Federal Disability Policy Updates
If 2020 felt like a long crawl across the Sahara Desert, 2021 feels a lot more like being in a race at the Indy 500 here in Washington! Check out the whirlwind of activity occurring both on Capitol Hill and with the new Biden administration with respect to hot topics like COVID-19, Community Living & HCBS, Disability Employment, Inclusive Education and Criminal Justice Reform.
CDC and ACL provide nearly $100 million in grants to help older adults and people with disabilities get vaccines
In late March, President Joe Biden announced several actions to expand access to COVID-19 vaccines, including an exciting partnership between Administration for Community Living (ACL) and the Centers for Disease Control and Prevention (CDC) to increase vaccine access for people with disabilities and older adults. Throughout the pandemic, ACL has advocated alongside the aging and disability networks and advocates, and with partners across US Department of Health and Human Services (HHS) and the federal government, to ensure equal access to care for older adults and people with disabilities. These grants will provide assistance with scheduling vaccine appointments, transportation to vaccine sites, direct support services needed to attend vaccine appointments, connection to in-home vaccination options, and education about the importance of receiving the vaccine. In addition, these grants will enable the aging and disability networks to identify people who are unable to independently travel to vaccination sites and to provide technical assistance to local health departments on improving access to vaccines.
Approximately $5 million will fund national hotlines to connect older adults and people with disabilities with local disability and aging agencies that can assist with vaccine registration and provide services and supports necessary to get the vaccine. An additional $93 million will be distributed as follows: State Units on Aging and Area Agencies on Aging ($50 million); Aging and Disability Resource Centers ($26 million); Centers for Independent Living that receive federal funding directly from ACL ($5 million); University Centers of Excellence in Developmental Disabilities ($4 million); Protection and Advocacy systems ($4 million); State Councils on Developmental Disabilities ($4 million).
This partnership was established to further the National Strategy for the COVID-19 Response and Pandemic Preparedness, which includes protecting those most at risk and advancing equity as goals.
Administrative Priorities: CMS releases guidance to states on enhanced FMAP funding as part of the American Rescue Plan Act (ARPA)
On May 13, the Centers for Medicare & Medicaid Services (CMS) issued guidance on how states can receive enhanced funding, provided through the ARPA, to increase access to home- and community-based services (HCBS) for Medicaid beneficiaries.
The additional federal funding made available under the ARPA allows states to tailor HCBS enhancements based on the needs and priorities of residents, while protecting and strengthening the HCBS workforce, safeguarding financial stability for HCBS providers, and accelerating long-term services and supports reform and innovation. Section 9817 of the ARPA provides states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid HCBS from April 1, 2021 through March 31, 2022 to improve HCBS under the Medicaid program. States must also comply with a number of Maintenance of Effort (MOE) requirements and can spend the funds through March 2024. Georgia’s spending plan was due to CMS by July 12, and we will continue to monitor and report on any updates.
Congressional Priorities: Bicameral Democratic leaders introduce Better Care Better Jobs Act
As the country begins to resurrect itself after the most devastating global public health pandemic in recent history, the Biden administration and Congress are working towards moving a massive $4 trillion infrastructure development and jobs package that reflects the most significant investment in the nation’s economic recovery since Roosevelt’s New Deal and Johnson’s Great American Society programs. And among this massive recovery plan is the introduction of the Better Care Better Jobs Act, which would allocate $400 billion toward reducing waiting lists of over 820,000 Americans who wish to receive support in their homes instead of in institutional settings, as well as to improve the quality of life of the 3.5 million older adults and people with disabilities already receiving HCBS.
On June 24, Sens. Bob Casey Jr. (D-PA), Ron Wyden (D-OR), Chuck Schumer (D-NY), Patty Murray (D-WA), Tammy Duckworth (D-IL), Maggie Hassan (D-NH), and Sherrod Brown (D-OH) introduced the Better Care Better Jobs Act. This legislation – along with its House companion introduced by Reps. Debbie Dingell (D-MI), Frank Pallone (D-NJ), Jan Schakowsky (D-IL), and Doris Matsui (D-CA) – would invest in and expand access to home- and community-based services for seniors and people with disabilities while boosting the wages, benefits and unionizing opportunities for home care workers.
The Better Care Better Jobs Act seeks to strengthen the country’s HCBS landscape by giving states more money to expand their Medicaid HCBS while also making certain popular policies permanent. Specifically, the bill would –
- Enhance Medicaid funding for HCBS by making states eligible for a permanent 10 percentage point increase in the federal Medicaid match for delivering HCBS as well as enhanced funding for administrative activities associated with improvement efforts. To receive these dollars, states must:
- strengthen and expand access to HCBS by expanding financial eligibility criteria for HCBS to federal limits; require coverage for personal care services; expand supports for family caregivers; adopt programs that help people navigate enrollment and eligibility; expand access to behavioral health care; improve coordination with housing, transportation and employment supports; and develop or improve programs to allow working people with disabilities to access HCBS.
- expand access to Medicaid HCBS and strengthen the HCBS workforce (which is largely made up of low-wage workers, the majority of whom are women and people of color) by addressing HCBS payment rates to promote recruitment and retention of direct care workers; regularly updating HCBS payment rates with public input; passing rate increases through to direct care workers to increase wages; and updating and developing training opportunities for this workforce as well as family caregivers.
- Provide an initial $100 million to encourage innovative models that benefit direct care workers and care recipients and offers additional incentives to help states build HCBS workforce programs that register direct care workers; help connect them to seniors and people with disabilities seeking care; facilitate coordination between the state and direct care workers; support care safety and quality; and help workers organize, among other functions.
States would have to show improvement in quality over time by demonstrating improved availability of services; reduced disparities in accessing and using HCBS; evidence of competitive wages and benefits for workers; and increases in HCBS spending. If passed, the Better Care Better Jobs Act would also provide more funding to CMS to conduct oversight and monitoring activities.
In addition to the previously outlined provisions, the Better Care Better Jobs Act would make permanent both the spousal-impoverishment protections in Medicaid and the Money Follows the Person program, the latter of which is meant to help people transition out of long-term care facilities back into their homes.
In all likelihood, the Better Care Better Jobs Act will not make it into a bipartisan infrastructure package. This means that the HCBS bill will have to pass as a standalone bill that goes through the traditional legislation process. That route is similarly doubtful, however, with Democrats and Republicans effectively lodged in a stalemate for sway in the Senate. Another avenue could be reconciliation, with Democrats actively working on a plan to unilaterally push through important chunks of an immediate infrastructure package that got scrapped. Working in the bill’s favor is the constant attention that HCBS has been receiving since the COVID-19 pandemic began, plus the clear and growing demand for more integrated services at home and in the community.
Administrative Priorities: Executive Order requires federal contractors to pay the $15 minimum wage to workers both with and without disabilities
On April 27, President Biden signed an executive order (EO)requiring federal contractors to pay a $15 minimum wage to hundreds of thousands of workers who are working on federal contracts. The EO builds on the Obama-Biden Executive Order 13658, issued in February 2014, requiring federal contractors to pay employees working on federal contracts $10.10 per hour, subsequently indexed to inflation. The minimum wage for workers performing work on covered federal contracts is currently $10.95 per hour and tipped minimum wage is $7.65 per hour. Specifically, the EO:
- Increases the hourly minimum wage for federal contractors to $15. Starting January 30, 2022 all agencies will need to incorporate a $15 minimum wage in new contract solicitations, and by March 30, 2022, all agencies will need to implement the minimum wage into new contracts. Agencies must also implement the higher wage into existing contracts when the parties exercise their option to extend such contracts, which often occurs annually.
- Continues to index the minimum wage to an inflation measure so that every year after 2022 it will be automatically adjusted to reflect changes in the cost of living.
- Ensures a $15 minimum wage for federal contract workers with disabilities. To ensure equity, similar to the Obama-Biden minimum wage executive order for federal contractors, this executive order extends the required $15 minimum wage to federal contract workers with disabilities.
- Eliminates the tipped minimum wage for federal contractors by 2024.
Congressional Priorities: House reintroduces the Transition to Competitive Integrated Employment Act (TCIEA)
On April 6, Representative Bobby Scott (VA-03), chairman of the Committee on Education and Labor, and Representative Cathy McMorris Rodgers (WA-05), ranking member of the Committee on Energy and Commerce, introduced the Transformation to Competitive Integrated Employment Act (H.R. 2373) to provide states and employers with the resources to transition workers with disabilities into fully integrated and competitive jobs while phasing out the subminimum wage for individuals with disabilities.
A Senate companion bill is expected to be introduced by Senator Bob Casey (D-PA) in the near future. Read the full legislative text here.
Organ transplant discrimination prevention legislation introduced in the US House of Representatives: Charlotte Woodward Organ Transplant Discrimination Prevention Act (HR 1235). Despite federal protections, such as the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973, people with disabilities still face discrimination determining eligibility to receive organ transplants. There are currently laws against organ transplant discrimination in the states of California, Delaware, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Missouri, New Jersey, Ohio, Oregon, Pennsylvania, Virginia and Washington. As of yet, there is no companion bill being prepared in the Senate.
Keeping All Students Safe Act (KASSA) reintroduced
Senators Chris Murphy (D-CT) and Patty Murray (D-WA), chair of the Senate Committee on Health, Education, Labor and Pensions (HELP), and US Representatives Don Beyer (D-VA), Robert C. “Bobby” Scott (D-VA) and A. Donald McEachin (D-VA) reintroduced the Keeping All Students Safe Act, legislation to protect students from dangerous seclusion and restraint discipline practices in school. The most current data reveals that 101,990 students were subjected to seclusion or restraint in the United States during the 2017-18 school year, 78% of whom were students with disabilities and disproportionately Black youth.
President Biden nominates Taryn Williams as assistant secretary for the Office of Disability Employment Policy (ODEP)
Williams is currently the Managing Director for the Poverty to Prosperity Program at the Center for American Progress, which works on progressive policies focused on a broad range of anti-poverty strategies. Before joining American Progress, Williams served as ODEP’s chief of staff during the Obama administration, and later as the director of the Youth Policy Team. Throughout her career, Taryn has worked on a variety of issues related to education, workforce policy, Social Security, Medicaid and civil rights. The Senate Health, Education, Labor and Pensions (HELP) Committee advanced Williams’ nomination to serve as assistant secretary of labor for Disability Employment Policy by a vote of 18 to 4 on June 16, and a final vote on her nomination is expected by early July.
- As the country reopens, lots of money is coming down the pike to get Americans back to work and to rebuild the country, including Home- and Community-Based Services (HCBS).
- In the meantime, states do have enhanced temporary funding through the American Rescue Plan Act of 2021, and advocates are urged to push Georgia to use this funding to expand and enhance HCBS.
- In addition, federal policymakers are focusing heavily on COVID-19 vaccine mobilization targeting people with disabilities and direct support professionals, HCBS modernization efforts, and improving access to competitive integrated employment for young adults with disabilities.
Note: information current as of 6/25/2021