Health Law Daily Wrap Up, GENERAL HEALTH CARE NEWS—GAO REPORTS: GAO addresses Congress’ concerns regarding caregiving youth issues, (May 30, 2025)

By Susan L. Smith, JD, MA

A Government Accountability Office (GAO) report to Congress regarding family caregiving youth addresses how federal programs support caregiving youth needs and compares England’s programs to support caregiving youth.

In a response to a request from Congress to examine issues relate to caregiving youth in the U.S. and the federal role in addressing their needs, the Government Accountability Office (GAO) examined (1) information on caregiving youth in the U.S.; (2) how federal caregiver support programs address caregiving youth needs; and (3) how England, a recognized leader in supporting caregiving youth, supports those youth through policy and programs. The GAO also reviewed relevant federal laws and regulations, as well as documents and surveyed a non-generalized sample of former caregiving youth ages 18 to 25 and obtained useable responses from 43 respondents. According to the GAO, little is known about children referred to as caregiving youth, however, research estimates that three to five million minors may be serving as caregivers for a family member. The GAO conducted the audit from July 2023 to May 2025. The GAO concluded that children and youth who serve as family caregivers face unique challenges balancing caregiving tasks with their own health, development, education, and wellbeing. Further, HHS and VA family caregiver support programs have primarily focused on assistance to adult caregivers, such as counseling, training, and respite care. The GAO recommended HHS to clarify information related to program eligibility on its website (GAO Report, GAO-25-106947, May. 14, 2025).

GAO surveys. The GAO stated that the surveys it identified did not allow for accurate estimates of minors who provide family care and may underestimate the population; however, in three state-level surveys where data were collected (Rhode Island, Colorado, and Florida) GAO identified that collected data on caregiving youth showed that middle school students and racial and ethnic minorities played a larger role providing care for a family member compared to other middle and high school students and non-White students played a larger caregiving role than White students. Generally, male and female students caregivers were similar across all three states. Caregiving youth also were more likely to face emotional challenges, delayed attention to their own physical health, and were more likely to be bullied at school. In addition, they had lower grades and reported having difficulty completing school assignments or arrived late to class because of their caregiving responsibilities. Former caregiving youth said they experienced challenges with their mental and physical health, peer relationships, and education while providing care to a family member. According to the selected studies, a GAO survey of 43 former caregiving youth and interviews with five of those youth, caregiving youth experience some positive effects from caregiving, but also face several challenges. For example, some respondents to the GAO survey reported experiencing stress and anxiety because of concerns about their family member’s health condition.

Key Federal Programs. The GAO noted that key federal programs that support family caregivers focus on adults and not on caregiving youth. Under the three federal caregiver support programs administered by HHS and Veterans Affairs (VA), officials told GAO that family caregivers must be adults to receive supports such as counseling, referrals, and respite care. The federal programs are HHS’s National Family Caregiver Support Program and two VA Caregiver Support Programs. The GAO pointed out, however, that according to a 2024 federal register notice issued by HHS, states and service providers may determine when family caregivers younger than age 18 could be eligible to receive supports under at least one federal caregiver support program. Because the HHS website does not, states and service providers may be unaware of any flexibilities because the HHS website does not include this information.

One of HHS’s objectives in its 2022–2026 Strategic Plan is to support high-quality services for older adults and people with disabilities, and their caregivers. The plan states that to achieve this objective, HHS leverages resources to better address the needs of all caregivers across the age spectrum. Without complete information from HHS on eligible caregivers, states and service providers may not be aware that they have flexibility to provide services to certain family caregivers under 18.

England’s policies. According to GAO stakeholder interviews, England established a national policy in 2014 that calls for local governments to take reasonable steps to identify and assess the needs of caregiving youth in their area. Local governments implement this policy by coordinating with municipal agencies, charities, and schools. Some English schools, provide lunchtime groups for caregiving youth and use school bulletins to raise awareness about the population.

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