As we round out the end of the fiscal year, action in the nation’s capital is both frenetic and action-packed. Congress is super-focused on passing a historic multi-trillion-dollar reconciliation bill that includes major investments in COVID recovery, infrastructure development, and expansion of Medicaid-funded home and community-based services. If successful, the legislation could create a new era of investments in improving the social determinants of health and quality of life outcomes for individuals with disabilities and their families.
Meanwhile, the Biden Administration has moved ahead with several initiatives aimed at improving access to supports for people with disabilities during COVID-19, provided relief to student loan borrowers who have permanent disabilities, and made preparations for launching the National Disability Employment Awareness Month.
CDC Launches COVID-19 Resources for People with Intellectual and Developmental Disabilities
The coronavirus disease 2019 (COVID-19) pandemic has created unique challenges for people with intellectual and developmental disabilities (I/DD). To address them, the Centers for Disease Control and Prevention (CDC) created a COVID-19 toolkit with communication resources explaining in plain language how people with I/DD and caregivers can protect themselves from the virus. The toolkit contains social stories, videos, posters and interactive activities that focus on five topics: getting a COVID-19 vaccine; wearing a mask; social distancing; hand washing; and getting a COVID-19 test. There is also a tip sheet for caregivers that offers suggestions for things they can do to ease their loved one’s worries about the virus.
Guidance on “Long COVID” as a Disability under the ADA, Section 504 and Section 1557
Although many people with COVID-19 get better within weeks, some people continue to experience symptoms that can last months after first being infected or may have new or recurring symptoms at a later time. This condition is known as “long COVID.” In light of the rise of long COVID as a persistent and significant health issue, the Office for Civil Rights of the Department of Health and Human Services (DHHS) and the Civil Rights Division of the Department of Justice co-issued guidance on the 31st anniversary of the Americans with Disabilities Act (ADA) that affirms that long COVID can be a disability under Titles II (state and local government) and III (public accommodations) of the ADA, Section 504 of the Rehabilitation Act of 1973, and Section 1557 of the Patient Protection and Affordable Care Act. The guidance also provides resources for additional information and best practices. This document focuses solely on long COVID, and does not address when COVID-19 may meet the legal definition of disability.
Build Back Better Act Includes Major Reforms to Expand Eligibility and Strengthen Medicaid & CHIP
Economic recovery legislation under consideration by the U.S. House of Representatives would create a permanent pathway to coverage for more than 2 million people in the Medicaid coverage gap, as well as strengthen Medicaid and Children’s Health Insurance Program (CHIP) coverage for parents and children, people returning to their communities from prisons, and people with disabilities and older Americans who need home- and community-based services (HCBS).
The Build Back Better Act, as approved by the House Energy and Commerce Committee, would ensure all pregnant people enrolled in Medicaid and CHIP can maintain coverage for 12 months after the end of their pregnancy; provide 12 months of continuous coverage to children and youth enrolled in Medicaid and CHIP; provide Medicaid coverage of healthcare services for people within 30 days of leaving prison, which could connect them to the care they need in the community; and make CHIP permanent. These policies would narrow racial and ethnic inequities in coverage and access to health services and promote long-term health and well-being among Medicaid enrollees at all stages of life.
Build Back Better Act Includes Increased Federal Funding that Would Improve Quality of and Access to Home- and Community-Based Services, Support Transitions to Community
The Build Back Better Act of 2021 also makes historic investments to allow more seniors and individuals with disabilities to receive the services they need in their homes, alongside their friends and family. The House version of the Act includes $190 billion for expanding access to quality home-based services and care for millions of older adults and people with disabilities. It will also strengthen the direct care workforce by improving provider payment rates and giving states the resources to improve their care infrastructure. The legislation also makes permanent the Money Follows the Person and the spousal impoverishment program, both successful Medicaid programs that help low-income older adults and individuals with disabilities receive home-based services.
The Build Back Better Act creates a financial incentive for states to improve quality of and access to Medicaid HCBS. First, states will apply to receive planning grants from DHHS to develop robust HCBS improvement plans. After the Secretary of HHS approves a state’s plan, the state would get a seven percentage-point increase in its federal matching rate (FMAP) for Medicaid HCBS. In addition, states would get an 80 percent FMAP for administrative costs associated with implementing the plan, significantly greater than the regular 50 percent FMAP states receive for administrative costs. These financial incentives would be available as long as states meet certain requirements to maintain eligibility levels, amount, duration and scope of Medicaid HCBS. States must also adopt policies to reduce barriers to accessing HCBS; provide coverage for personal care services; adopt “no wrong door” and other policies to streamline HCBS eligibility and enrollment; expand access to behavioral health services; improve coordination between Medicaid HCBS and programs focused on employment, housing and transportation; provide supports to family caregivers; and take steps to expand Medicaid HCBS eligibility or benefits. Finally, states must update qualifications and training opportunities for direct care workers and family caregivers; and update (as appropriate) payment rates for HCBS providers to support workforce recruitment and retention and to ensure that rate increases are appropriately passed through to direct care workers.
It is anticipated the legislative package will advance through both chambers of Congress in early-mid October but has been stalled due to internal disagreements among moderate and progressive Democrats regarding how much the package should include. The original package included $3.5 trillion in new federal investments, but moderate Democrats in the House and Senate are pushing for a significantly smaller bill capped at $1.5 trillion in spending. In the meantime, disability advocates are pushing hard for the funding set aside for HCBS expansion efforts to increase beyond the $190 billion (as previously reported during our last quarterly publication, the initial proposal called for $400 billion toward the HCBS components of the legislation).
Federal Student Loan Borrowers to Receive Automatic Total and Permanent Disability Discharges (TPD)
Over 323,000 borrowers who have a TPD will receive more than $5.8 billion in automatic student loan discharges due to a new regulation announced today by the U.S. Department of Education. The change will apply to borrowers who are identified through an existing data match with the Social Security Administration (SSA). The policy change went into effect with the Department’s quarterly data match with SSA in September 2021. Borrowers will receive notices of their approval for a discharge in the weeks after the match and all discharges should occur by the end of the year.
Build Back Better
In addition to work completed by the House Energy & Commerce Committee, the House Education & Labor Committee also marked up key sections of the Build Back Better Act that include $1.48 billion in competitive grants addressing direct care workforce development issues. The legislation also includes $300 million for transformation grants to states to collaborate with providers who hold 14(c) certificates, and funding for a national center to provide technical assistance to State grantees. It remains to be foreseen whether these provisions will be preserved in the final consensus Build Back Better Act package.
National Disability Employment Awareness Month (October 2021)
The theme for the 2021 National Disability Employment Awareness Month (NDEAM), “America’s Recovery: Powered by Inclusion,” reflects the importance of ensuring that people with disabilities have full access to employment and community involvement during the national recovery from the COVID-19 pandemic.
NDEAM is held each October to commemorate the many contributions of people with disabilities to America’s workplaces and economy. Browse their website for ideas and resources for employers, community organizations, state and local governments, advocacy groups and schools to participate in celebrating NDEAM through events and activities centered around the theme. The U.S. Department of Labor’s Office of Disability Employment Policy (ODEP) offers a range of resources to help employers and other organizations plan NDEAM observances, including not only the official poster, but also sample articles, a press release, proclamation and social media content.
- If successfully passed and enacted, the Build Back Better Act could create a new chapter in the provision of Medicaid HCBS, and propel efforts forward to better help people with disabilities and older adults access services to live, work and thrive in the community.
- Policy guidance was released that affirms protections under existing civil rights statutes for individuals experiencing long COVID.
- Additional policy guidance has relinquished student loan borrowers with permanent disabilities from paying back their student loans.
- October is National Disability Employment Awareness Month (NDEAM)! There are numerous ways you and your organization can get involved – check out ODEP’s resources and get engaged!
Note: information current as of 9/30/2021