Federal COVID-19 Response Actions Affecting Older Adults and Persons with Disabilities
This post highlights key federal actions in response to coronavirus disease 2019 (COVID-19) — through April 16, 2020 — relating to social services and health programs that serve older adults and persons with disabilities. Specifically, we describe the aging and disability-related components of the two most recent pieces of COVID-19 federal legislation (H.R. 6201 and H.R. 748). Additionally, we explain other key federal actions, beyond those taken through the two most recent pieces of COVID-19 federal legislation, that affect older adults and persons with disabilities. While this post reflects our best understanding of the high-level content and implications of federal actions, we will update the post as new information and clarifications become available. We will also update the post to reflect any future federal actions.
Families First Coronavirus Response Act (FFCRA)
On March 18, 2020, the President signed H.R. 6201, the FFCRA, which includes various actions and federal funding to address the COVID-19 outbreak. In this section, we describe the additional funding provided under the FFCRA to health and human services programs that serve older adults and persons with disabilities. Additionally, we describe how the two weeks paid sick leave policy implemented by the FFCRA affects certain aging and disability service programs.
Increased Funding to Medi-Cal Program. The FFCRA temporarily increases the federal share of cost in Medi-Cal, California's version of the federal-state Medicaid program that provides health care coverage to low-income residents, from 50 percent to 56.2 percent beginning January 1, 2020 and ending the first quarter in which the COVID-19 public health emergency is not in effect. While considerably uncertain, we estimate that the enhanced federal funding could potentially offset state and local government spending in Medi-Cal, including In-Home Supportive Services (IHSS) and Department of Developmental Services (DDS) programs that rely on Medicaid funding, by a total of $300 million to $400 million per month (while the enhancement remains in effect). We explain this in more detail in another post.
Increased Funding to Senior Nutrition Programs. The FFCRA also increases funding for the senior nutrition programs under the Older American Act (OAA) by $250 million nationally. California received about $25 million of this funding.
Provides Two Weeks Emergency Paid Sick Leave. In California, IHSS provides personal care and domestic services to eligible Medi-Cal beneficiaries (typically older adults and persons with disabilities) to help them remain safely in their own homes and communities. In most cases, the IHSS recipient is responsible for hiring and supervising a paid IHSS provider. Currently, IHSS providers are eligible to use up to eight hours of accrued paid sick leave annually (scheduled to increase to 16 hours on July 1, 2020 and ultimately to 24 hours on July 1, 2022). The FFCRA requires private employers with fewer than 500 employees, as well as all public sector employers, to provide two weeks paid sick leave for any employee impacted by COVID-19, including individuals subject to isolation orders or who are suffering from COVID-19 symptoms. The amount of paid sick leave individuals receive depends on how they have been impacted by COVID-19. (For more information on the federal paid sick leave benefit, see our other post.) On April 3, 2020, the state requested federal approval to implement technical changes to make available the new federal COVID-19 paid sick leave to IHSS providers — to the extent they meet the specific federal requirements. The federal paid sick leave will be in addition to the regular paid sick leave IHSS providers already receive through the state.
Coronavirus Aid, Relief, and Economic Security (CARES) Act
On March 27, 2020, the President signed H.R. 748, the CARES Act, a federal relief act aimed at mitigating the economic and public health consequences of COVID-19. In this section, we explain the financial and programmatic implications of the CARES Act on key human services and health programs that serve older adults and persons with disabilities.
Financial Assistance to Programs and Individuals
In this section, we summarize the financial assistance provided to aging and disability services programs and older adults and persons with disabilities under the CARES Act.
Provides Funding for Various Aging and Disability Services Programs. The CARES Act provides over $950 million nationally for the following aging and disability services programs:
$480 million for OAA senior nutrition programs (in addition to $240 million provided under the FFCRA, of which California received $25 million).
$200 million for OAA supportive services.
$100 million for the Family Caregiver Support Program.
$85 million for Centers for Independent Living.
$50 million for Aging and Disability Resource Centers (ADRC).
$20 million for the Long-Term Care Ombudsman Program.
$20 million for supportive and nutrition services to older Native Americans (in addition to $10 million provided under the FFCRA, of which tribes in California received about $1 million).
Extends and provides additional funding for the Money Follows the Person demonstration program to continue to facilitate the transition of individuals from institutional settings to community-based settings through November 30, 2020. Congress has provided a number of temporary, short-term extensions to this funding in recent years, most recently through May 22, 2020.
Extends and provides additional funding for the Medicare Improvements for Patients and Providers Act program to continue to help low-income, older adults and people with disabilities apply for Medicare prescription drug subsidies and Medicare Savings Programs (through which Medicaid covers some or all Medicare premiums and other cost sharing payments) through November 30, 2020.
In general, the additional funds provided to state aging and disability programs under the CARES Act will be directly allocated to states, with the exception of ADRC funds. Specifically, states will need to apply to receive ADRC funding. On April 7, 2020, the federal government published the application for the $50 million of ADRC funding, of which California is eligible to receive up to $3 million. We do not yet know exactly how much funding California will receive from the remaining programs. However, based on past allocation formulas for each program, the state could receive, in total, roughly $100 million.
Provides Financial Assistance to Small Business — Including Those That Provide Supports for Older Adults and Persons With Disabilities. In California, regional centers — overseen by DDS — contract with nonprofit and for-profit entities (referred to as DDS service providers) to provide state-funded services and supports, including day programs and therapeutic, residential, and transportation services, to individuals with developmental disabilities. Similarly, Community-Based Adult Services (CBAS) centers provide health and personal care services in adult day care centers to older adults who generally live in their own homes but are at risk of needing institutional nursing care.
The CARES Act provides $377 billion for financial assistance to small businesses (businesses and nonprofits with fewer than 500 employees). Most of these funds will be used to create a new forgivable loan program — called the Paycheck Protection Program — that is intended to help small businesses meet payroll and operational costs while their revenues are reduced by COVID-19 response efforts. In general, small businesses will need to apply for assistance and the loans are available on a first-come, first-served basis. (Additional information on the federal assistance for small businesses can be found in another post.) It is our understanding that DDS service providers and CBAS centers generally are eligible for small business financial assistance provided under the CARES Act. (Additionally, DDS service providers and CBAS centers may be eligible for other small business assistance, including the Economic Injury Disaster Loan Program.) These entities may experience a reduction in revenues and need assistance to fully meet payroll and operational costs because they are unable to provide certain reimbursable services, such as group activities, due to shelter-in-place and social distancing guidelines. (The state has also provided other funding options and program flexibilities to assist DDS service providers and CBAS centers through the public health emergency.)
Provides One-Time Cash Assistance to Adults, Including Seniors and Persons With Disabilities. Under the CARES Act, adults earning less than $75,000 are generally eligible for a one-time cash payment of $1,200, and $500 for each child. Eligibility will be determined primarily through an individual's most recent tax filing (2019 for those who have already filed, 2018 otherwise). Initially, the Internal Revenue Service (IRS) released guidance stating that people who typically do not file a tax return, including low-income, older adults and individuals with disabilities, will need to file a tax return or register through an online tool to receive the one-time cash assistance. However, the IRS updated its guidance (most recently April 15, 2020) to no longer require recipients of social security or railroad retirement benefits to file a tax return or register online, meaning these individuals will automatically receive the $1,200 cash assistance. This includes individuals who receive Supplemental Security Income/State Supplementary Payment (SSI/SSP), Social Security retirement, Social Security Disability Insurance, and Social Security survivor benefits. (Social security beneficiaries who do not file tax returns and have children will need to provide additional information to the IRS to also receive $500 payment per child.) It is our understanding that the cash assistance will not affect eligibility for the large means-tested programs, including SSI/SSP and Medi-Cal.
Expands Eligibility for Unemployment Benefit to Workers Directly Affected by COVID-19. Under current state law, individuals employed by their child or spouse are ineligible for state unemployment benefits. In the case of IHSS, this means that IHSS providers that provide services to their child or spouse are ineligible for state unemployment benefits. The CARES Act creates a new federal unemployment benefit program for individuals who generally are (1) ineligible for state unemployment benefits, and (2) available but unable to work as a direct result of COVID-19 (such as individuals whose place of employment is closed due to COVID-19 or who are caring for a family or household member who has been diagnosed with COVID-19). This new benefit will be administered by the state Employment Development Department (EDD). (For more information on new federal unemployment benefits, see our other post.) As of now, EDD is in the process of developing all of the necessary system programming, guidance, and producers to implement the new benefit. We will continue to monitor the guidance released by EDD on how the benefit will affect California residents, including whether IHSS parent and spouse providers are eligible. (At this time, it is not known to what extent IHSS providers are unable to work as a direct result of COVID-19.)
Program Flexibilities and Guidance
In this section, we describe the program flexibilities and guidance provided under the CARES Act across various aging and disability services programs.
Grants Additional OAA Program Flexibility and Guidance. Under the CARES Act, states were provided additional program flexibility and guidance for the following OAA programs:
Senior Nutrition Programs. Allows states to (1) transfer up to 100 percent of funding from congregate to home-delivered meals program without prior federal approval (generally states are only allowed to transfer up to 50 percent of funding with federal approval), (2) provide home-delivered meals to individuals who are homebound for social distancing purposes regardless of state or local policies (this was already allowable in California prior to COVID-19), and (3) temporarily waive certain dietary guidelines for meals.
Senior Employment Program. Allows participation in the senior community service employment program to be extended beyond the federal time limits.
Long-Term Care Ombudsman Program. Allows long-term care ombudsmen to have continued “direct access (or other access through the use of technology) to residents in long-term care facilities” during the public health emergency.
Allows Some Medicaid Home- and Community-Based Services (HCBS) to Be Provided in Hospitals. The CARES Act allows Medicaid HCBS — such as case management services — that are historically required to be provided in a home setting to be provided in acute care hospitals in instances where the services (1) meet needs not met through hospital services, (2) are not a substitute for services the hospital is obligated to provide, and (3) are designed to ensure smooth transitions between acute care settings and home- and community-based settings. More federal guidance on this provision will likely be needed before it can be implemented.
Other Federal Actions
In this section, we explain other key federal actions, beyond those taken through the FFCRA or CARES Act, that affect older adults and persons with disabilities, including flexibilities for how programs and services for these individuals operate that are authorized in part through federal waivers, as well as the release of federal guidance.
Flexibility for HCBS Programs. The Department of Health Care Services (DHCS) requested that the federal government waive certain program requirements across various HCBS programs that provide assistance to older adults and persons with disability in the community as opposed to an institution such as a hospital or nursing facility. While federal approval for some waiver requests is still pending, the state has implemented key program flexibilities in the following HCBS programs:
IHSS. While counties must still perform initial face-to-face assessments to determine IHSS eligibility, they may suspend recipient annual reassessments through June 30, 2020. Counties can choose to continue performing reassessments via telephone, but any “adverse actions” related to any reassessments, such as reduction in service hours or termination of services, shall not take effect until June 30, 2020. The state has requested federal authorization to waive the requirement that initial assessments be performed face-to-face but federal approval of this and other IHSS program flexibility requests is still pending. (For more information on IHSS program flexibilities, see the “COVID-19” section on the DSS website.)
CBAS. As a result of the Governor's stay-at-home executive order, CBAS centers are no longer allowed to provide congregate services inside its physical site. However, CBAS centers can provide certain services, including nursing care, behavioral health services, and physical therapy, in a recipient's home, telephonically, or via live virtual video conferencing. CBAS centers will still be reimbursed for services provided in an alternative setting.
“Appendix K” Flexibility. On April 2, 2020, the federal government approved the state's “Appendix K” amendments to implement certain flexibilities in the following five programs: Home- and Community-Based Alternatives Waiver, Multipurpose Senior Services Program, HIV/AIDS, DDS, and Assisted Living Waiver. The approved program flexibilities include delaying in-person visits, conducting initial and ongoing reassessments through telephonic and video conferencing, authority to make retainer payments due to absences, and allow certain services to be provided in a recipient's home. (For more detailed information on flexibilities approved for each program, see the “Appendix K” section on the DHCS COVID-19 website.)
Federal Guidance on Nursing Facilities. On March 13, 2020, the federal Centers for Medicare and Medicaid Services (CMS) put in place several measures to protect nursing home residents from COVID-19. Specifically, CMS directed to (1) restrict all visitors to nursing facilities except instances of compassionate care such as end-of-life situations, (2) restrict all volunteers and nonessential health care personnel from facilities, (3) cancel group activities and communal dining, and (4) implement active screening of residents and health care personnel for respiratory illness. (The state has also issued guidance to health and long-term care facilities, including how to prepare for the continued admission of individuals with suspected or confirmed COVID-19 infection in skilled nursing facilities, which can be found on the California Department of Public Health's website.)
Changes to Federal SSI Program Operations. The U.S. Social Security Administration (SSA) largely administers SSI/SSP. It is our understanding that COVID-19 has not affected SSA's ability administer SSI/SSP and social security payments, meaning individuals will continue to receive monthly benefits. The SSA, however, has made significant changes to its operations and policies in response to COVID-19 concerns, including closing all local SSA offices. As a result, individuals now receive application assistance and services over the phone and online. Additionally, in-person hearings are being rescheduled as telephone hearings or postponed if an individual declines a telephone hearing. (Some SSA employees are continuing to work in local offices on priority items, such as requests for “dire need” benefit payments and disability applications for those with the most severe disabilities.) The SSA also is not conducting medical continuing disability reviews and has suspended processing and collecting most new overpayments.