In this Policy Round Up:
- HHS response to Supreme Court decision to overturn Roe v. Wade.
- From HUD: New funding to expand housing services to address unsheltered homelessness, particularly in rural communities
- COVID-19 Updates:
- Updated vaccine recommendations: CDC recommends COVID-19 vaccines for people 6 months and older; boosters for people 5 and up
- Public Health Emergency Unwinding Updates: Medicaid eligibility; Audio telehealth
- CDC report illustrates increased risks of COVID-19 for people with disabilities
- HHS Extends American Rescue Plan Spending Deadline for States to Expand and Enhance Home- and Community-Based Services for People with Medicaid
- New Medicaid Transportation Page on Medicaid.gov
- U.S. Department of Education’s Office for Civil Rights: Actions to Improve Digital Access in Education
- In case you missed it:
- COVID-19 tests for people who are blind or have low vision
- From the Network: NDRN toolkit on voting rights and guardianship
HHS response to Supreme Court decision to overturn Roe v. Wade.
On Friday, June 24, the Supreme Court overturned Roe v. Wade in its ruling Dobbs v. Jackson Women’s Health Organization.
Following the decision, HHS Secretary Xavier Becerra issued this statement, and HHS launched a new website, ReproductiveRights.gov, to provide accurate, up-to-date information about access to and coverage of reproductive health care and resources.
Yesterday, Sec. Becerra, along with Secretary Marty Walsh, and Janet L. Yellen of the U.S. Departments of Labor and Treasury, respectively, issued a letter to group health plans and health insurance issuers reminding them of their obligations under the Affordable Care Act (ACA) to provide coverage for contraceptive services at no cost.
New funding from HUD: Community-based approaches to addressing unsheltered, rural homelessness
Last week, the Department of Housing and Urban Development announced an initiative to address unsheltered homelessness, particularly in rural communities. The goal is to connect people and families experiencing (or at risk of) homelessness to housing, health care, and supportive services.
This initiative will fund competitive grants totaling $322 million to existing Continuums of Care (CoC), which bring together community partners from multiple sectors, including public housing and housing services agencies, health care organizations, and community-based organizations that provide supportive services to address homelessness. It also includes additional funding for housing vouchers.
The aging and disability networks are actively engaged in many communities’ CoCs and could be invaluable partners to CoCs in other communities. Not already involved in yours? This page on HUD’s website includes a state-by-state list of CoCs along with contact information.
In nearly every community, people with disabilities, as well as people who identify as LGBTQ+ and those who are Black, indigenous, and from other communities of color are substantially overrepresented in the homeless population. Homelessness is also a growing crisis for older adults; in 2020, people 65 and older were the fastest-growing age group of people who are homeless, and their numbers are projected to triple by 2030.
While the funding is directly available only to certain HUD grantees, the aging and disability networks can partner with housing authorities to help secure the resources for their communities. Applications are due October 20, 2022.
Unsheltered homelessness refers to people living on the streets or in tent cities, cars, abandoned buildings, or other places not meant for human residence. Unsheltered homelessness is continuing to rise in many areas of the country, and recent analysis of homelessness data shows that people experiencing unsheltered homelessness report significantly greater health challenges and experiences of trauma and violence than their sheltered peers. These challenges often begin before they lose their housing.
The new initiative includes:
- $322 million in Continuum of Care Program grants through a Special Notice of Funding Opportunity to fund homeless outreach, permanent housing, supportive services, and other costs as part of a comprehensive community approach to solve unsheltered homelessness, including a set-aside of $54.5 million specifically for rural communities. These grants will fund projects for three-years, after which they will be eligible for renewal through the annual Continuum of Care program competition. To apply, CoCs will need to demonstrate a comprehensive community approach to reduce homelessness among people experiencing homelessness with severe service needs, especially those with histories of unsheltered homelessness.
- $43 million to fund approximately 4,000 new incremental vouchers will be allocated via a separate notice to public housing authorities with a priority to those that are partners in comprehensive community approaches to solve homelessness. These vouchers will be administered through a separate but coordinated PIH process. The idea is that communities will seek both the grant through the CoC NOFO and separately seek the new vouchers to leverage the two resources in addressing unsheltered homelessness.
In every state and community, there are a number of entities and programs helping people access housing and supportive services, but the housing and service systems often are siloed. Stronger collaboration between these systems would enable states and communities to coordinate resources to help older adults, people with disabilities and people experiencing homelessness achieve housing stability, live with dignity and independence in the community, and avoiding homelessness and costly institutional care.
To build that collaboration, HHS and HUD launched the Housing and Services Resource Center in December 2021. The Housing and Services Resource Center website brings together -- for the first time -- a wide variety of federal resources and guidance on both housing and services that support community living, including Medicaid-funded home and community-based services, behavioral health supports, vouchers, and other housing programs. The HSRC website also provides information about the organizations in the respective networks and examples of successful partnerships and strategies for more effectively and efficiently connecting people to affordable, accessible housing and the services provided in the home or community to support independent living. Through the Housing and Services Resource Center, HHS and HUD will offer webinars, develop and disseminate new technical assistance resources, facilitate peer-to-peer learning and launch a learning collaborative.
CDC recommends COVID-19 vaccines for people 6 months and older; boosters for people 5 and up
On June 18, the Centers for Disease Control and Prevention recommended the use of vaccines in children ages 6 months to 4 years, noting their safety, as well as their effectiveness in preventing severe COVID-19 outcomes. This comes on the heels of FDA emergency use authorization for the Pfizer BioN-Tech and Moderna vaccines for this age group on June 17. With this recent approval, COVID-19 vaccines are now recommended for nearly everyone in the United States.
Vaccines for children age 5 to 11 have been available since November, and the CDC is now recommending a booster dose for children who received their primary vaccine series at least five months ago.
The CDC’s website includes comprehensive information on vaccines for children and teens, including a tool for determining if it is time for a booster, safety information and a vaccine locator. Vaccines.gov (English) and Vacunas.gov (Spanish) also are available to help people locate vaccines. The federal government is providing vaccines free of charge irrespective of insurance or immigration status. CMS has released a number of resources for providers on how to bill for vaccines, including children covered by CHIP and Medicaid.
Public Health Emergency Unwinding Updates: Medicaid eligibility
As we’ve discussed in recent blogs, states have not been allowed to disenroll people from Medicaid during the COVID-19 pandemic (with limited exceptions). When the Public Health Emergency (PHE) ends, states will go through an “unwinding” of this requirement, and others that have been in place for the last two years. As a result, the eligibility of millions of Medicaid beneficiaries will have to be redetermined.
New tool for states
The Centers for Medicare and Medicaid Services (CMS) has released a number of resources to help states prepare for the eventual end of the PHE and return to normal Medicaid and CHIP eligibility and enrollment operations. Most recently CMS recently released a fact sheet for states that consolidates a number of other helpful resources and lays out ten critical steps t to take as they prepare for the transition. These include coordinating with government and community partners, launching effective communications strategies, and obtaining updated contact information for beneficiaries.
Help for beneficiaries
CMS also has updated Medicaid.gov to help beneficiaries prepare for renewal of their Medicaid or CHIP coverage. The enhancements will make it easier for beneficiaries to connect to their state Medicaid agency, where they can update their contact information, get information on how to prepare for renewal and complete renewal forms.
Public Health Emergency Unwinding Updates: Audio-Only Telehealth Guidance
The HHS Office for Civil Rights recently released guidance on how HIPAA rules permit the use of audio-only telehealth services when the March 2020 Telehealth notification suspending certain HIPAA compliance requirements expires at the end of the public health emergency.
Issued in response to an Executive Order on Transforming Federal Customer Experience and Service Delivery to Rebuild Trust in Government (E.O. 14058), this guidance will help ensure people can continue to benefit from audio-only telehealth options and improve public confidence in privacy and security of health information.
This HHS website brings together telehealth resources for consumers and providers, including information about Medicare and Medicaid coverage and billing for telehealth services.
CDC report illustrates increased risks of COVID-19 for people with disabilities
In a new Morbidity and Mortality Weekly Report, CDC reports findings from a comparison of data on COVID-19 cases and hospitalizations from January 2020 to November 2021 for two groups of Medicare beneficiaries:
- Adults (of any age) who were initially eligible for Medicare due to disability (“disability-eligible beneficiaries”).
- Beneficiaries who became eligible for Medicare when they turned 65 (“age-eligible beneficiaries”).
(People who became eligible for Medicare due to disability but who had reached the age of 65 were counted only in the disability-eligible group; nearly half of the disability-eligible beneficiaries were over the age of 65.)
- Overall, incidence and hospitalization rates were significantly higher for disability-eligible beneficiaries than for age-eligible beneficiaries.
- The overall incidence rate was 35 percent higher for disability-eligible beneficiaries
- The overall hospitalization rate was nearly 50 percent higher for disability-eligible beneficiaries.
- The one exception was for American Indian and Alaska Native (AI/AN) beneficiaries; rates were higher for age-eligible AI/AN beneficiaries than for disability-eligible AI/AN beneficiaries.
- The differences in hospitalization rates are even more stark for people 65 and older.
- For people ages 65-74, the hospitalization rate for disability-eligible beneficiaries was more than two and a half times that of people without disabilities.
- Disability-eligible beneficiaries ages 75-84 were nearly twice as likely to be hospitalized than their age-eligible peers.
- For both groups:
- Hospitalization rates were highest for AI/AN beneficiaries, followed closely by Black and then Hispanic beneficiaries.
- Incidence rates also were highest for AI/AN beneficiaries, followed by Hispanic and then Black beneficiaries.
- Both incidence and hospitalization rates increased with age .
It’s important to note that the report findings cannot be extrapolated to say that all people with disabilities are at higher risk of hospitalization than older adults.
Among other limitations, the report notes that disability-eligible Medicare beneficiaries are not representative of all people with disabilities; they may have more (or more severe) risk factors and therefore more severe outcomes than those experienced by people with disabilities overall.
The report concludes by stating that continued COVID-19 prevention efforts and focused messaging for with disabilities remain high-impact public health priorities. It specifically calls for:
- Additional prioritization of people with disabilities in public health programs, data systems, and preparedness and response activities at the federal, state, and local levels.
- Collection of disability status as a core demographic variable in public health surveillance data and identification and addition of disability questions in other existing data sources to guide research and development of interventions for persons with disabilities.
HHS Extends American Rescue Plan Spending Deadline for States to Expand and Enhance Home- and Community-Based Services for People with Medicaid
CMS has extended the deadline to use funding made available by the American Rescue Plan (ARP) for HCBS by one year, to March 31, 2025. As we have written in previous blogs, Section 9817 of the ARP provided states with a temporary 10% increase in federal funding, also referred to as “the FMAP bump,” to enhance, expand, or strengthen home and community-based services under the Medicaid program.
The extended deadline gives states more time to use federal funding to improve their home and community-based services infrastructure.
For example, states can use the additional time to increase workforce capacity, reduce waitlists and develop additional supports for family caregivers. CMS has collected a variety of resources to assist states assist states on a dedicated “one-stop shop” webpage, and ACL created a fact sheet to help states explore options for using ARP funding to expand employment supports for people with disabilities.
ACL’s networks have assisted states as they develop and implement their ARP plans and will continue to be an important partner moving forward. Continue to spread the word and continue collaborating with states through March 2025 and beyond to maximize the impact of the FMAP bump.
New Medicaid Transportation Page on Medicaid.gov
CMS has launched a new webpage on Medicaid.gov with information about requirements for non-emergency medical transportation under Medicaid, which changed in 2021. States have had a long-standing requirement to provide transportation for emergency and non-emergency visits and are now required to meet additional requirements to ensure the safety of beneficiaries and the integrity of the benefit. These include:
- Transportation providers and individual drivers are not eligible to provide Medicaid transportation services if they currently are excluded from participating in any federal health care program (e.g., Medicare, Medicaid);
- Each individual driver must have a valid driver’s license;
- The transportation provider must have a process in place to address any violation of state drug laws;
- The transportation provider must have a process to disclose to the state Medicaid program the driving history of each individual driver employed by the provider.
Transportation providers in the aging and disability networks can find more information and recordings of stakeholder listening sessions for shared provider expertise and perspective on the new CMS page.
U.S. Department of Education’s Office for Civil Rights Announces Actions to Improve Digital Access in Education
In May, the U.S. Department of Education Office of Civil Rights (OCR) launched 100 new reviews of digital accessibility of public-facing and student-facing websites and educational platforms maintained by state departments of education, school districts, charter schools, public libraries, and public and private 2- and 4-year colleges and universities.
Under Section 504 of the Rehabilitation Act and Title II of the ADA covered entities must make reasonable modifications to their digital platforms to ensure all are accessible to people with disabilities. Compliance reviews are a tool used to enforce this requirement.
In partnership with the ACL-funded ADA National Network, the Department of Education’s OCR also released a comprehensive 20-part video series on digital accessibility. to help covered entities comply with ADA and Sec. 504 requirements. The videos are a useful tool for anyone – including the aging and disability networks -- seeking to build or improve a digital platform and range from the fundamentals of digital accessibility and to advanced information and guidance.
Please help share them with your contacts and partners.
In case you missed it:
- COVID-19 tests for people who are blind or have low vision: On June 23, the Biden-Harris Administration launched a new initiative to expand the availability of at-home tests that are more accessible for people who are blind or have low vision. The tests work with a compatible Bluetooth-enabled smartphone and free app to provide users with audible instructions and audible test results. They are available for free while supplies last, and can be ordered online or by calling 1-800-232-0233.
- From the Network: NDRN toolkit on voting rights and guardianship: Voting is a fundamental right that should almost never be taken away. Sometimes, however, individuals who have a guardian appointed by a court are prevented from voting because state laws disqualify them from voting or because the right to vote is taken away when a guardian is appointed. The National Disability Rights Network, in partnership with the Bazelon Center for Mental Health Law, created a toolkit to help people seeking to retain or restore their right to vote. It contains sample court documents that can be used by individuals seeking to retain or restore their right to vote in a guardianship proceeding.