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Direct disability support services are mostly administered by nonprofits that take Medicaid money, organizations that may not be eligible for relief with the new bill.
UPDATE: The provision described below was taken out of the final legislation, a reprieve for disabled people and their caregivers.
After a long, arduous negotiation, the Senate and the White House have agreed on the final details for a coronavirus relief bill. Final passage has not been reached, and as of press time the text of the bill has not been released, but some details have been made public. There’s $250 billion set aside for direct payments to individuals and families, $350 billion in small-business loans, $250 billion in unemployment insurance benefits, and $500 billion in loans for companies (which the Federal Reserve can top up to over $4 trillion). Senate Minority Leader Chuck Schumer (D-NY) called it “the largest rescue package in American history” Wednesday morning on the Senate floor. But major questions remain for how the bill might impact the people most vulnerable to coronavirus: disabled people and seniors.
In an earlier Republican proposal, “nonprofits receiving Medicaid expenditures” would not have access to forgivable small-business loans. Some Democratic aides, according to The Washington Post, suspect that this exclusion is an effort to defund reproductive health care (and abortion) providers like Planned Parenthood. Sen. John Barrasso (R-WY) seemingly confirmed this to Bret Baier Tuesday night on Fox News.
However, the provision would have a much larger splash zone than just Planned Parenthood. Direct disability support services—for example, home health care aides and day programs for people with significant disabilities—are mostly administered by nonprofits that take Medicaid money. The Arc of the United States is a prime example. That organization has 620 chapters and, according to Senior Policy Director Nicole Jorwic, serves approximately one million people with intellectual and developmental disabilities and their families. Services provided include adult day services for people who may not be able to work and help with activities of daily living like getting out of bed or showering.
In a desire to kneecap Planned Parenthood, Republicans may decimate the care that millions of disabled people rely upon.
Many nursing homes are also nonprofits that rely on Medicaid, although it appears they have a specific carve-out in the agreement: $200 million to assist nursing homes with infection control, as these facilities have emerged as particularly vulnerable to coronavirus. Having a lot of at-risk people living close together is usually a tinderbox for infection, and that is even more true in the time of coronavirus. However, according to the U.S. Census Bureau, only 5 percent of Americans over 65 live in nursing homes, assisted-living facilities, or other forms of congregate care. The majority rely on paid home care, which is mostly administered by nonprofits funded by Medicaid, or unpaid care from family members. These are precisely the kinds of entities that would be locked out of small-business loans, under the earlier Republican bill. In a desire to kneecap Planned Parenthood, Republicans may decimate the care that millions of disabled people rely upon.
There is already a crisis among home care providers, because there simply aren’t enough workers. The average pay is $10.72 an hour, annual turnover is 45 percent, and the average vacancy rate is around 9 percent, according to one 2017 report. Organizations are not able to raise wages themselves, because the amount Medicaid pays out per person is set by the states, and most are not profitable enterprises.
Home care is often intimate. It can involve helping someone get dressed, brushing a person’s teeth, and more. The risk of infection transmission to both providers and the disabled people they serve is high. As more states issue shelter-in-place orders and as the virus spreads, the shortage of home health aides is only going to get worse, leaving some of the most vulnerable people in our society unable to fulfill basic needs. Caregivers are going to get sick. Then what will happen to the people they take care of?
The Senate is set to pass the legislation imminently. Hopefully, Democrats and Republicans have not decided to discard people with significant disabilities as they rush toward addressing the economic crisis.
