Congress Expected to Send America Rescue Plan to President This Week

Posted on March 10, 2021 by Kari Thurlow

The Senate has finally released the complete version of the American Rescue Plan passed on Saturday, and the bill has now gone to the House. It is expected that the House will vote on that bill today – and passage is expected – so the President can sign the bill into law by the end of the week. Because this legislation will provide the State with additional financial support, we are optimistic that its passage will support our advocacy work at the state level to support a Hero Pay Bonus for all caregivers in congregate care settings during the pandemic. 

Below are some of the key provisions in the bill that are notable for senior care providers. We are still reviewing the bill and its contents and will be working with state policymakers as they work to utilize these new resources. 

HCBS FMAP bumped up from 7.35% to 10%
State plan home /health and personal care, PACE services, and waiver services – such as Adult Day Services – are eligible for this increased federal match. This is larger than the 7.35% increased the House bill included, and the 10% increase will direct about $12 billion to Medicaid HCBS from April 1, 2021-March 31, 2022. The money will go to state agencies, which will have discretion over how to use the dollars. Critically, the American Rescue Plan requires that states actually use these dollars for their HCBS programs and not for other purposes. Specifically, the legislation requires states to use the funds to "supplement, and not supplant, the level of State funds expended for home and community-based services for eligible individuals through programs in effect as of April 1, 2021". Further, states must "enhance, expand, or strengthen" their HCBS programs, but the legislation does not spell out how the states can/cannot do so.

Provider Relief Fund
The Senate bill includes an $8.5 billion allocation to the Provider Relief Fund specifically for providers in rural areas who have yet to receive a payment. This was something that LeadingAge advocated for and is a victory for rural providers. Eligible providers include both congregate settings as well as other home and community-based service providers. There was an amendment offered by Senator Susan Collins (R-ME), Senator Tillis (R-NC) and Senator Cramer (R-ND) that would have offered an additional $35 billion in relief for providers including assisted living and “senior congregate home providers.” However, this amendment was defeated on the Senate floor. 

Older Americans Act COVID-19 Vaccine and Activity Funding
Older Americans Act (OAA) programs will receive emergency funding under the American Rescue Plan. About half of the proposed $1.4 billion will go to senior nutrition programs, and about a half billion dollar would go to supportive services, which can include HCBS. States can also use the half billion-dollar allocation for COVID-19 vaccine outreach, education and transportation specific to older adults as well as activities to mitigate the virus itself and its implications for older people, including social isolation.

Funding for Nursing Homes
There are two separate pots of money for continued support for nursing homes. The bill includes $200 million for COVID-19 infection control support in skilled nursing facilities. Support will be provided via quality improvement organizations. The bill also includes $250 million to establish “strike teams” to respond to COVID-19 outbreaks in skilled nursing facilities.

State and Local Aid
The American Rescue Plan also includes $350 billion for state and local (city and county) governments. States will receive roughly $195 billion of this amount and the remainder will be divided evenly between cities and counties. Funds can cover costs incurred through the end of 2024. It appears that Minnesota state and local governments are estimated to receive an allocation of approximately $4.88 billion. These dollars are separate from and in addition to the CARES Act state and local dollars. The American Rescue Plan offers states and localities more flexibility with how to use the dollars relative to the CARES Act money.

Paycheck Protection Program Enhancements
While the December relief bill created a second draw loan program and added $284 billion to the PPP fund, the American Rescue Plan makes some additional changes to the program that could expand eligibility. Under current PPP rules, most organizations must employ 500 workers or fewer to be eligible, regardless of how many locations they operate. The American Rescue Plan modifies this policy for not-for-profit organizations and allows larger not-for-profit organizations to receive a PPP loan if they have 500 workers or fewer in each physical location they operate. For example, a not-for-profit multisite aging services organization that has a nursing home with 300 workers, an adult day services program with 20 workers and a home health agency with 350 workers currently cannot get a PPP loan because it has 670 workers. Under the American Rescue Plan, however, it would be eligible because each of its locations has fewer workers than the limit of 500. First draw PPP loans are based on 2.5x an organization’s monthly payroll, limited to $10 million.

We will provide more information about this legislation as it is passed and implementation begins.