Supporting Community Living during COVID-19: CARES Act and Civil Rights Protections

On Friday, the President signed the Coronavirus Aid, Relief and Economic Security Act, or CARES Act, into law. The Act provides a total of $2.2 trillion, with $955 million directed to ACL programs. On Saturday, the HHS Office of Civil Rights issued a bulletin to protect people with disabilities from unlawful discrimination in decisions about their treatment during the COVID-19 health care emergency. Together, these will provide significant support to older adults and people with disabilities.

OCR Bulletin: Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19)

OCR provided this bulletin to ensure that entities covered by civil rights authorities keep in mind their obligations under laws and regulations that prohibit discrimination on the basis of race, color, national origin, disability, age, sex, and exercise of conscience and religion in HHS-funded programs. The bulletin states that, "…persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative “worth” based on the presence or absence of disabilities or age. Decisions by covered entities concerning whether an individual is a candidate for treatment should be based on an individualized assessment of the patient and his or her circumstances, based on the best available objective medical evidence."

CARES Act

A total of $955 million will be provided to existing grantees in the aging and disability networks, including State Units on Aging and Centers for Independent Living, as well as to Tribes and tribal organizations. The CARES Act includes:

$200M for Home and Community Based Services (HCBS) under Title III-B of the Older Americans Act (OAA);
$480M for nutrition programs under Title III-C of the OAA;
$20M for nutrition and related services for Native American Programs under Title VI of the OAA;
$100M for the National Family Caregiver Support Program under Title III-E of the OAA;
$20M for the Ombudsman Program under Title VII of the OAA;
$50M for Aging and Disability Resource Centers; and
$85M for Centers for Independent Living under Title VII, Part C, Chapter I of the Rehabilitation Act.

ACL staff currently are developing FAQs and other technical assistance materials. We will share these in the coming days through our resource centers and our COVID-19 page. These will include:

Programmatic and fiscal FAQs for Centers for Independent Living
Updates to the FAQs for nutrition services providers, which will address both the provisions of the CARES Act and other questions we have received about how waivers for Daily Reference Intake requirements affect eligibility for the Nutrition Services Incentive Program, working with food banks, contracting with food vendors, coordination with FEMA, and more
Information on reporting requirements for COVID-19 services
FAQs related to ADRC funding including timing, eligibility, and how states can use the funds to address COVID-19 needs.

In addition, we will update the Fiscal FAQ (for Older Americans Act programs) to reflect the increase in the allowance for administration costs that went into effect with reauthorization.

CARES Act Highlights

In addition to this supplemental funding, there are many provisions in the CARES Act that will benefit people with disabilities, older adults, and the aging and disability networks. Highlights include:

Section 3222 describes three waivers that will allow (1) 100% of funds to be transferred between congregate and home-delivered meal programs, (2) individuals who are homebound for social distancing purposes to be eligible for home-delivered meals, regardless of state or local policies, and (3) waiver of dietary guidelines, so networks can provide available meals to recipients. (These provisions will be addressed in this week’s FAQs.)

Section 3715 allows direct care workers who provide services under Medicaid waivers (1915 and 1115) to accompany people with disabilities as they enter hospitals to continue to provide services that are not provided by the hospital.

Section 3803 provides an extension of funding for the Medicare Improvements for Patients & Providers Act (MIPPA). Provisions in this section will allow for continued funding to State Health Insurance Assistance Programs (SHIPs), Aging and Disability Resource Centers (ARDCs) and Area Agencies on Aging (AAA) to help older Americans and people with disabilities enroll in the Low-Income Subsidy for Medicare Part D (which helps pay for the Part D premium) and the Medicare Savings Programs (which helps pay for Medicare Part B).

Section 3811 extends funding for the Money Follows the Person demonstration program through November 30, 2020.

In addition, the CARES Act provides for expanded telehealth options and explicitly includes non-profit organizations in the provisions for small business loans.