Full-year FY2023 appropriations for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations act 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. Previously, FY2023 funding had been provided temporarily through three continuing resolutions (P.L. 117-180, P.L. 117-229, and P.L. 117-264). This report provides a brief summary of the status of LHHS appropriations during the FY2023 cycle, including relevant congressional actions and a topline comparison of discretionary funding enacted in FY2022 and FY2023, versus relevant FY2023 legislative proposals as of the cover date of this report. It also provides background on the scope of the bill and the budgetary context for congressional decisionmaking. In addition, it summarizes the FY2023 LHHS emergency-designated appropriations enacted in P.L. 117-180 and P.L. 117-328.

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.

Scope of the LHHS Bill

The LHHS bill is the largest ($1.4 trillion in FY2023) of the 12 annual appropriations bills when accounting for both mandatory and discretionary funding.¹ It provides annually appropriated budget authority for the following federal departments and agencies:

• the Department of Labor (DOL);
• most agencies at the Department of Health and Human Services (HHS), 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 (funded through the Interior-Environment appropriations bill);
• the Department of Education (ED); and
• more than a dozen related agencies (RA), including the Social Security Administration (SSA), 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.

In general, mandatory funding represents just over 80% of the total LHHS bill, supporting annually appropriated entitlements such as Medicaid and Supplemental Security Income (SSI). Discretionary funds, which account for less than 20% of total funds in the bill, tend to be the focus of congressional debate during the appropriations process.² This is because the appropriations process generally has little control over the amount of mandatory funding provided for appropriated entitlements; rather, the authorizing statute controls the program parameters (e.g., eligibility rules, benefit levels) that entitle certain recipients to payments. Consequently, the focus of this report generally is on the discretionary spending that has been or would be provided for LHHS programs and activities under various laws and proposals.

Even though discretionary appropriations represent a relatively small share of the entire LHHS bill, the bill is typically the largest single source of nondefense discretionary funding for the federal government. (The Department of Defense bill is the largest single source of discretionary funding overall.)

Context for FY2023

Under the congressional budget process, congressional consideration of annual appropriations traditionally is preceded by the submission of the President's budget request and the adoption of the congressional budget resolution. However, the FY2023 cycle has been affected by a number of timing and budgetary issues related to the late submission of the President's budget and the lack of congressional agreement on topline discretionary spending amounts for the appropriations committees. Background related to these issues is provided below.

FY2023 President's Budget Submission

The Budget and Accounting Act of 1921 (P.L. 67-13), as amended, requires the President to submit an annual consolidated federal budget to Congress at the beginning of each regular congressional session, not later than the first Monday in February. Many of the proposals in the President's budget would require changes to laws that govern mandatory spending levels or policies, which are typically established on a multiyear or permanent basis. Discretionary spending, however, which is roughly one-third of the federal budget,⁶ is decided and controlled each fiscal year through the annual appropriations process. While Congress is ultimately not required to adopt the President's proposals or recommendations, the submission of the President's budget typically initiates the congressional budget process and informs Congress of the President's recommended spending levels for agencies and programs.⁷

The President's budget request for FY2023 was submitted on March 28, 2022, about seven weeks after it was due. It was preceded by the enactment of FY2022 full-year annual appropriations (P.L. 107-103) on March 15, 2022, more than six months into the fiscal year. In some cases, the President's budget request reflected those full-year appropriations amounts that had been enacted two weeks prior. However, in many other cases, the funding requested for LHHS programs and activities was based on annualized estimates of the continuing appropriations that were in effect at the time the budget was being prepared. As a consequence, many of the underlying assumptions about funding increases and decreases relative to the prior year that went into the formulation of the budget were outdated by the time the budget was submitted.

On June 7, the President submitted amendments to the FY2023 budget that included changes to appropriations language requested for DOL and HHS.⁸ The Administration characterized the two LHHS budget amendments as technical in nature; neither were estimated to affect budget authority totals on net in the bill.

FY2023 Discretionary Spending Levels and Appropriations Allocations

The congressional budget process generally enforces discretionary spending levels in appropriations measures via procedural means.⁹ This procedural budget enforcement is primarily associated with the budget resolution, which provides a process for the House and the Senate to agree on budgetary targets ahead of consideration of spending and revenue legislation.

The budget resolution imposes a limit on total discretionary spending available to the appropriations committees (commonly referred to as a 302(a) allocation) and, subsequently, limits on spending under the jurisdiction of each appropriations subcommittee are created (referred to as 302(b) suballocations). Certain spending is effectively exempt from these limits (commonly referred to as adjustments to the limits). In recent years, adjustments that have been applied to LHHS appropriations are for emergency requirements, to accommodate new budget authority for specified program integrity initiatives at HHS (health care fraud and abuse control) and the SSA (continuing disability reviews and redeterminations), and for DOL to fund reemployment services and eligibility assessments conducted by the states related to unemployment compensation.¹⁰

As of the cover date of this report, there has been no House or Senate action on an FY2023 budget resolution. In its absence, on June 8, 2022, the House adopted a resolution (H.Res. 1151) to provide for 302(a) allocations to the House Appropriations Committee at a specified level, provide limits on advance appropriations,¹¹ and allow adjustments to those allocations for emergency requirements, health care fraud and abuse control, and continuing disability reviews and redeterminations (as well as other purposes that do not apply to LHHS).¹² Pursuant to this resolution, the chair of the House Budget Committee, Representative Yarmuth, published in the Congressional Record the House Appropriations Committee allocations on June 21.¹³ The Senate has not taken similar action to establish Senate Appropriations Committee allocations.¹⁴

Generally, the next step in the appropriations process is for each of the appropriations committees to adopt suballocations from the total amount allocated to them. These 302(b) suballocations provide a limit on current-year (i.e., FY2023) appropriations within each subcommittee's jurisdiction and incorporate any applicable scorekeeping adjustments made by CBO. The House Appropriations Committee reported their initial 302(b) suballocations for all 12 subcommittees on June 24 (H.Rept. 117-390).¹⁵ The discretionary budget authority suballocation for LHHS of $224.399 billion represented a 14% (+$27.405 billion) increase relative to FY2022. That amount did not include funding subject to adjustments, such as for emergency requirements.

FY2023 LHHS Legislative Action

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). The FY2023 LHHS appropriations provided in the FY2023 omnibus are summarized in "FY2022 and FY2023 Discretionary Funding Levels."

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. 117-229), 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.

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).¹⁶ The CRs also included several anomalies that were specific to LHHS accounts or related activities (§§101(8), 145-150).¹⁷

FY2023 Emergency-Designated Appropriations

Emergency designated appropriations are effectively exempt from otherwise applicable budget enforcement requirements, such as committee allocations, as described above. A handful of proposals 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).¹⁸
• Division M of H.R. 2617 (P.L. 117-328), the Additional Ukraine Supplemental Appropriations Act, 2023, provided $2.40 billion in emergency-designated appropriations for the Refugee and Entrant Assistance Account at ACF.¹⁹
• Division N of H.R. 2617 (P.L. 117-328), 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);
• $2.5 million to the National Institute of Environmental Health Sciences (National Institutes of Health; NIH);
• $25 million to the Office of the Director (NIH);
• $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
• $128.8 million to the Public Health and Social Services Emergency Fund.

Prior Congressional Action on an FY2023 Full-Year LHHS Bill

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.

While the Senate Appropriations Committee did not vote to report its version of the legislation, the committee chair, Senator Leahy, released a majority draft of the LHHS bill and accompanying draft report language on July 28, 2022.²⁰

FY2022 and FY2023 Discretionary Funding Levels

Table 1 displays the CBO estimate of enacted LHHS discretionary appropriations for FY2022 and FY2023, the House committee-reported FY2023 discretionary appropriations for LHHS, and those in the Senate majority draft proposal. The amount shown for "regular discretionary appropriations" does not include any funding that is subject to program integrity adjustments or emergency designations. The amount shown represents current-year budget authority subject to the spending limits and takes into account any applicable CBO scorekeeping adjustments. Under this method of estimating the bill, the House proposal would increase regular discretionary appropriations for LHHS relative to FY2022 by 14% (+$27.4 billion), while the Senate majority draft proposal would increase those appropriations by 10% (+19.1 billion).²¹ Ultimately, the FY2023 enacted amount was an increase in such funding of 5.3% (+10.4 billion).

As previously mentioned, certain LHHS appropriations, such as those allowed for program integrity funding or designated for emergency requirements, are effectively exempt from the discretionary spending limits. FY2023 enacted and the FY2023 House and Senate proposals would provide the same amount for program integrity spending (see discussion in the "FY2023 Discretionary Spending Levels and Appropriations Allocations" section). With regard to new FY2023 funding for emergency requirements, no such emergency-designated funding was proposed in the House committee bill, but the Senate majority draft would enact such funding in Titles II and VI. The "adjusted appropriations" total in the table includes these additional funds along with "regular discretionary appropriations."