept. 117-403) 6/30/22 32-24 Resolution of House and Senate Differences Senate House Initial Passage Senate Initial Passage Conf. Report — — — — House Final Passage Senate Final Passage H.R. 2617, Division H, 12/23/22 225-201 H.R. 2617, Division H, 12/22/22 68-29 Public Law P.L. 117328 12/29/22 Source: CRS Appropriations Status Table. FY2023 Consolidated Appropriations Act Full-year FY2023 appropriations for LHHS were enacted on December 29, 2022, when the Consolidated Appropriations Act, 2023 (FY2023 omnibus; H.R. 2617, P.L. 117-328) was signed into law by the President. The FY2023 omnibus provided full-year appropriations for all 12 annual appropriations acts in Divisions A-L. (Full-year LHHS appropriations were enacted in Division H.) Prior to its enactment, the final version of the measure was approved by the Senate on December 22 (68-29). It was approved by the House on December 23 (225-201). See Figure 1 for a breakdown of FY2023 discretionary and mandatory LHHS appropriations enacted in the FY2023 LHHS omnibus.10 Annual discretionary LHHS appropriations totaled 10 While the percentages in this figure were calculated based on amounts in the FY2022 LHHS omnibus, they are generally also illustrative—within a few percentage points—of the share of mandatory and discretionary funds in FY2022 and under the FY2023 President’s budget and the FY2023 House committee bill. Congressional Research Service 5 Labor, Health and Human Services, and Education: FY2023 Appropriations $225.9 billion. This amount is 5.6% more than FY2022 enacted and 7.8% less than the FY2023 President’s budget request. The omnibus also provided $1.196 trillion in mandatory funding, for a combined LHHS total of $1.422 trillion. Figure 1. FY2023 Enacted LHHS Appropriations Source: Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2023 LHHS omnibus (P.L. 117-328) available in the Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8874-S9198. Enacted totals for FY2023 do not include emergency-designated appropriations. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255), as amended. Notes: Details may not add to totals due to rounding. Amounts in this figure (1) reflect all 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. FY2023 Continuing Appropriations Between the start of FY2023 and the enactment of full-year appropriations, FY2023 LHHS regular appropriations were provided by a series of CRs. The first CR was signed into law on September 30, 2022 (Division A of H.R. 6833; P.L. 117-180), providing continuing appropriations for all 12 of the annual appropriations acts (including LHHS) through December 16, 2022. The measure, which was originally an unrelated vehicle that had been passed previously by the House, was taken up by the Senate the week prior to the start of the fiscal year. The Senate amended the measure to contain the CR, and passed it as amended (72-25) on September 29, 2022. The House subsequently took up the measure and agreed to the Senate amendment (230-201) on September 30, 2022. A second CR was signed into law on December 16, 2022 (Division A of H.R. 1437; P.L. 117229), extending appropriations through December 23, 2022. The measure, which was originally an unrelated vehicle that had been passed previously by the House and the Senate, was amended in the House to contain the CR. The House passed (224-201) the amended bill on December 14. The Senate passed (71-19) the bill on December 15. Congressional Research Service 6 Labor, Health and Human Services, and Education: FY2023 Appropriations A third CR was signed into law on December 23, 2022 (Division A of H.R. 4373; P.L. 117-264), extending appropriations through December 30, 2022. The measure, which was originally an unrelated appropriations measure that had been passed previously by the House, was amended by the Senate to contain the CR. The Senate passed (voice vote) the amended bill on December 22. The House agreed to the measure pursuant to provisions of H.Res. 1531 on December 23. In general, the FY2023 CRs funded discretionary programs at the same rate and under the same conditions as in FY2022 (§101) and annually appropriated entitlements at their current law levels (§111).11 The CRs also included several anomalies that were specific to LHHS accounts or related activities (§§101(8), 145-150).12 Prior Congressional Action on an LHHS Bill FY2023 LHHS Action in the Senate The Senate Appropriations Committee did not report the FY2023 LHHS bill. However, the committee chair, Senator Leahy, released a majority draft of the LHHS bill and accompanying draft report language on July 28, 2022.13 These draft numbers are not presented in this report. Also on July 28, 2022, Senator Patty Murray, chair of the Senate Appropriations LHHS Subcommittee, introduced an FY2023 LHHS bill (S. 4659).14 Because S. 4659 has not received any congressional action, this report does not discuss this measure. FY2023 LHHS Action in the House (H.R. 8295) On June 30, 2022, the House Appropriations Committee voted to report the FY2023 LHHS bill, 32-24; the measure was subsequently reported to the House on July 5 (H.R. 8295; H.Rept. 117403). Previously, the measure was approved in subcommittee, via a voice vote, on June 23, 2022. As reported by the full committee, the bill would have provided $243.3 billion in discretionary LHHS funds, a 13.8% increase from FY2022 enacted levels. This amount was 0.6% less than the FY2023 President’s request. In addition, the House committee bill would have provided an estimated $1.196 trillion in mandatory funding, for a combined total of $1.439 trillion for LHHS as a whole. 11 For an estimate of the discretionary appropriations contained in Division A of H.R. 6833, see CBO, Estimated Discretionary Appropriations Under Division A of Senate Amendment Number 5745 to H.R. 6833, the Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023, with Adjustments Made in the Senate, September 28, 2022, https://www.cbo.gov/system/files/2021-09/57491-CBO-Estimate-for-HR5305.pdf. For an estimate of the discretionary appropriations contained in Division A of H.R. 1437, see CBO, Estimated Discretionary Appropriations Under Division A of the Further Continuing Appropriations and Extensions Act, 2023 (Rules Committee Print 117-72, the House Amendment to the Senate Amendment to H.R. 1437) as posted on the Rules Committee Website (https://rules.house.gov/bill/117/hr1437-sa), with Adjustments Made in the House, December 14, 2022, https://www.cbo.gov/system/files/2022-12/hr1437%28as_modified%29.pdf. 12 The LHHS anomalies are discussed in CRS Report R47283, Overview of Continuing Appropriations for FY2023 (Division A of P.L. 117-180). 13 See the draft text and explanatory statement linked to Senate Appropriations Committee, “Chairman Leahy Releases Fiscal Year 2023 Senate Appropriations Bills,” July 28, 2022, https://www.appropriations.senate.gov/news/majority/breaking-chairman-leahy-releases-fiscal-year-2023-senateappropriations-bills. See also Senate Appropriations Committee, “Shelby: Democrats’ Partisan Bills Threaten FY23 Appropriations Process,” July 28, 2022, https://www.appropriations.senate.gov/news/minority/shelby-democratspartisan-bills-threaten-fy23-appropriations-process. 14 The text of S. 4659 as introduced was generally the same as the draft LHHS bill released by the chair of the Senate Appropriations Committee on July 28, discussed above. Congressional Research Service 7 Labor, Health and Human Services, and Education: FY2023 Appropriations FY2023 President’s Budget Request The FY2023 President’s budget request was submitted to Congress on March 28, 2022. Subsequently, on June 7, 2022, the Biden Administration submitted several FY2023 budget amendments to Congress.15 The Administration characterized the two LHHS budget amendments as technical in nature; neither were estimated to affect net budget authority totals.16 The President requested $244.9 billion in discretionary funding for accounts funded by the LHHS bill, which is an increase of 14.5% from FY2022 levels. In addition, the President requested $1.196 trillion in annually appropriated mandatory funding, for a total of $1.441 trillion for LHHS as a whole. FY2022 LHHS Omnibus (Division H, Consolidated Appropriations Act, 2022, H.R. 2471, P.L. 117-103) On March 15, 2022, the Consolidated Appropriations Act, 2022 (FY2022 LHHS omnibus; H.R. 2471) was signed into law by the President (P.L. 117-103). The FY2022 omnibus provided fullyear appropriations for all 12 annual appropriations acts in Divisions A-L.17 (Full-year LHHS appropriations were enacted in Division H.) Prior to its enactment, the final version of the measure was approved by the House on March 9. (The vote to approve the portion that contained LHHS appropriations was 260-171.)18 The bill was approved by the Senate (68-31) on March 10. Annual discretionary LHHS appropriations in the FY2022 LHHS omnibus totaled $214.2 billion. This amount is 7.9% more than FY2021 enacted and 15.7% less than the FY2022 President’s budget request. The omnibus also provided $1.102 trillion in mandatory funding, for a combined LHHS total of $1.316 trillion.19 (Note that these totals are based only on amounts of nonemergency appropriations and do not include emergency-designated or supplemental funds, which were provided in addition to the annual appropriations.) 15 U.S. President (Biden), “Letter to the Speaker of the House of Representatives on Fiscal Year 2023 Budget Amendments,” 117th Cong., 2nd sess., June 7, 2022, https://www.whitehouse.gov/wpcontent/uploads/2022/06/FY_2023_Budget_Amendments_Package_6-7-22.pdf. 16 Ibid, p. 14 and p. 20. 17 The FY2022 omnibus was originally intended to carry additional supplemental appropriations related to the COVID19 pandemic in Division M, but Division M was omitted prior to floor consideration. 18 The special rule, H.Res. 973, provided for the consideration of an amendment consisting of the FY2022 omnibus (as contained in House Rules Committee Print 117-35) to the Senate amendment to H.R. 2471. H.Res. 973 also provided for the House to adopt the amendment in two votes: the first on Divisions B, C, F, X, Z, and titles 2 and 3 of division N, and the second on the remaining divisions and titles. The House adopted Divisions B, C, F, X, Z, and titles 2 and 3 of division N by a vote of 361-69, and adopted the remaining divisions and titles by a vote of 260-171. The subsequent motion that the House agree to the Senate amendment with an amendment was agreed to by a voice vote. 19 For a full discussion of the FY2021 LHHS omnibus, see CRS Report R47029, Labor, Health and Human Services, and Education: FY2022 Appropriations. Congressional Research Service 8 Labor, Health and Human Services, and Education: FY2023 Appropriations Summary of FY2023 LHHS Appropriations Dollars and Percentages in this Report Amounts displayed in this report are typically rounded (e.g., to the nearest million), 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. These totals include, where applicable, full-year non-emergency appropriations provided in continuing resolutions. Throughout this report, the FY2023 House Appropriations Committee-reported LHHS bill is commonly referred to as the House “committee bill.” Amounts for the FY2022 Enacted, FY2023 Request, and FY2023 Enacted are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2023 LHHS omnibus (P.L. 117-328), available in the Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8874-S9198, unless otherwise noted. FY2023 House Committee amounts are generally drawn from the committee report (H.Rept. 117-403) accompanying the FY2023 House committee bill (H.R. 8295, as reported), unless otherwise noted. FY2022 and FY2023 enacted totals (“Total BA in the Bill”) do not include emergency-designated LHHS appropriations. For informational purposes, FY2022 and FY2023 enacted emergency-designated amounts are displayed separately at the bottom of tables throughout the report and not summed in that separate display. Those amounts are based on CRS analysis of the texts of those laws. One exception to this rule is made in the Appendix, which includes FY2022 and FY2023 enacted emergency-designated funds in the “Adjusted Appropriations” totals, as scored by the Congressional Budget Office. For consistency with source materials, amounts in this report generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities, except as noted.20 CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255), as amended. The descriptions of the LHHS appropriations in this report frequently reference “report language,” which Congress may use to further specify funding or to communicate a range of directives to the agency. Each regular appropriations bill reported from committee is usually accompanied by a written committee report, and the final explanatory text may be used to reconcile any differences between those reports. For example, earlier report language may address certain issues in ways that are difficult to reconcile harmoniously with the final enacted text. In these instances, the explanatory text normally seeks to clarify how the affected agency is to proceed. On the other hand, if the original committee language is ultimately acceptable to congressional negotiators, the explanatory statement might be silent due to an expectation that the agency will follow the original directive. For further information, see CRS Report R44124, Appropriations Report Language: Overview of Components and Development. Table 2 displays FY2023 discretionary and mandatory LHHS budget authority proposed and enacted, by bill title, along with FY2022 enacted levels. The amounts shown in this table reflect total budget authority provided in the annual LHHS bill (i.e., all funds appropriated in the bill, regardless of the fiscal year in which the funds become available), not total budget authority available for the current fiscal year. (For a comparable table showing current-year budget 20 The general practice for CRS reports on the LHHS bill has been to reflect conventions used in source materials. These conventions have varied over the years. For instance, CRS reports on LHHS appropriations for FY2012-FY2015 generally relied on source materials that adjusted appropriations amounts in the prior-year column to reflect sequestration, reestimates of mandatory spending, transfers, reprogramming, and other adjustments for comparability. However, the FY2016 version of this report broke from that practice due to differing display conventions in source documents, and did not reflect any such adjustments (except sequestration for the Prevention and Public Health Fund [PPHF]). The FY2017 version of this report differed from both of these prior practices, in that it reflected a smaller subset of transfers (generally concentrated at the National Institutes of Health) and other adjustments for comparability (e.g., program moves from one account to another), but not reprogramming of funds or mandatory sequestration (except sequestration of the PPHF). The FY2018-FY2021 versions of this report, however, relied on source materials that generally did not reflect any transfers or other budgetary adjustments pursuant to administrative authorities except PPHF sequestration. For FY2023, the source materials used for this report continue this most recent approach. Congressional Research Service 9 Labor, Health and Human Services, and Education: FY2023 Appropriations authority, see Table A-2.) Note that the totals in this table do not include emergency-designated appropriations; those amounts are displayed separately at the bottom of the table and are in addition to regular appropriations. Table 2. LHHS Appropriations Overview by Bill Title, FY2022-FY2023 (total budget authority provided in the bill, in billions of dollars) Bill Title Title I: Labor FY2022 Enacted FY2023 Request FY2023 House Cmte. (H.R. 8295) FY2023 Enacted 14.4 16.2 16.3 15.1 Discretionary 13.2 14.9 15.0 13.8 Mandatory 1.2 1.3 1.3 1.3 Title II: HHS 1,147.9 1,255.0 1,255.3 1,246.5 Discretionary 108.3 123.9 124.2 115.4 Mandatory 1,039.6 1,131.1 1,131.1 1,131.1 Title III: Education 80.1 92.3 90.7 83.5 Discretionary 76.4 88.3 86.7 79.6 Mandatory 3.7 3.9 3.9 3.9 73.0 77.4 77.0 76.7 Discretionary 16.0 17.7 17.4 17.0 Mandatory 57.0 59.6 59.6 59.6 Total BA in the Bill 1,315.4 1,440.8 1,439.3 1,421.9 Discretionary 213.9 244.9 243.3 225.9 Mandatory 1,101.5 1,196.0 1,196.0 1,196.0 P.L. 117-43, Divisions A and C 4.2 0.0 0.0 0.0 P.L. 117-58, Division J 0.1 0.0 0.0 0.0 P.L. 117-70, Division B 1.3 0.0 0.0 0.0 P.L. 117-128 , Title IV 1.0 0.0 0.0 0.0 P.L. 117-159, Division B 3.0 0.0 0.0 0.0 P.L. 117-180, Division A 0.0 0.0 0.0 2.8 P.L. 117-328, Division M 0.0 0.0 0.0 2.4 P.L. 117-328, Division N 0.0 0.0 0.0 4.3 Advances for Future Years (provided in current bill)a 210.7 242.8 242.8 242.8 Advances from Prior Years (for use in current year)a 197.6 210.7 210.7 210.7 Additional Scorekeeping Adjustmentsb -14.7 -33.9 -16.5 -16.1 Title IV: Related Agencies Emergency Funding (not in above totals or memoranda below) Memoranda: Congressional Research Service 10 Labor, Health and Human Services, and Education: FY2023 Appropriations Source: Amounts in this table for the FY2022 Enacted, FY2023 Request, and FY2023 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2023 LHHS omnibus (P.L. 117-328) available in the Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8874-S9198. Amounts in the FY2023 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 117-403) accompanying the FY2023 House committee bill (H.R. 8295, as reported). Enacted totals (“Total BA in the Bill”) for FY2022 or FY2023 do not include emergency-designated appropriations. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. Notes: BA = budget authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect all BA appropriated in the 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 a given fiscal year is as follows: Total BA in the Bill, minus Advances for Future Years, plus Advances from Prior Years. b. Totals in this table have generally not been adjusted for scorekeeping. (To adjust for scorekeeping, add this line to the total budget authority.) Figure 2 displays discretionary and mandatory LHHS funding levels enacted for FY2023, by bill title. (While the percentages discussed in this section were calculated based on the FY2023 enacted amounts, they are generally also illustrative—within several percentage points—of the share of funds directed to each bill title in FY2022, and under the FY2023 President’s budget and House committee bill.) As this figure demonstrates, HHS accounts for the largest share of total FY2023 LHHS appropriations: $1.247 trillion, or 87.7%. 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 5.9% and 5.4%, respectively. (The majority of the ED appropriations each year are discretionary, while the bulk of funding for the Related Agencies goes toward mandatory payments and administrative costs of the Supplemental Security Income program at the Social Security Administration.) DOL accounts for the smallest share of total LHHS funds, 1.1%. 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 (51.1%), while ED accounts for a relatively larger share (35.2%). Together, these two departments represent the majority (86.3%) of discretionary LHHS appropriations. DOL and the Related Agencies account for the remaining discretionary funds, at 6.1% and 7.5% of the total, respectively. Congressional Research Service 11 Labor, Health and Human Services, and Education: FY2023 Appropriations Figure 2. FY2023 Enacted LHHS Appropriations by Title (budget authority in billions of dollars unless otherwise indicated) Source Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2023 LHHS omnibus (P.L. 117-328), available in the Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8874-S9198. Enacted totals for FY2023 do not include emergency-designated appropriations. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255), as amended. Notes: Details may not add to totals due to rounding. Amounts in this figure (1) reflect all BA appropriated in the 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. Department of Labor (DOL) 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 (e.g., to the nearest million), 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. Congressional Research Service 12 Labor, Health and Human Services, and Education: FY2023 Appropriations 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).22 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)21 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. FY2023 DOL Appropriations Overview Table 3 displays FY2023 enacted and proposed funding levels for DOL, along with FY2022 levels. Following the conventions in this report, the totals in this table do not include emergencydesignated appropriations; however, note that DOL received no emergency-designated appropriations in FY2022 or FY2023. Discretionary funds represent the majority of DOL appropriations, accounting for 92% of FY2022 and FY2023 enacted levels. The FY2023 LHHS omnibus increased discretionary appropriations for DOL by $652 million (+4.9%) compared to FY2022 enacted. Relative to FY2022 enacted, discretionary DOL appropriations would have increased by $1.8 billion (+14.0%) under the FY2023 House committee bill and $1.7 billion (+13.0%) under the FY2023 President’s budget request. 21 Departmental Management includes the DOL salaries and expenses, Veterans Employment and Training Service (VETS), IT Modernization, and the Office of the Inspector General. 22 The Pension Benefit Guaranty Corporation (PBGC) is funded primarily through insurance premiums and related fees from companies covered by the PBGC. For further information, see CRS In Focus IF10492, An Overview of the Pension Benefit Guaranty Corporation (PBGC). Congressional Research Service 13 Labor, Health and Human Services, and Education: FY2023 Appropriations Table 3. DOL Appropriations Overview (in billions of dollars) FY2022 Enacted FY2023 Request FY2023 House Cmte. (H.R. 8295) Discretionary 13.2 14.9 15.0 13.8 Mandatory 1.2 1.3 1.3 1.3 14.4 16.2 16.3 15.1 — — — — Funding Total BA in the Bill Emergency Funding (not in above totals) FY2023 Enacted Source: Amounts in this table for the FY2022 Enacted, FY2023 Request, and FY2023 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2023 LHHS omnibus (P.L. 117-328), available in the Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8874-S9198. Amounts in the FY2023 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 117-403) accompanying the FY2023 House committee bill (H.R. 8295, as reported). Enacted totals (“Total BA in the Bill”) for FY2022 or FY2023 do not include emergency-designated appropriations. 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 FY2023 enacted and proposed appropriations compared to FY2022 enacted appropriations for selected DOL accounts and programs.23 Table 4 displays funding for DOL programs and activities discussed in this section. Employment and Training Administration (ETA) ETA administers the primary federal workforce development statute, the Workforce Innovation and Opportunity Act (WIOA, P.L. 113-128, as amended). The WIOA, which replaced the Workforce Investment Act, was enacted in July 2014 and authorized appropriations for its programs and activities from FY2015 through FY2020. 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. The FY2023 LHHS omnibus provided a $50 million increase (+1.7%) for the three WIOA state formula grant programs compared to FY2022. Compared to FY2022 enacted levels, the FY2023 President’s budget would have provided $140 million more (+4.9%) and the House committee bill would have increased funding by $256 million (+8.9%). The FY2023 LHHS omnibus provided $326 million for the Dislocated Workers Activities National Reserve (DWA National Reserve), an increase of $25 million (+8.3%) compared to the FY2022 enacted level. The House committee bill would have increased funding for the DWA 23 DOL budget materials can be found at https://www.dol.gov/general/aboutdol#budget. Congressional Research Service 14 Labor, Health and Human Services, and Education: FY2023 Appropriations National Reserve by $157 million (+52.0%), whereas the FY2023 President’s budget would have increased funding for the DWA National Reserve by $227 million (+75.3%), compared to FY2022. In addition, the FY2023 LHHS omnibus maintained a provision in that account (which originated in the FY2018 omnibus) directing $50 million from the DWA National Reserve toward training and employment assistance for workers dislocated in the Appalachian, lower Mississippi, and Northern Border Regional Commission regions. The FY2023 LHHS omnibus maintained a provision that originated in the FY2020 omnibus directing $65 million from the DWA National Reserve to be used in developing, offering, or improving career training programs at community colleges. The FY2023 LHHS omnibus provided $285 million for the Apprenticeship Grant program, which was $50 million (+21.3%) more than the level enacted in FY2022. The House committee bill and the FY2023 President’s budget would have increased the level of funding for the Apprenticeship Grant program by $68 million (+28.9%) compared to the FY2022 enacted level. Finally, under the pilot and demonstration authority in WIOA (§169), the FY2023 House committee bill and the FY2023 President’s budget would have provided new funding for a National Youth Employment Program ($75 million), a Climate Corps ($15 million), and a Veterans Clean Energy Training program ($10 million). These did not ultimately receive funding in the FY2023 LHHS omnibus. Employment Service The FY2023 LHHS omnibus provided $705 million for the Employment Service (ES), which was an increase of $5 million (+0.7%) compared to the FY2022 LHHS omnibus. The FY2023 House committee bill would have provided $749 million for the ES, which would have been an increase of $49 million (+7.0%) compared to the FY2022 LHHS omnibus and $28 million (+3.8%) more than requested in the FY2023 President’s budget. The ES is a joint federal-state partnership that funds staff to provide career counseling, job search services, and administration of the work test for the UI system. The FY2023 House committee bill included a provision to prohibit DOL from using any funds provided in the bill to implement or enforce a 2020 final rule allowing the use of non-merit-staff employees to deliver Employment Service services.24 This provision was not included in the FY2023 LHHS omnibus. Wage and Hour Division (WHD) The FY2023 LHHS omnibus provided $260 million for the WHD, an increase of $9 million (+3.6%) compared to FY2022 enacted. The FY2023 House committee bill would have provided $313 million for WHD, an increase of $62 million (+24.6%) compared to the FY2022 enacted level and $5 million (+1.6%) more than the FY2023 President’s budget. The WHD is responsible for enforcing the Fair Labor Standards Act (FLSA), the Davis-Bacon Act (DBA), the Family and Medical Leave Act (FMLA), and other labor standards statutes. Bureau of Labor Statistics (BLS) The FY2023 LHHS omnibus provided $698 million for BLS, an increase of $10 million (+1.5%) compared to FY2022 enacted, whereas the FY2023 House committee bill would have provided a $38 million increase (+5.6%) and the FY2023 President’s budget proposed a $54 million increase (+7.8%) relative to FY2022. The explanatory statement accompanying the FY2023 LHHS omnibus notes that total funding includes $10 million for BLS to implement the National 24 See Section 112. Congressional Research Service 15 Labor, Health and Human Services, and Education: FY2023 Appropriations Longitudinal Survey of Youth (NLSY) and $14.5 million for BLS to continue planning and developing the new NLSY established in the FY2020 LHHS act.25 Bureau of International Labor Affairs (ILAB) The ILAB provides research, advocacy, technical assistance, and grants to promote workers’ rights in different parts of the world. The FY2023 LHHS omnibus provided $116 million for ILAB, which was an increase of $10 million (+9.4%) from the FY2022 enacted level. The FY2023 House committee bill would have increased funding for ILAB by $33 million (+30.9%) compared to the FY2022 LHHS omnibus, while the FY2023 President’s budget would have increased funding by $23 million (+21.5%) for ILAB. 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 FY2023 LHHS omnibus. The FY2023 LHHS omnibus continued several provisions that have been included in at least one previous LHHS appropriations act, including provisions that • • • • • • exempted certain insurance claims adjusters from overtime protection for two years following a “major disaster” (included since FY2016)26; directed 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)27; authorized the Secretary of Labor to provide up to $2 million in “excess personal property” to apprenticeship programs to assist training apprentices (included since FY2018)28; authorized 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)29; authorized 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)30; and prohibited annual appropriations from being used to alter the Interagency Agreement between DOL and the U.S. Department of Agriculture or to close any 25 Congressional Record, December 20, 2022, vol. 168, no. 198, book II, pp. S8874-S8875. 26 See Division H, Title I, §108 of P.L. 117-328. 27 See Division H, Title I, §110 of P.L. 117-103. 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 the employer meets certain conditions. 28 See Division H, Title I, §112 of P.L. 117-328 29 See Division H, Title I, §113 of P.L. 117-328. 30 See Division H, Title I, §114 of P.L. 117-328. Congressional Research Service 16 Labor, Health and Human Services, and Education: FY2023 Appropriations Civilian Conservation Centers unless certain conditions are met (included since FY2020).31 Table 4. Detailed DOL Appropriations (in millions of dollars) Agency or Selected Program FY2022 Enacted FY2023 House Cmte. (H.R. 8295) FY2023 Request FY2023 Enacted ETA—Mandatorya 540 494 494 494 ETA—Discretionary 9,942 11,076 11,269 10,488 Training and Employment Services: 3,912 4,411 4,598 4,141 State Formula Grants: 2,879 3,019 3,135 2,929 Adult Activities Grants to States 871 900 941 886 Youth Activities Grants to States 933 964 1,033 948 1,076 1,155 1,162 1,096 1,033 1,392 1,462 1,212 DWA National Reserve 301 527 457 326 Native Americans 57 64 64 60 Migrant and Seasonal Farmworkers 95 97 105 97 YouthBuild 99 145 145 105 Reintegration of Ex-Offenders 102 150 150 115 6 6 6 6 Apprenticeship Grants 235 303 303 285 Community Projects 138 0 132 217 National Youth Employment Program 0 75 75 0 Climate Corps 0 15 15 0 Veterans Clean Energy Training 0 10 10 0 1,749 1,779 1,799 1,760 Community Service Employment for Older Americans 405 405 450 405 State Unemployment Insurance and Employment Service Operations (SUI/ESO): 3,711 4,258 4,214 4,009 Unemployment Compensation 2,869 3,353 3,303 3,158 Employment Service 700 721 749 705 Foreign Labor Certification 80 99 95 84 One-Stop Career Centers 63 86 68 63 Discretionary ETA Programs: Dislocated Worker Activities (DWA) Grants to States National Activities: Workforce Data Quality Initiative Job Corps 31 See Division H, Title I, §115 of P.L. 117-328. Congressional Research Service 17 Labor, Health and Human Services, and Education: FY2023 Appropriations Agency or Selected Program FY2022 Enacted FY2023 Request FY2023 House Cmte. (H.R. 8295) FY2023 Enacted ETA Program Administration 164 223 209 173 Employee Benefits Security Administration 186 234 234 191 Pension Benefit Guaranty Corp, (PBGC) program level (non-add) b (473) (493) (493) (473) Wage and Hour Division 251 308 313 260 Office of Labor-Management Standards 46 50 46 49 Office of Federal Contract Compliance Programs 108 147 147 111 Office of Workers’ Compensation Programs—Mandatoryc 683 756 756 756 Office of Workers’ Compensation Programs—Discretionary 120 146 146 123 Occupational Safety & Health Administration 612 701 712 632 Mine Safety & Health Administration 384 423 404 388 Bureau of Labor Statistics 688 742 726 698 Office of Disability Employment Policy 41 59 59 43 Departmental Management 812 1,015 975 859 Salaries and Expenses 368 492 499 392 (106) (129) (139) (116) Veterans Employment and Training 325 331 339 335 IT Modernization 28 48 38 34 Working Capital Fund 0 36 0 0 Office of the Inspector General 91 108 99 97 Total, DOL BA in the Bill 14,412 16,151 16,281 15,092 Subtotal, Mandatory 1,223 1,250 1,250 1,251 Subtotal, Discretionary 13,189 14,900 15,031 13,841 Total, BA Available in Fiscal Year (current year from any bill) 14,415 16,151 16,282 15,092 Total, BA Advances for Future Years (provided in current bill) 1,783 1,782 1,782 1,783 Total, BA Advances from Prior Years (for use in current year) 1,786 1,783 1,783 1,783 — — — — International Labor Affairs (non-addd) Memoranda (non-emergency funds only) Emergency Funding (not in above totals) Source: Amounts in this table for the FY2022 Enacted, FY2023 Request, and FY2023 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2023 LHHS omnibus (P.L. 117-328), available in the Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8874-S9198. Amounts in the FY2023 House Committee column are generally drawn from or Congressional Research Service 18 Labor, Health and Human Services, and Education: FY2023 Appropriations calculated based on data contained in the committee report (H.Rept. 117-403) accompanying the FY2023 House committee bill (H.R. 8295, as reported). Enacted totals (“Total BA in the Bill”) for FY2022 or FY2023 do not include emergency-designated appropriations. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. Notes: BA = budget authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect all BA appropriated in the 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) 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 American Rescue Plan Act of 2021 [P.L. 117-2]). All amounts in this section are rounded (e.g., to the nearest million), as labeled. The dollar changes and percentage changes discussed in the text are based on unrounded amounts. For consistency with source materials, amounts do not reflect sequestration or re-estimates of mandatory spending programs, where applicable. HHS Agencies Funded via the LHHS Appropriations Process Health Resources and Services Administration (HRSA) Centers for Disease Control and Prevention (CDC) National Institutes of Health (NIH) Substance Abuse and Mental Health Services Administration (SAMHSA) Agency for Healthcare Research and Quality (AHRQ) Centers for Medicare & Medicaid Services (CMS) Administration for Children and Families (ACF) Administration for Community Living (ACL) Office of the Secretary (OS)* * This report includes funding for the Office of the Assistant Secretary for Preparedness and Response (ASPR) within OS, consistent with source materials. About HHS HHS is a large federal department composed of multiple agencies working to enhance the health and well-being of Americans. Annual LHHS appropriations laws direct funding to most (but not all) HHS agencies (see text box for HHS agencies supported by the LHHS bill).32 For instance, 32 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 (continued...) Congressional Research Service 19 Labor, Health and Human Services, and Education: FY2023 Appropriations the LHHS bill directs funding to multiple Public Health Service (PHS) agencies, including the Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Agency for Healthcare Research and Quality (AHRQ). 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). (The HHS Office of the Assistant Secretary for Preparedness and Response, recently renamed the Administration for Strategic Preparedness and Response [ASPR, see discussion below], is also a component of the PHS. ASPR funding has historically been provided within the Office of the Secretary.) In addition, the LHHS bill provides funding for annually appropriated components of the CMS,33 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 Affordable Care Act (ACA; P.L. 111-148, as amended). The LHHS bill also provides funding for two HHS agencies focused primarily on the provision of social services: the Administration for Children and Families (ACF) and the Administration for Community Living (ACL). ACF’s mission is to promote the economic and social well-being of vulnerable children, youth, families, and communities. ACL was formed with a goal of increasing access to community supports for older Americans and people with disabilities. The LHHS bill also provides funding for the HHS Office of the Secretary (OS), which encompasses a broad array of management, research, oversight, and emergency preparedness functions in support of the entire department. On July 22, 2022, HHS announced that the Office of the Assistant Secretary for Preparedness and Response (ASPR) would be renamed the Administration for Strategic Preparedness and Response (but keep its acronym, ASPR).34 According to the announcement, HHS planned to move ASPR out of OS and, instead, establish the agency as an HHS operating division (i.e., an organizational level comparable to CDC or NIH). This reorganization was approved by the HHS Secretary on January 27, 2023, and became effective on February 11, 2023.35 As the FY2023 President’s budget, House committee bill, and FY2023 LHHS omnibus were formulated prior to this announcement, this report reflects the assumptions underlying those proposals in keeping ASPR funding within the OS. FY2023 HHS Appropriations Overview Table 5 displays enacted and proposed FY2023 funding levels for HHS, along with FY2022 levels. The totals in this table do not include emergency-designated appropriations. Those (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. 33 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. 34 HHS Press Office, “HHS Strengthens Country’s Preparedness for Health Emergencies, Announces Administration for Strategic Preparedness and Response (ASPR),” July 22, 2022, https://www.hhs.gov/about/news/2022/07/22/hhsstrengthens-countrys-preparedness-health-emergencies-announces-administration-for-strategic-preparednessresponse.html. 35 U.S. Department of Health and Human Services, “Statement of Organization, Functions and Delegations of Authority,” 88 Federal Register 10125-10127, February 16, 2023. Congressional Research Service 20 Labor, Health and Human Services, and Education: FY2023 Appropriations amounts (if applicable) are displayed separately, along with the law in which they were enacted, at the bottom of the table and are in addition to regular appropriations. In general, discretionary funds account for about 9% of HHS appropriations in the LHHS bill. Compared to the FY2022 funding levels, the FY2023 LHHS omnibus increased HHS discretionary appropriations by 6.6%. Both the House committee bill and the President’s request would have increased HHS discretionary appropriations to a greater degree, by 14.7% and 14.4%, respectively. Table 5. HHS Appropriations Overview (in billions of dollars) FY2022 Enacted FY2023 Request FY2023 House Cmte. (H.R. 8295) FY2023 Enacted Discretionary 108.3 123.9 124.2 115.4 Mandatory 1,039.6 1,131.1 1,131.1 1,131.1 Total BA in the Bill 1,147.9 1,255.0 1,255.3 1,246.5 P.L. 117-43, Divisions A and C 4.2 — — — P.L. 117-58, Division J 0.1 — — — P.L. 117-70, Division B 1.3 — — — P.L. 117-128, Title IV 1.0 — — — P.L. 117-159, Division B 3.0 — — — P.L. 117-180, Division A — — — 2.8 P.L. 117-328, Division M — — — 2.4 P.L. 117-328, Division N — — — 4.3 Funding Emergency Funding (not in above totals) Sources: Amounts in this table for the FY2022 Enacted, FY2023 Request, and FY2023 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2023 LHHS omnibus (P.L. 117-328), available in the Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8874-S9198. Amounts in the FY2023 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 117-403) accompanying the FY2023 House committee bill (H.R. 8295, as reported). Enacted totals (“Total BA in the Bill”) for FY2022 or FY2023 do not include emergency-designated appropriations. 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. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255), as amended. Notes: BA = budget authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect all BA appropriated in the 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 FY2023 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 Congressional Research Service 21 Labor, Health and Human Services, and Education: FY2023 Appropriations $1.118 trillion, which is 89.7% of all enacted appropriations for HHS. NIH and ACF account for the next-largest shares of total HHS appropriations, receiving 3.7% and 3.8% apiece, respectively. By contrast, when looking exclusively at discretionary appropriations, funding for CMS constitutes about 4.0% of FY2023 enacted HHS appropriations. The bulk of discretionary appropriations went to the PHS agencies, which combined to account for 62.0% of discretionary appropriations provided for HHS.36 NIH typically receives the largest share of all discretionary funding among HHS agencies (39.9% in FY2023), with ACF accounting for the second-largest share (26.6% in FY2023). Figure 3. FY2023 Enacted HHS Appropriations by Agency (budget authority in billions of dollars) Source: Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2023 LHHS omnibus (P.L. 117-328), available in the Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8874-S9198. Enacted totals for FY2023 do not include emergency-designated appropriations. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255), as amended. Notes: Details may not add to totals due to rounding. The bar representing the combined mandatory and discretionary total for CMS has been abbreviated due to space constraints. When taking into account both mandatory and discretionary funding, CMS receives over 20 times the funding appropriated to either ACF or NIH in the FY2023 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. 36 This calculation does not include funding for ASPR, which is included in the totals for the Office of the Secretary, as per the source materials. Congressional Research Service 22 Labor, Health and Human Services, and Education: FY2023 Appropriations Special Public Health Funding Mechanisms Annual appropriations for HHS public health service agencies are best understood in the context of certain HHS-specific funding mechanisms: the Public Health Service Evaluation Set-Aside, and the Prevention and Public Health Fund (PPHF). In recent years, LHHS appropriations have used these funding mechanisms to direct additional support to certain programs and activities. Public Health Service Evaluation Tap The PHS Evaluation Set-Aside, also known as the PHS Evaluation Tap, is a unique feature of HHS appropriations. It is authorized by Section 241 of the Public Health Service Act (PHSA), and allows the Secretary of HHS to redistribute a portion of eligible PHS agency appropriations across HHS for program evaluation purposes. The PHSA limits the set-aside to not less than 0.2% and not more than 1.0% of eligible program appropriations. LHHS appropriations acts have commonly established requirements in addition to those discussed above. These include a higher maximum percentage for the set-aside and directing specific amounts of tap funding to selected HHS programs. Since FY2010, and including in FY2023, this higher maximum set-aside level has been 2.5% of eligible appropriations.37 (Both the House committee bill and the President’s budget would have continued this 2.5% level.)38 Before FY2015, LHHS appropriations acts Display of PHS Evaluation Tap Transfers traditionally used the PHS Evaluation Tap to By convention, appropriations acts direct where specified PHS Evaluation Tap transfers are to be provide more than a dozen HHS programs allocated, but do not specify the PHS funds that are to with funding beyond their annual be the sources of those transfers. Thus, tables in this appropriations; in some cases, this was the report show only the amount of PHS Evaluation Tap sole source of funding for a program or funds received by an agency (i.e., tables do not subtract activity. However, since FY2015 and the amount of the evaluation tap from donor agencies’ appropriations). This also means that tap amounts including in FY2023, LHHS appropriations shown in the following tables are in addition to laws have directed tap funds to a smaller amounts shown for budget authority, but the amounts number of programs or activities within three shown for budget authority have not been adjusted to HHS agencies (NIH, SAMHSA, and OS) and reflect potential “transfer-out” of funds to the tap. 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.39 Since FY2015, LHHS appropriations laws have directed the largest share of tap transfers to NIH. 37 See Section 204, Division H, P.L. 117-328, for the FY2023 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 FY2023 omnibus 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. 38 After the LHHS appropriations act allocates this transfer authority to specified programs, any transfer authority that remains unallocated is available to be used by the HHS Secretary pursuant to the parameters established in law. (Such post-enactment PHS Evaluation Tap transfers for FY2022 and FY2023 are not within this scope of this report.) 39 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 (continued...) Congressional Research Service 23 Labor, Health and Human Services, and Education: FY2023 Appropriations Under the FY2023 LHHS omnibus, the amount of PHS Evaluation Tap transfers to SAMHSA ($134 million) were the same as those directed in FY2022. This amount of tap transfers to SAMHSA was also proposed by the House committee bill and the President’s budget. For the OS, the FY2023 LHHS omnibus slightly increased the amount of directed tap transfers, by $2 million (+1.5%), to $131 million. In contrast, the amount of OS tap transfers would have been increased by $33 million (+25.8%) in the House committee bill, and $60 million (+46.3%) in the President’s budget. The enacted and proposed tap transfer increases for OS were largely directed to the Office of the National Coordinator for Health Information Technology, which was solely funded by tap transfers as of FY2022, and continued to receive no discretionary funding for FY2023. The FY2023 LHHS omnibus increased NIH tap funding by 7.9% (+$103 million), to $1.4 billion. Such transfers to NIH would have been increased to a similar degree by the House committee bill (+$111 million, +8.5%), but would have been decreased under the President’s budget (-$38 million, -2.9%). In addition to the transfers to SAMHSA, OS, and NIH, the President’s budget requested that AHRQ receive a tap transfer of $40 million, for a funding total inclusive of transfers of $416 million. In contrast, the House committee bill would have funded AHRQ at $385 million, and directed no tap transfers. Ultimately, the FY2023 LHHS omnibus also declined to direct any tap transfers, and provided AHRQ with $374 million in discretionary appropriations. The President’s budget proposed expanding the activities and agencies funded by the PHS Evaluation Tap to include the Public Health Scientific Services and Environmental Health at the CDC ($151 million), and Paralysis Resource Center, Limb Loss, and Traumatic Brain Injury at ACL ($28 million). Neither the FY2023 LHHS omnibus nor the House committee bill adopted these proposals. 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.40 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. PPHF funds are intended to supplement (sometimes quite substantially) the funding that selected programs receive through regular appropriations. The PPHF authority instructs the HHS Secretary to transfer amounts from the fund to HHS agencies. However, 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.41 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. 40 For more information, see CRS Report R41301, Appropriations and Fund Transfers in the Affordable Care Act (ACA). 41 For the FY2023 LHHS omnibus, see Division H, §222, P.L. 117-328 . Congressional Research Service 24 Labor, Health and Human Services, and Education: FY2023 Appropriations The ACA had appropriated $2 billion in mandatory funds to the PPHF for FY2023, but this amount was reduced by subsequent laws that decreased PPHF funding for FY2022 and other fiscal years. Under current law, the FY2023 appropriation is $1.3 billion.42 This appropriation was subject to a 5.7% reduction due to sequestration of nonexempt mandatory spending.43 (For more information on sequestration, see the budget enforcement discussion in the Appendix.) After sequestration, the total PPHF appropriation available for FY2023 was $943 million, the same amount as FY2022. The FY2023 LHHS omnibus continued the FY2022 allocations of this funding: $903 million to CDC, $12 million to SAMHSA, and $28 million to ACL. These were the same as the allocations proposed by the FY2023 House committee bill and the FY2023 President’s budget. Selected HHS Highlights by Agency This section begins with a limited selection of FY2023 discretionary funding highlights by Display of PPHF Transfers HHS agency. The discussion is largely based PPHF transfer amounts displayed in the HHS tables in on the enacted FY2023 levels as compared to this report are in addition to amounts shown for FY2022 enacted levels, and to a limited budget authority provided in the bill. For consistency with source materials, the amounts shown for PPHF degree, the amounts that were proposed by the transfers in these tables reflect the estimated effects of FY2023 President’s budget and the House mandatory spending sequestration; this is not the case 44 committee bill. These summaries are for other mandatory spending shown in this report followed by a brief overview of significant (also for consistency with source materials). 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 FY2022 enacted and FY2023 proposed and enacted funding levels for HHS. Health Resources and Services Administration (HRSA) The HRSA mission is focused on delivering health care services to those who are geographically isolated and economically or medically vulnerable.45 The FY2023 LHHS omnibus provided $9.5 billion in discretionary budget authority for HRSA. This was $912 million (+10.6%) more than HRSA’s FY2022 discretionary funding level and $961 million (+11.3%) more than the FY2023 President’s budget request. The FY2023 LHHS omnibus increased funding for a number of maternal health programs, including an increase of $75 million (+10.0%) compared to the FY2022 LHHS omnibus for the Maternal and Child Health Block Grant. The FY2023 LHHS House committee report, which proposed a more substantial increase to the block grant (+$125 million), noted that the “COVID– 19 pandemic has exacerbated maternal mental health conditions, with pregnant and new mothers experiencing anxiety and depression at a three to four times higher rate than prior to the pandemic.”46 Within total amounts available for Maternal and Child Health, report language also directed $15 million ($3 million more than FY2022) for “Alliance for Innovation in Maternal 42 42 U.S.C. §300u-11. 43 OMB, OMB Report to the Congress on the BBEDCA 251A Sequestration for Fiscal Year 2023, March 28, 2022, p. 7 of 16, https://www.whitehouse.gov/wp-content/uploads/2022/03/BBEDCA_251A_Sequestration_Report_FY2023.pdf. 44 HHS budget materials can be found at http://www.hhs.gov/budget/. 45 HRSA, About HRSA, https://www.hrsa.gov/about/index.html. 46 H.Rept. 117-403. Congressional Research Service 25 Labor, Health and Human Services, and Education: FY2023 Appropriations Health Safety Bundles” and $7 million ($3 million more than FY2022) for the maternal mental health hotline.47 The FY2023 LHHS omnibus also supported a number of initiatives to improve access to behavioral health care. For instance, the LHHS omnibus provided $145 million ($10 million more than FY2022) for the Rural Communities Opioid Response Program (RCORP)48 to continue three rural centers of excellence and “to address rural tobacco and alcohol addiction.”49 In addition, the explanatory statement included $153 million ($30 million more than FY2022) for Behavioral Health Workforce Education and Training (BHWET), which “establishes and expands internships or field placement programs in behavioral health, serving populations in rural and medically underserved areas.”50 Centers for Disease Control and Prevention (CDC) The CDC works to protect public health by providing leadership, information, and scientific expertise in preventing and controlling diseases, including outbreaks of infectious diseases. The CDC also works to promote health and quality of life by preventing and controlling injury, disability, and environmental health threats. The FY2023 LHHS omnibus provided $8.3 billion in discretionary budget authority for the CDC, which was $760 million (+10.1%) more than the CDC’s FY2022 funding level. The FY2023 LHHS omnibus did not direct any PHS tap funds to the CDC, continuing the practice started in FY2015. The FY2023 LHHS omnibus supplemented discretionary CDC appropriations by directing $903 million in PPHF transfers to the CDC, which was the same level as in FY2022. Altogether, this combination of funding represented $9.2 billion, an increase of $760 million (+9.1%) relative to FY2022 in budget authority that is inclusive of directed transfers. The President’s FY2023 budget request would have increased discretionary budget authority by $2.1 billion (+28.3%) relative to FY2022, while also requesting that $151 million in tap funds be directed to the CDC. The President’s budget also requested $903 million in PPHF transfers, the same as FY2022 enacted. All told, this combination of funding would have totaled $10.7 billion, representing an increase of $2.3 billion (+27.1%) from FY2022. The FY2023 omnibus provided $1.5 billion (-14.2%) less than the FY2023 requested amount, inclusive of directed transfers. (The FY2023 request also included other CDC mandatory spending proposals that were not adopted by Congress.) All FY2023 CDC programmatic accounts received increases relative to FY2022 enacted levels, both in terms of discretionary appropriations and inclusive of directed transfers. Among notable increases, the CDC’s Public Health Scientific Services account received an increase of $103 million relative to FY2022 enacted, which included an increase of $75 million ($175 million total) for the CDC’s public health data modernization efforts.51 CDC’s public health data modernization efforts aim to modernize the technology, systems, and workforce for collecting 47 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8876. See also H.Rept. 117-403, p. 8 and p. 55. 48 Note that this program is referred to as the Rural Communities Overdose Response Program in the LHHS omnibus, explanatory statement, and House committee report. HRSA documents refer to this as the Rural Communities Opioid Response Program. 49 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, p. S8877. 50 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8875-S8876 and p. S9133. See also H.Rept. 117-403, p. 54. 51 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, p. S8879; and Congressional Record, vol. 168, no. 42, March 9, 2022, p. H2672. Congressional Research Service 26 Labor, Health and Human Services, and Education: FY2023 Appropriations public health data at the CDC and at state, territorial, tribal, and local levels. In addition, the CDC-Wide Activities and Program Support account received an increase of $230 million (+69%) relative to FY2022 enacted discretionary funding. Within this account, $350 million was provided for the public health infrastructure and capacity program, an increase of $150 million relative to FY2022. These funds are intended to support general capabilities of state, territorial, and local health departments by supporting core functions such as workforce and technology. Furthermore, the CDC-Wide Activities and Program Support account newly includes a line item for the Center for Forecasting Epidemics and Outbreak Analytics ($50 million). The Center for Forecasting Epidemics and Outbreak Analytics was first funded and established by the CDC in 2022 using American Rescue Plan Act (P.L. 117-2) appropriations.52 The explanatory statement also includes funding to establish an Office of Rural Health ($5 million), which is intended to “enhance the implementation of CDC's rural health portfolio, coordinate efforts across CDC programs, and develop a strategic plan for rural health at CDC that maps the way forward both administratively and programmatically.”53 National Institutes of Health (NIH) NIH is the federal government’s lead health and medical research agency. The FY2023 LHHS omnibus provided $46.0 billion in discretionary budget authority for NIH. This was $2.4 billion (+5.5%) more than the FY2022 level. In addition, the FY2023 LHHS omnibus directed $1.4 billion in PHS tap transfers to NIH, $103 million (+7.9%) more than FY2022. Inclusive of directed transfers, NIH received $47.5 billion in the FY2023 omnibus, an increase of $2.5 billion (+5.6%) relative to FY2022 enacted. The FY2023 omnibus also provided $1.5 billion for the Advanced Research Projects Agency for Health (ARPA-H) under the HHS Office of the Secretary—an increase of $500 million (+50.0%) relative to FY2022. ARPA-H is a new agency focused on high-risk, high-reward health research that was first funded in the FY2022 omnibus. HHS used these funds to establish ARPA-H as an agency within NIH in March 2022.54 NIH and ARPA-H together received a total of $49.0 billion in the FY2023 omnibus, an increase of $3.0 billion (+6.5%) relative to the FY2022 level. The FY2023 President’s budget request for NIH proposed $50.2 billion, comprising $49.0 billion in discretionary budget authority (including $5.0 billion for ARPA-H) and $1.3 billion in PHS tap transfers.55 Thus, the FY2023 omnibus provided $1.3 billion (-2.5%) less than the budget requested amount inclusive of transfers and ARPA-H funding. (The FY2023 request also included other NIH mandatory spending proposals that were not adopted by Congress.) All NIH Institute and Center (IC) accounts received increases in FY2023 relative to FY2022, when accounting for directed transfers. Among the ICs, the National Institute of Minority Health and Health Disparities (NIMHD) saw the largest percentage increase compared to FY2022 (+14.2%). Of the total $65 million increase for NIMHD, $25 million was directed for health disparities research in the explanatory statement.56 The explanatory statement also directed increases for certain diseases and research areas within NIH accounts. For example, a $226 52 CDC, “CDC Launches New Center for Forecasting and Outbreak Analytics,” press release, April 19, 2022, https://www.cdc.gov/media/releases/2022/p0419-forecasting-center.html. 53 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, p. S8881. 54 See the textbox on the Advanced Research Projects Agency for Health in CRS Report R43341, National Institutes of Health (NIH) Funding: FY1996-FY2023. 55 The budget request proposed ARPA-H appropriations in an account within NIH. See NIH, FY2023 Congressional Justification, p. 33, https://officeofbudget.od.nih.gov/pdfs/FY23/br/Overview%20of%20FY%202023%20Presidents%20Budget.pdf. 56 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, p. S8884. Congressional Research Service 27 Labor, Health and Human Services, and Education: FY2023 Appropriations million total increase for Alzheimer’s disease and related dementia research across NIH, including increases specified for the National Institute of Neurological Disorders and Stroke ($75 million) and for the National Institute on Aging ($151 million).57 The explanatory statement also directed $75 million for implementing the Accelerating Access to Critical Therapies for ALS Act (ACT for ALS Act; P.L. 117-79), an increase of $50 million, within the Office of the Director account.58 Substance Abuse and Mental Health Services Administration (SAMHSA) SAMHSA is the federal agency primarily responsible for supporting community-based mental health and substance use treatment and prevention services. The SAMHSA mission is focused on reducing the impacts of substance use and mental illness.59 SAMHSA supports activities that include education and training, prevention programs, early intervention activities, treatment services, and technical assistance. The FY2023 LHHS omnibus provided $7.4 billion in discretionary budget authority for SAMHSA. This amount was $970 million (+15.2%) more than SAMHSA’s FY2022 funding level and $2.8 billion (-27.3%) less than the President’s FY2023 budget request. The FY2023 LHHS omnibus also directed $134 million in PHS Evaluation Tap funding and $12 million in PPHF funding to SAMHSA, which were the same amounts as FY2022. Inclusive of these directed transfers, the LHHS omnibus provided $7.5 billion, or $970 million (+14.8%), more funding than FY2022. Within the Mental Health Programs of Regional and National Significance account, the FY2023 LHHS omnibus explanatory statement60 included $502 million for the 988 Program (also known as the 988 Suicide and Crisis Lifeline or the 988 Lifeline), which represents an increase of $400 million (+493.6%) compared to the FY2022 LHHS omnibus.61 In July 2022, the 988 Lifeline (formerly called the National Suicide Prevention Lifeline) transitioned from a 10-digit number (1800-273-8255) to the 3-digit hotline number (9-8-8). The 988 Lifeline is a national hotline that provides immediate crisis counseling and referral services for individuals experiencing suicidal thoughts or other mental distress. The new three-digit number was launched to “make it simpler for people experiencing a mental health crisis to connect with lifesaving crisis intervention services.”62 Within the increase for the 988 Lifeline, $10 million is for Spanish speakers seeking text or chat access and $30 million is for providing capacity and infrastructure for vulnerable youth.63 Within the Substance Abuse Treatment account, the FY2023 LHHS omnibus provided an increase of $50 million (+3.3%) for the State Opioid Response (SOR) grants compared to the FY2022 LHHS omnibus. The explanatory statement notes that “large swings in funding between grant cycles can pose a significant challenge for States seeking to maintain programs that were instrumental in reducing drug overdose fatalities” and directs SAMHSA to “prevent unusually large changes” in a state’s allocation.64 57 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8882-S8883. 58 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, p. S8885. 59 SAMHSA, About Us, https://www.samhsa.gov/about-us. 60 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8887-S8888. 61 Congressional Record, vol. 168, no. 42, book IV, March 9, 2022, pp. H2679-H2680. 62 H.Rept. 117-403, pp. 159-160. 63 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8888. See also H.Rept. 117-403, pp. 159-160. 64 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, pp. S8888. Congressional Research Service 28 Labor, Health and Human Services, and Education: FY2023 Appropriations Agency for Healthcare Research and Quality (AHRQ) AHRQ conducts research aimed at reducing the costs of health care, promoting patient safety, measuring the quality of health care, and improving health care services, organization, and financing. The FY2023 LHHS omnibus provided $374 million in discretionary budget authority to AHRQ. 65 This amount was $23 million (+6.6%) more than the amount provided by the FY2022 LHHS omnibus and $3 million (-0.7%) less than the FY2023 President’s discretionary budget request.66 The FY2023 LHHS omnibus did not adopt the President’s budget proposal to transfer $40 million in PHS tap funds to AHRQ; the FY2023 LHHS omnibus funding was 10.2% less than the President’s budget when including this proposed PHS tap transfer and the discretionary budget request for AHRQ.67 The FY2023 LHHS omnibus funded Health Costs, Quality and Outcomes (HCQO) at $229 million, which was $23 million (+11.2%) more than the FY2022 LHHS omnibus level. The explanatory statement accompanying the FY2023 LHHS omnibus provided $10 million in new funding within HCQO for health systems research on Long COVID, including the development and implementation of new models of patient-centered coordinated care.68 The explanatory statement also urged AHRQ to fund research on improving maternal health, but did not specify a dollar amount.69 Centers for Medicare & Medicaid Services (CMS) CMS is the largest single health payer in the United States.70 The agency administers Medicare, Medicaid, the State Children’s Health Insurance Program (CHIP), and the federal Marketplace. The FY2023 LHHS omnibus provided $4.6 billion in discretionary budget authority for CMS, $20 million (+0.4%) more than FY2022 enacted. Both the President’s budget and the House committee bill would have provided $703 million (+15.5%) more than in FY2022. The FY2023 LHHS omnibus provided $893 million for the CMS Health Care Fraud and Abuse Control (HCFAC) account, 2.3% more than FY2022 and 0.7% less than what was proposed by the President’s budget and House committee bill. Of this total amount for HCFAC, $576 million was specified in the LHHS omnibus as being effectively exempt from discretionary budget caps. (See the Appendix for an explanation of the LHHS budget cap exemptions.) 65 In addition to funds provided through the annual appropriations process, AHRQ is also scheduled in FY2023 to receive a transfer of certain mandatory funds that were authorized and appropriated to the Patient-Centered Outcomes Research Trust Fund (PCORTF) by ACA Section 6301(e), as amended (26 U.S.C. §9511). Transfers to AHRQ from the PCORTF are to be used to disseminate the results of patient-centered outcomes research. (PCORTF funds are generally not displayed in this report, as they are not provided by or modified through annual LHHS appropriations bills.) For more information on the PCORTF, see CRS Insight IN11010, Funding for ACA-Established PatientCentered Outcomes Research Trust Fund (PCORTF) Extended Through FY2029. 66 HHS, AHRQ, FY2023 Congressional Justification, p. AHRQ-15, https://www.ahrq.gov/sites/default/files/wysiwyg/cpi/about/mission/budget/2023/fy2023-cj.pdf. The President’s budget requested $40 million in PHS tap funds to AHRQ for Research on Health Costs, Quality and Outcomes (HCQO), which, in addition to the discretionary budget request of $376 million, would have brought AHRQ’s total combined funding to $416 million (18.7% more than the FY2022 LHHS omnibus level of $350 million). Total AHRQ funding in the FY2023 LHHS omnibus was 10.2% less than FY2023 President’s budget request (inclusive of requested tap transfers). 67 Since FY2015, annual LHHS appropriations laws have not directed tap transfers to AHRQ, but in earlier years (FY2003-FY2014) AHRQ was funded primarily with tap transfers. 68 Congressional Record, vol. 168, no. 198, book II, December 20, 2022, p. S8889. 69 Ibid. 70 FY2023 HHS Budget in Brief, p. 74, https://www.hhs.gov/sites/default/files/fy-2023-budget-in-brief.pdf. Congressional Research Service 29 Labor, Health and Human Services, and Education: FY2023 Appropriations The FY2023 LHHS omnibus provided the same amount as FY2022 enacted to the CMS Program Management Account ($3.7 billion). Both the House committee bill and the President’s request had proposed to increase that account by $677 million (+18.5%). 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 FY2023 LHHS omnibus continued a provision (§227) that has been 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 $455 million (a $100 million increase relative to the FY2022 limit on such transfers), and explicitly prohibited such transfers from being used to support or supplant funding for ACA implementation. Both the President’s budget and the House committee bill would have eliminated this provision. Administration for Children and Families (ACF) The ACF mission is focused on promoting the “economic and social well-being of children, youth, families, and communities.”71 ACF administers a wide array of human services programs, including Head Start, child care, and various child welfare programs. The FY2023 LHHS omnibus provided $30.7 billion in discretionary budget authority for ACF, $742 million (+2.5%) more than FY2022. The President’s budget would have increased funding for ACF relative to FY2022 enacted, by $3.4 billion (+11.3%), whereas the House committee bill would have increased funding to a greater degree, by $4.5 billion (+15.0%). The FY2023 LHHS omnibus provided $6.4 billion for the Refugee and Entrant Assistance programs account, an increase of $2 million (+0.03%) relative to FY2022.72 The President’s budget would have decreased this account relative to FY2022, by $97 million (-1.5 %), whereas the House committee bill would have increased the account by $1.6 billion (+24.2%). The FY2023 LHHS omnibus retained a provision, included in LHHS appropriations since FY2015, authorizing HHS to augment appropriations for the Refugee and Entrant Assistance account via transfers from other discretionary HHS funds. The 15% limit on those transfers was the same as FY2022. The explanatory statement accompanying the FY2023 LHHS omnibus directed $5.5 billion of the appropriation for Refugee and Entrant Assistance programs toward the Unaccompanied Alien Children (UAC) program, the same amount as FY2022.73 The UAC program provides for the shelter, care, and placement of unaccompanied alien children who have been apprehended in the United States. The President’s budget would have decreased this account relative to FY2022, by $604 million (-11.0 %), while including a mandatory spending proposal for contingency funds as to help address the “unpredictable fluctuations in program needs,” which it estimated would cost $1.5 billion.74 The House committee bill would have increased the account by $1.2 billion (+21.9%), without providing any contingency funds. Ultimately, in addition to the $5.5 billion noted above, the FY2023 LHHS omnibus included the requested contingency funding, but it was 71 ACF, What We Do, https://www.acf.hhs.gov/about/what-we-do. 72 Of the total amount for FY2022, $1.6 billion was enacted as part of the second CR for FY2022, P.L. 117-70, for the Unaccompanied Alien Children program. 73 Ibid. 74 ACF, FY2023 Congressional Justification, pp. 41-42, https://www.acf.hhs.gov/sites/default/files/documents/olab/fy2023-congressional-justification.pdf. Congressional Research Service 30 Labor, Health and Human Services, and Education: FY2023 Appropriations provided as discretionary spending. The FY2023 law directed that the amount of contingency funding be based on the unaccompanied children in excess of 13,000 that are referred to HHS under specified authorities for a given month during FY2023. Following the conventions of congressional source documents, the estimated budgetary cost of this contingency funding ($1.0 billion) is included in the scorekeeping adjustments to the LHHS bill, and not the amounts for the Refugee and Entrant Assistance programs account.75 (See the Appendix for further information.) The FY2023 LHHS omnibus also included several general provisions that were enacted in FY2022 related to the UAC program. [Text truncated at 120,000 characters. The full text is on the page linked above.] --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/crs%3AR47345. Public record. Not legal advice.