GAO Report on Medicaid

In the process of conducting interviews with Medicaid directors of 47 states, the Government Accountability Office (GAO) identified a score of challenges and opportunities for improvement within the Medicaid system. Medicaid involves a complex interweaving of federal and state laws, regulations, and procedures that can inhibit efficient delivery of the program. The GAO’s report  cited a range of shortcomings within the program. For example, current policy excludes states from using Medicaid funds to support coverage for residents of institutions for mental diseases. 39 states criticized the mandate that requires coverage for outpatient prescription drugs, particularly high-cost new drugs that had little proven health benefit. Many states cited the complexity of integrating the Medicaid and Medicare programs. Payment methods relating to qualified health centers and rural health clinics also came under scrutiny in the report. As for solutions, the GAO report listed some broader factors that federal and state governments should consider as they work to improve the Medicaid program. For example, the report recommended more targeted oversight of critical areas and more data collection to help inform policy making.

New Flexibility in PPP Program

After passing the Senate and the House of Representatives in recent days, H.R. 7010 was signed into law by President Trump on June 5. The bill will allow additional flexibility for borrowers in the Paycheck Protection Program (PPP). The PPP, which was originally created through the CARES Act in late March, gives low-interest loans to businesses and 501(c)3’s with less than 500 employees, with the option to make those loans forgivable if the organization reaches pre-pandemic levels of employment by the end of the loan period. This new legislation implements the following changes to PPP:

  1. Extends the time period during which the loan can be used from June 30 to Dec 31 or 24 weeks after a loan is issued, whichever comes first.
  2. Pushes back the deadline at which organizations must restore pre-pandemic employment levels from June 30 to Dec 31.
  3. Allows organizations to still receive loan forgiveness for employees that were not able to be rehired, as long as they provide documentation.
  4. Allows organizations to spend up to 40% of a loan on non-payroll costs, such as rent and utilities, and still receive full loan forgiveness. Before, they were only allowed to spend up to 25% of the loan on overhead costs.
  5. Extends the period to pay back the loan from 2 years to 5 years – for borrowers who apply after the passage of H.R. 7010. Organizations that applied beforehand are now able to negotiate loan maturity terms with their lenders.

With these changes, the PPP program will grant nonprofits more flexibility in utilizing the much-needed funds. Because of social distancing guidelines, for example, many organizations have had trouble hiring back workers and are spending many more loan dollars on overhead costs rather than payroll costs. H.R. 7010 takes this common situation into account and gives these organizations more time to staff up and more discretion in allocating the funds to non-payroll costs.

ACF Guidance on Extended Foster Care During COVID-19

The Children’s Bureau recently released a new letter on program instructions that describe how title IV-E agencies can use enhanced foster care programs during the COVID-19 pandemic to support youth who have left or may leave foster care. The available flexibilities include allowing states to opt into the title IV-E extended foster care program through a simplified process. It also allows agencies to request flexibility to provide IV-E payments to otherwise eligible youth ages 18-21 who are unable to meet the program’s education and employment eligibility requirements as a result of the pandemic.

Source: American Public Human Services Association

Joint Letter from ACF and HRSA on Family Strengthening and Virtual Primary Prevention

The Children’s Bureau, Office of Child Care, and the Office of Early Childhood Development and Head Start released a joint letter with the Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA). This letter urges family support, maternal and child health, early education programs including home visiting, Head Start, and other early intervention programs, to promote family strengthening and prevention strategies remotely during COVID-19. The letter offers ideas for partnering with families and other organizations, including links to resources and funding opportunities.

Source: Child Welfare and Mental Health Coalition

New Program Instructions on CARES Act Funding for Title IV-B

The Children’s Bureau released a new program instruction  to provide guidance to agencies administering the Title IV-B, Subpart 1 program on the supplemental FY2020 funds provided under the CARES Act. This document provides information on allowable uses of funding and reporting requirements. Each agency receiving CARES Act funding is required to submit a brief narrative describing their planned use of the supplemental funds by July 10.

ACYF-CB-PI-20-11 had three attachments:

Source: Child Welfare and Mental Health Coalition

Census Deadline Extended

Because of the COVID-19 crisis, many census offices were shut down to avoid spreading the virus through face-to-face contact. Over the course of May, the Census Bureau announced the resumption of operations in a growing list of states across the country. As of June 8, all 248 area census offices  were fully open or in the process of the phased reopening. So far, 60% of households  have responded to the census, with approximately 80% choosing to do so online. Because of the COVID-19 shutdown, the deadline to submit your census information was extended from July 31 to Oct. 31. Every year, $675 billion is distributed from the federal government to local communities, largely based on the information collected through the decennial census. Please encourage your community members to visit  to submit a reply.

The Emergency Food Assistance Program (TEFAP)

In the CARES Act passed in late March, Congress allocated $450 million to TEFAP to help communities respond to the economic crisis brought on by the COVID-19 pandemic. States were required to submit applications for the funds by May 1, detailing how they would use the funds and for what purpose. By May, all those funds were disbursed to the states. A complete list of the state-by-state allocations can be found here . Typically, states distribute the funds to food banks, which then pass along those funds to soup kitchens and food pantries. In some cases, the funds go directly from states to community action agencies, which serve low-income families.