Congress and the President just sent a huge and hopeful message to people with disabilities across the country: Help is on the way! The American Rescue Plan Act is an historic COVID-19 relief bill that includes the largest infusion of federal support for services for people with disabilities in over a decade.
People with disabilities have been hit hard by the COVID-19 pandemic. As COVID-19 swept through nursing facilities, psychiatric hospitals, and group homes for people with disabilities, it became very clear that isolating in one’s own home is safer than a congregate facility. However, many individuals with disabilities require direct hands-on services to help with bathing, eating, and moving around that make it difficult to isolate. These and other services that help people live and participate in their communities are known as Home and Community-Based Services (HCBS). Personal care aides and other direct service professionals who provide HCBS may work with multiple clients across various settings (including high risk settings such as nursing facilities), which can increase exposure risk to both the caregivers and their clients. Access to personal protective equipment was, and in some cases remains, inadequate.
Despite the elevated risks, the first five federal COVID-19 relief bills failed to provide targeted support that could help people with disabilities isolate safely and maintain access to the HCBS they need to keep living in the community.
A Big Funding Boost for HCBS
Finally, the Act provides states with a 10% boost in federal Medicaid matching funds for HCBS through March 2022, which should infuse $12.67 billion in extra funding. States must reinvest the added federal funding to supplement their annual expenditures on supports and services for people with disabilities. For example, states could reduce or eliminate HCBS waiting lists, add new services and programs or increase their availability, or increase low rates for HCBS providers to ensure adequate networks. HHS should quickly provide states with clear guidance on different options they can use to invest these funds to build their HCBS capacity, so that improvements can start right away.
Additional Support for Behavioral Health Services
A second key change in the Act’s provision is that it includes a broad definition of what counts as HCBS. The definition includes service categories that are often used to cover community-based behavioral health services – like counseling, community support services, and assertive community treatment – that sometimes get left out of HCBS initiatives. These essential services for individuals with psychiatric disabilities and substance use disorder will receive a much-needed temporary boost to help people remain in the community. Several studies have shown not only that the pandemic has increased stress and the prevalence of behavioral health conditions, but also that it has decreased access to mental health and substance use disorder treatments.
States that want to add a longer term boost to their behavioral health treatment capacity can also take advantage of another Rescue Plan provision that provides an enhanced 85% federal matching rate for three years to fund mobile crisis team services trained in trauma-informed care and de-escalation strategies. These teams effectively reduce harm to people undergoing acute episodes by avoiding potentially dangerous encounters with undertrained law enforcement, and can free the police to prioritize other activities. Enhanced funding for mobile crisis begins one year after enactment of the law. Advocates should be aware, however, that this boost allows states to disregard important Medicaid enrollee protections, such as the requirement that states provide the Medicaid services statewide, and not just in one city or town. Engaging early with states that might consider taking up this option can ensure the benefit is delivered equitability to all who need it.
Even as vaccine availability increases, the effects of the COVID-19 pandemic will have long-lasting impacts on the disability community. Despite its tragic impact, the pandemic has also led to new models of community-based care that de-emphasize congregate care settings and provide individuals the services they need in their own homes. We have long known that community-based models lead to better outcomes and more independence, often at a lower per person cost, than large congregate approaches. The American Rescue Plan Act can provide much needed boost for these innovations giving states the capital they need to build their HCBS capacity. Advocates are already thinking how to keep this momentum going after the one-year boost winds down. After all, access to HCBS helps many people with disabilities do what most of us are longing for – engage with others and enjoy the full benefits of community living.
See other entries in our American Rescue Plan Act series:
- American Rescue Plan Act Takes Landmark Step Toward Ending Our Black and Indigenous Maternal Mortality Epidemic
- The American Rescue Plan Act: What’s it do for Health?