Letter from Secretary Sebelius to Governor Bentley
May 6, 2011
The Honorable Robert Bentley
Governor of Alabama
Montgomery, AL 36130-2751
Dear Governor Bentley:
I am writing to express my concern and sympathy for the loss of life and property in your state as a result of the horrific storms of last week. I realize that these tragic circumstances present many challenges for you and the people of Alabama in the weeks and months ahead and I want to offer our support for the recovery effort that is underway. The Department of Health and Human Services (HHS) stands ready to assist you in every way possible as you work to help families put their lives back together and to meet both their physical and emotional needs.
Specifically, there are a number of tools available as you work to maintain access to health care through the Medicaid program for residents of your state. In the past, we have encouraged states to respond as needed to disasters, with the assurance that the federal government would make available Medicaid authority and funding to the extent legally permissible through demonstrations or state plan amendments that would be effective as early as the beginning of the disaster period. In particular:
- States may respond to heightened community needs by expanding access to Medicaid through temporary increases in income eligibility limits and the removal of resource tests.
- States may allow residents who may have lost documents in the storm to certify their income and residency when applying for Medicaid, with appropriate verification procedures when it becomes practicable, and states may use other methods to streamline eligibility and enrollment.
- States may reduce administrative burdens by delaying the process of re-determining whether an individual remains eligible for Medicaid until administrative resources are available.
You have my commitment that any Medicaid plan amendment or waiver request you submit will be reviewed and acted upon as quickly as possible.
HHS has a strong history of using the Medicaid program to help states during times of crisis and through the recovery process. For example, in the wake of the September 11th attacks, CMS granted New York a section 1115 Medicaid waiver to create Disaster Relief Medicaid (DRM). The waiver was needed because the attacks had damaged New York City’s Medicaid computer systems making it difficult to process applications at a time when many people needed assistance. DRM was a temporary program that used a simplified, expedited application process and expanded eligibility.
Likewise, in 2008, CMS responded to the State of Iowa’s request for assistance in the aftermath of flooding across five counties in the State. Through a fast-track waiver, Iowa was able to suspend eligibility redeterminations for residents of the affected counties in order to ensure continuity of Medicaid and CHIP coverage, and to relax the documentation requirements for new applicants who may have lost documents in the flooding. And, after Hurricanes Katrina and Rita, HHS supported states by assisting them in providing temporary Medicaid coverage to low-income individuals affected by the disaster.
In addition, the Department’s Substance Abuse and Mental Health Services Administration (SAMHSA) is providing technical assistance and consulting with your state behavioral health authorities to address the behavioral health impact on citizens. SAMHSA is working with states as they draft applications to the Federal Emergency Management Agency’s (FEMA’s) Crisis Counseling Program, has provided information and training materials for counselors, and remains engaged to address identified behavioral health needs. SAMHSA is also seeking to expand the availability of its Oil Spill Distress Helpline, which provides telephonic crisis counseling, to those impacted by the tornados.
The Administration for Children and Families (ACF), in partnership with FEMA, provides the Disaster Case Management Program (DCMP). The DCMP is a federally funded program that provides case management services in association with non-governmental organizations. Once a state is approved for Disaster Case Management, Catholic Charities USA, a current affiliate, provides case managers contracted first from the local area and if necessary, case managers are brought in from around the state and the region.
I know that my staff has been in close contact with your state’s health and human services agencies, including the Medicaid agency, and I have instructed them to provide the consultation and guidance necessary to help your state expeditiously address the needs of your state’s residents affected by this disaster. We also directed our Regional Emergency Coordinators to work closely with your state health officers to assist with any requests to HHS for public health and medical support. The ACF Regional Offices are always available to help you with human services issues and to provide additional information regarding Disaster Case Management. We are committed to standing shoulder to shoulder with you as you work through this difficult time.
If you have any questions, please feel free to contact me or have your staff contact our Director of Intergovernmental Affairs, Paul Dioguardi, who can be reached at (202) 690-6060.
Kathleen G. Sebelius