Policy Round-Up: Medicaid Final Rule, COVID-19 Updates, Head Start Expands Eligibility, and ACL Fact Sheet

June 2, 2022
Vicki Gottlich, Director - Center for Policy and Evaluation

In this Policy Round Up:

Medicaid final rule: Reinstates exemption that helps HCBS workers get employee benefits

In May, CMS published a final rule on reassignment of Medicaid provider claims. The rule includes provisions that will help direct care workers who provide home and community-based services (HCBS) get important benefits like health insurance and job training. By helping to address one of the key causes of the severe shortage of direct care workers, this rule will help improve and stabilize the workforce, which is critical to improving the quality and availability of services for older adults and people with disabilities. The rule also will help to level the playing field between agency-employed workers and independent practitioners.

The aging and disability network works with a number of these individual practitioners and can help spread the word among workers and states to ensure all direct care workers have access to important employee benefits.

A 2019 rule changed longstanding Medicaid payment policy regarding how state Medicaid programs could pay for benefits on behalf of certain providers. With this rule, CMS returns to its prior interpretation of the statute. The current policy allows (but does not require) state Medicaid programs to pay for benefits generally offered through an employer-like health insurance, training fees and union dues- on behalf of “individual practitioner” (sometimes also called an independent provider). An individual practitioner is not employed by a private agency, institution or state Medicaid agency but provides Medicaid services and receives most of their revenue from reimbursement for those services. Because of this, an individual practitioner has an employee-like relationship with the Medicaid agency. These practitioners could be home health workers, personal care assistants or other home and community-based service providers.

COVID-19 Updates:

New CMS resource: Public health emergency “unwinding period”

The Centers Medicare & Medicaid Services recently released a new resource to help states understand and meet legal requirements for Medicaid, the Basic Health Program and the Children’s Health Insurance Program when the COVID-19 public health emergency (PHE) ends. 

With limited exemptions, states have not been allowed to disenroll Medicaid beneficiaries during the PHE. When the PHE ends, states will have to perform millions of redeterminations to see who is still eligible and who is not. To assist states with that work, the tool includes information on the requirements for eligibility renewals and redeterminations, application processing, fair hearings, coordination with the Marketplace, and other processes.  It also highlights temporary options available to states during the unwinding period to facilitate eligibility and enrollment processing and to help retain coverage for eligible individuals. 

It will require “all hands on deck” to ensure the PHE unwinding period goes smoothly to avoid harmful gaps in coverage for people who rely on Medicaid to stay well and independent. The aging and disability networks are critical partners in ensuring older adults and people with disabilities can continue to receive the supports and services they need without disruption.

More info:

Updated CMS COVID-19 vaccine toolkit

CMS recently updated the portions of its COVID-19 vaccine toolkit for Medicaid, the Children’s Health Insurance Program (CHIP) and the Basic Health Program. The toolkit, which is updated as new information is available, is intended to help policymakers identify and address issues relating to vaccine coverage and reimbursement for people enrolled in Medicaid, CHIP and the Basic Health Program. On May 5 and May 6, CMS published updates to the following sections of the toolkit:

  • Vaccine distribution recommendations, which include the current list of vaccines available for use in the United States (Page 5).
  • Medicaid & CHIP Reporting Requirements & Implications (Page 53).
  • COVID-19 Resources from HHS (Page 64).

DOJ fact sheet: Enforcement actions COVID-19 vaccine website accessibility issues

A new fact sheet from the Department of Justice (DOJ) reiterates earlier guidance on accessibility requirements for websites under the Americans with Disabilities Act and describes some of the enforcement actions taken by DOJ to address inaccessibility of COVID-19 vaccine websites. DOJ reached agreements with several companies to address issues that limited people with disabilities in using vaccine scheduling websites, such as required information (like first and last names, birthdates, and zip codes) not being “read” to users of screen readers, and available vaccination times not being available to “select” by people using keyboards.

The ADA requires that businesses provide people with disabilities full and equal access to services including those offered online. Similarly, state and local governments must not discriminate based on disability including in services and programs provided online. Both must ensure that they communicate effectively with people with disabilities. As the aging and disability network continue to assist people with disabilities access vaccines and boosters, any suspected violations of the ADA should be reported to the Department of Justice.

Head Start expands eligibility to SNAP recipients

The Administration for Children and Families recently announced that receiving Supplemental Nutrition Assistance Program, or SNAP (sometimes called “food stamps”) meets the definition of “public assistance” for the purposes of determining eligibility for Head Start services. This means that if a family receives SNAP, they automatically qualify for Head Start.

This will make it easier for Head Start programs to reach families, minimize the burden on families seeking public assistance and coordinate benefit programs so that families eligible for one program can more easily participate in other services for which they qualify.

With programs for infants, toddlers, and preschoolers, Head Start helps children from low-income families – including children with disabilities  get ready for school. SNAP supplements food budgets for low-income families, with special eligibility rules for families that include an older person or a person with disabilities.

ACL fact sheet: Using American Rescue Plan funding to advance competitive, integrated employment

The American Rescue Plan provided states with a temporary 10% increase in federal funding to enhance, expand, or strengthen home and community-based services – including many employment services  under the Medicaid program. This Federal Medical Assistance Percentage increase, or “FMAP bump,” totals an estimated $12.7 billion and offers states a rare opportunity to promote and support competitive integrated employment for people with disabilities.

To access these funds, states must submit plans to the federal government with details on how they will spend their federal money. With extensive experience and expertise in supporting employment for people with disabilities and older adults in their communities and eliminating barriers to inclusion and health equity, ACL’s networks are important partners for states as they put their plans into action. This fact sheet includes state examples and resources to support those partnerships and facilitate sharing of information across states.


Last modified on 06/02/2022


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