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NCD CMS COVID-19 letter

Tuesday, March 24, 2020

March 24, 2020

Seema Verma
Administrator, Centers for Medicare & Medicaid Services
U.S. Department of Health & Human Services
200 Independence Ave., S.W., Mail Stop 314G
Washington DC 20201

Dear Ms. Verma:

I write on behalf of the National Council on Disability (NCD) - an independent, nonpartisan federal agency charged with advising the Administration, Congress, and federal agencies on disability policy - to ask you to remind the states of the availability of Medicaid waivers to assist in the retention of Direct Service Providers (DSP). DSPs play a pivotal role in the daily functions of people with disabilities. The COVID-19 pandemic has upended all Americans’ routines and it has the potential to drastically disrupt the availability of DSPs and seriously impact the needs for assistance in daily living of people with disabilities who rely on DSPs to continue to live independently in the community.

Independent of the COVID-19, there is a DSP workforce shortage. As day programs are being shuttered because of  Covid-19, DSP workers from these facilities are not receiving a paycheck. DSPs are at the lower end of the pay scale and can easily find employment in other employment sectors that offer the same hourly wage or often more. Hence, DSPs are difficult to retain and equally difficult to replace. When day programs are reopened, states will desperately need all of the DSPs to return to work, which will prove to be a challenge if they have already found alternate employment. States need Medicaid flexibility via a waiver to provide an incentive to retain DSPs who have been displaced by actions enacted to mitigate the impact of the COVID-19 pandemic.

Yet another scenario in which a state could request a waiver, is when a person with a disability who has high functioning behavioral issues or requires assistance with personal care is admitted to a hospital. Current Medicaid policy does not provide for a DSP to provide services for the person with a disability while hospitalized. During this pandemic, hospital staff will be ill-equipped to provide the services a person with a disability who has specific needs requires. Even absent a pandemic, hospital staff are not trained or equipped to assist patients with high functioning behavioral issues or personal care needs. A Medicaid waiver could be requested to allow states to use Medicaid funds to pay for DSP services during a hospital stay. This would benefit both the hospital staff and the patient. Hospital staff would then be able to focus their resources on combating the pandemic and the DSP can do its job by assisting the person with a disability with the necessary specialized service required by the person with a disability.

Medicaid waivers 1115,1135 and 1915c appendix K are assets states have at their disposal, upon request, to modify its Medicaid program. Medicaid waivers are extremely useful assets to mitigate the impact of the COVID-19 pandemic among the DSP profession and the disability community. NCD understands CMS is developing a template for some of the waivers in order to expedite state waiver requests. NCD asks CMS to prioritize the completion of these templates so they can be made available to the states as soon as possible.

NCD implores CMS to do everything within its power to assist and encourage states to avail themselves to this significant Medicaid tool. The waivers can mitigate the impact among the DSP profession to ensure that people with disabilities who depend on DSPs to live independently in the community are not disproportionately impacted by the COVID-19 pandemic.

If you wish to discuss this with me directly I would be delighted to do that at your convenience. However, if a member of your team would like to discuss this with a member of my team please have them contact Lisa Grubb, Executive Director at, and Joan Durocher, General Counsel and Director of Policy at


Neil Romano

An official website of the National Council on Disability