Jobs in home care are expected to grow by 40 percent in the next decade to meet demand from older adults and people with disabilities. Despite being part of one of the fastest growing industries, many home care workers did not have federal minimum wage and overtime protections until 2015. The Department of Labor extended these protections through a regulation known as the Home Care Rule. We compar...

Genetic test results can help diagnose or confirm a condition. Genetic counseling can help explain the results and available treatment options. Some studies have raised concerns on whether there are enough genetic counselors and medical geneticists—genetic test providers—to meet the current and future demand for genetic services. About 4,700 genetic counselors and 1,240 medical geneticists are...

In response to the COVID-19 pandemic, Congress appropriated $2.6 trillion in emergency assistance for people, businesses, the health care system, and state and local governments. How are federal agencies spending these funds? We testified that the Small Business Administration processed over $512 billion in guaranteed small business loans, but isn’t ready to address fraud risks and hasn’t sa...

The Department of Labor has awarded grants to help states address the opioid crisis through training and employment services. State officials told us that job seekers who are in recovery may have additional challenges with finding employment, in part, due to employers’ concerns about potential criminal histories, relapse, and social stigma. To help meet the training and employment needs of thos...

The federal government’s Black Lung Disability Trust Fund faces financial challenges and has borrowed billions to cover costs. The Trust pays benefits to certain coal miners when no coal mine operator can be held responsible, or when the liable operator does not pay. Three mine operator bankruptcies have further strained Trust finances by transferring $865 million in estimated benefit responsib...

The federal government’s Black Lung Disability Trust Fund faces financial challenges and has borrowed billions to cover costs. The Trust pays benefits to certain coal miners when no coal mine operator can be held responsible, or when the liable operator does not pay. Three coal mine operator bankruptcies have further strained Trust finances by transferring $865 million in estimated benefit resp...

People whose disabilities keep them from working can apply for Social Security Disability Insurance. People who claim these benefits may also be on prescription opioids for chronic pain. Opioids are addictive and can be misused. Social Security staff must deny claims if claimants who stopped using drugs or alcohol would be employable. Staff in 5 of 6 offices we visited were confused about when to...

Before 2008, many health insurance plans provided lower benefits for mental health care than other types of medical care. Congress set parity requirements to help address this discrepancy. This means things like copayment amounts or treatment approval requirements must be equal or comparable for mental health and other care. The Departments of Labor and Health and Human Services commonly find vio...

The Black Lung Benefits Program helps coal miners who have been totally disabled due to black lung disease. Coal companies found liable or the Black Lung Disability Trust Fund pay these benefits. The trust may pay if, for example, a company goes bankrupt. A domestic coal tax is the trust’s primary funding source. We reported in 2018 that the trust faces financial challenges and that its debt co...

Multiple factors have challenged Black Lung Disability Trust Fund (Trust Fund) finances since it was established about 40 years ago. Its expenditures have consistently exceeded its revenues, interest payments have grown, and actions taken that were expected to improve Trust Fund finances did not completely address its debt. When necessary to make expenditures, the Trust Fund borrows with interest...