On Tuesday, May 5th, 2020, Academy Members and partners convened for the Academy’s third Virtual Roundtable on Responding to the COVID-19 Crisis: Impacts on the Disability Community, moderated by Rebecca Vallas, Senior Fellow at the Center for American Progress. The online discussion featured three Academy experts:
- Merrill Friedman, Senior Director, Disability Policy Engagement, Anthem
- Bethany Lilly, Director of Income Policy, The Arc
- Robert Espinoza, Vice President of Policy, PHI
During this Virtual Roundtable, panelists discussed the health and economic impact of the COVID-19 pandemic on people with disabilities, examined the adequacy of the current policy response, and outlined how future federal and state legislation might further address the needs of people with disabilities. (A close-captioned recording of the webinar is available on the event page.)
Merrill Friedman kicked off the roundtable by discussing how the health of people with disabilities has and will continue to be impacted by the COVID-19 crisis. People with disabilities are at an elevated risk of infection due to a variety of socioeconomic and health factors, such as prevalence of underlying conditions, congregate settings (i.e. institutional care), and higher rates of poverty. Additionally, people with disabilities are likely to need to shelter in place longer, even after restrictions are lifted, and face difficulties accessing assistance with daily living activities during the COVID-19 crisis.
As health care providers continue to shift to telehealth visits, Friedman reminded the audience to remember that these services are not accessible to all. “People with disabilities have always been at higher risk during any crisis. While non-disabled people can easily rely on technology during shutdown, there are many issues to navigate for accessibility,” Friedman stated.
There are a variety of policy responses that the health care industry can take to ensure that available services meet the needs of people with disabilities. Friedman recommends that providers and insurers collaborate with community leaders, partner with local and national community organizations, and maintain an open and on-going dialogue with members of the disability community.
Friedman concluded with recommendations to Congress from Anthem’s National Advisory Board. These recommendations include creating policies to support the direct care workforce that provides essential assistance to people with disabilities, ensuring equal access to health care treatment and services under the Americans with Disabilities Act, and including coverage of peer support services for people with mental health and substance use disorders. People with disabilities also need exceptions to restrictive hospital visitor policies, so a care worker can assist and advocate for them. Lastly, the recommendations suggest allowing Medicare and Medicaid health plans to dispense a 90-day supply of medications or facilitate early and/or mail order refills of psychiatric prescriptions.
The impacts of the pandemic are not just limited to health. Bethany Lilly’s presentation highlighted the significant toll of the pandemic on the economic wellbeing of people with disabilities. Current relief packages include provisions to address these impacts and increase resources available for people with disabilities, but the packages still have considerable gaps and many people are getting left out.
The Families First Coronavirus Response Act (FFCRA) included emergency paid family and medical leave for parents whose children have lost their usual source of care (school, day care, etc.). However, people with disabilities who are at high risk of complications from COVID-19 and caregivers who are not parents are not eligible under this Act. Additionally, people working for employers with over 500 employees are not eligible for the paid leave benefits under the FFCRA.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) includes $1,200 direct payments (tax rebates) to individuals. Rather than using the Social Security payment system, which is able to quickly reach many persons with a disability regardless of tax-filing status, the payments are being made through the IRS system. Initially, automatic payments were only available for those who have filed taxes. With advocates weighing in, federal officials clarified that automatic payments would be available for some non-filers, including Supplemental Security Income (SSI) recipients, and Social Security (retirement and disability) beneficiaries. Unfortunately, there are still gaps. Those that are SNAP and/or Medicaid expansion recipients have not received automatic payments, and children who receive SSI benefits have not automatically received the $500 dependent payment. There are policies in place to enable eligible non-filers to receive their payments, but people may require assistance filing the form, and it is currently not accessible for blind or visually impaired individuals who use screen reader software.
The $1,200 direct payment does not count toward asset limits for federal and state assistance programs. However, this is not the case for unemployment benefits for some programs. Many individuals automatically access Medicaid coverage through receiving SSI benefits. The boosted $600 weekly unemployment benefit may put recipients over the threshold for SSI benefits, which means people can lose access to Medicaid. This was addressed by the maintenance of effort provisions in prior legislation authorizing increased Medicaid funding, but this example highlights the interaction between different programs and how people can fall through the cracks. “We should be thinking of how all of these systems work together when we design relief packages,” Lilly stressed in her presentation.
Direct Care Workforce Impacts
Direct care workers are critical resources for people with disabilities to live independently in home and community settings, but these workers have largely been left out of recent legislation. Robert Espinoza provided critical insights on the impact of COVID-19 on direct care workers and potential policy options to better support this critical workforce.
“There are 4.5 million home care workers in private homes, nursing homes, and residential care. They are essential workers who are underrecognized and undervalued. Their median income is $12 an hour, and most live at or near the poverty level,” said Espinoza. Direct care workers are deemed essential during the COVID-19 crisis and yet have limited access to personal protective equipment (PPE), supplies and general resources, and lack adequate compensation and benefits. Additionally, there are growing workforce shortages and there is a need to include COVID-19 training in the workforce pipeline.
Espinoza concluded with recommendations for state and federal policymakers to better support the direct care workforce. Recommendations for state leaders include improving compensation for workers, ensuring access to PPE, filling the gaps in emergency paid leave policies, disseminating training on COVID-19 to all direct care workers, and building pipelines into direct care jobs. For federal leaders, Espinoza recommends considering passing the “Coronavirus Relief for Seniors and People with Disabilities Act,” ensuring access to paid sick leave, implementing immediate recruitment campaigns, and increasing the data across the sector on COVID-19 infections and deaths.
Current COVID-19 response packages include provisions to address the impacts on, and increase the resources available for, people with disabilities, such as expansions to paid leave benefits, increases in nutrition assistance programs, expansions of unemployment insurance programs, and increases in funding for housing and independent living centers for people with disabilities.
“The devil is in the details,” stressed moderator Rebecca Vallas. The response legislation to-date is a step forward, but the Academy’s Virtual Roundtable highlighted the many gaps that still need to be addressed. People with disabilities, their family caregivers, and direct care workers are not fully receiving the help they need to weather the storm. When designing future relief packages, policymakers need to examine how different social insurance programs work together and support policies that ensure that people with disabilities have access to critical services during this crisis.