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Capitol Correspondence - 10.20.20

Ask Your U.S. Representative to Pressure CMS to Extend Timeframe for HCBS Retainer Payments

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Please take a few minutes today to contact your U.S. Representative on an important issue surrounding the Medicaid Home and Community Based Services (HCBS) program. Specifically, please ask them to sign onto a letter led by U.S. Representative Rob Woodall (R-GA), which will be sent to the Centers for Medicare and Medicaid Services (CMS) to ask that the agency “use its regulatory authority to extend the timeframe in which states are allowed to issue retainer payments to qualifying Home and Community-Based Services (HCBS) providers for the duration of the COVID-19 public health emergency.” This letter is the result of strong advocacy by ANCOR members such as SPADD in Georgia – please contribute to its success by lending your advocacy to this issue. The more U.S. Representatives across the nation join this letter, the more likely CMS will be to prioritize the request. The deadline to sign on is this Thursday (10/22).

Next steps:

  • See below for the full text that will be sent to CMS. 
  • Identify your U.S. Representative here.
  • Send their office an email asking for their support – sample email also below.

Text that will be sent to CMS after the sign-on deadline:

Dear Administrator Verma:

We appreciate the steps the Centers for Medicare and Medicaid Services (CMS) has taken since the onset of the public health emergency to provide guidance, assistance, and support to ensure providers are able to continue serving Americans and their families. As we have witnessed, no single state or community has been impacted in the same way, and the flexibilities that CMS has provided during this time have been critical in ensuring continuity of care and allowing providers to adapt to realities as they exist on the ground.

This is particularly true of the flexibilities you have provided to states through approval of their respective Appendix K emergency preparedness response plans, which has allowed states to adapt their Home and Community-Based Services (HCBS) programs under the Medicaid program. Through those plans, CMS has approved requests from states to issue retainer payments to qualifying HCBS providers that are unable to provide routine services during this time.

However, CMS places a ceiling on the number of days in which states are allowed to provide these payments. While we appreciate the agency’s action earlier this year to extend that limit beyond the initial 30-day period, indicating that states may authorize these payments up to three, 30-day periods (for a total of 90 days), many providers are continuing to face hurdles to a full return, particularly due to the challenges of serving a population that the Centers for Disease Control and Prevention indicates may be at increased risk of severe illness from COVID-19. As the public health threat posed by COVID-19 remains acute, we ask that CMS use its regulatory authority to extend for the duration of the national public health emergency the time in which these payments can be utilized by states who receive approval from CMS and elect to do so.

As you know, HCBS providers deliver a wide range of home health, personal care, educational, and support services for targeted population groups, including individuals with intellectual and developmental disabilities (ID/D), physical disabilities, and mental illness. That community-based approach to care often means that these services must be provided in person, making providers’ ability to continue to serve the ID/D community particularly vulnerable to the challenges caused by the spread of COVID-19. True to their name, many HCBS providers are small, local nonprofits who are almost entirely funded under Medicaid and operate on already-thin margins. These retainer payments have served as a valuable line of support for providers who are unable to provide comparable services, many of whom lack the infrastructure to provide for these services remotely, or the nature of whose services cannot be conducted virtually. These payments have helped state agencies administering their Medicaid programs stabilize their HCBS provider networks so that lapses in funds do not mean these providers are forced to close their doors for good.

We must stress, CMS’s action to extend the time limits for these reimbursements would not require any state to provide retainer payments; it simply would give states whose provider networks remain at risk of permanent closure the continued flexibility to evaluate their needs and determine how best to support them. Further, guardrails that CMS already has in place will ensure that federal support from other programs, like the U.S. Small Business Administration’s Paycheck Protection Program, are not duplicated.

We know our nation’s HCBS providers remain eager to serve our communities and have continued to look for creative and strategic ways to serve individuals through Medicaid-supported programs. But when the option for them to do so is limited or non-existent, these payments have served as critical lifelines, and we ask that CMS act to further this important relief mechanism by allowing states the ability to continue utilizing this option.

Thank you for your attention to this important matter, and we are grateful for the Agency’s continued partnership in ensuring that in a time fraught with uncertainty, providers furnishing these critical services in our communities will be able to do so in the future.


Sample email to send your U.S. Representative – as a reminder, you can find their office’s contact information here.


As a constituent who cares deeply about issues affecting people with disabilities, I encourage you to sign onto a letter currently being circulated by U.S. Representative Rob Woodall (GA) to ask the Centers for Medicare and Medicaid Services to extend the time frame in which states are allowed to issue retainer payments to qualifying Home and Community-Based Services (HCBS) providers for the duration of the COVID-19 public health emergency.

HCBS is the largest Medicaid program providing at-home supports for people with disabilities – these supports are essential to keeping people with disabilities safe and healthy during the pandemic. However, due to increased demand for services, combined with increased expenses, the pandemic has pushed these supports to the breaking point – particularly day and employment supports which closed to comply with social distancing requirements but will be hugely important once the pandemic is over.

While many states have requested and subsequently received approval from CMS to provide retainer payments (reimbursements to providers when they are not able to provide routine services) due to COVID-19, CMS currently limits the time frame in which states can utilize this option to three, 30-day periods (90 days total). CMS has the authority to extend these limits and doing so will ensure that states whose HCBS provider networks remain at risk of dissolution or collapse can continue providing these retainer payments with available funds if they choose.

I urge you to support people with disabilities by reaching out to Lauren Williams on Representative Wood’s staff at [email protected] to join his request to CMS to extend these limits. The deadline to sign on to this letter is Thursday, October 22.