INDIANAPOLIS – Marion County is expected to receive $168 million from the federal CARES Act while other cities, towns and counties in Indiana are still waiting to see what money is coming their way to help with pandemic expenses.
This is just one of the questions state leaders have to sort out as $2.4 billion in federal money arrives in Indiana. Another is how to spend additional Medicaid dollars.
Late Friday, Gov. Eric Holcomb announced $300 million would be made available to local governments for unexpected expenses. The allocation will be based on population.
“While we anxiously await any information on what funding will be made available, we are incurring several ongoing unbudgeted expenditures as we work to combat the virus locally,” said Megan Hubartt, spokeswoman for the Allen County Department of Health.
So far, that cost is about $82,000 – mostly in overtime pay but also supplies and personal protective equipment.
Cris Johnston, head of the Indiana Office of Management and Budget, said last week that the Indiana Economic Relief and Recovery Team spent four hours discussing the topic recently. That group is made up of highly touted Republicans tapped by Holcomb to guide Indiana's use of the federal dollars.
“There is going to be a package with a local impact focus on it. The exact structure has not been finalized,” Johnston said.
He clarified Friday afternoon that the money will be sent out on a reimbursement basis after claims are made.
Once the request with documentation is submitted and approved the funds will be paid to the local units. The allocations along with program administration instructions should be sent out in the coming week.
Guidance issued by the federal government says the money must be used for costs incurred from March-December 2020 that are “necessary expenditures incurred due to the public health emergency with respect to the Coronavirus Disease” and for “expenditures that are not part of the current biennial budget.
“Funds may not replace revenues lost because of public health emergency.”
The reason Marion County gets an automatic slice is the federal bill carved out cities with populations of 500,000 or more.
Jennifer Simmons, chief operating officer for Accelerating Indiana Municipalities, said cities and towns are looking for reimbursement for eligible expenditures like personal protective equipment, sanitizers, cleaners, overtime directly related to the pandemic, IT expenses directly related to delivering services remotely and more.
“Down the line, as declining and/or lagging revenues are more evident, we will certainly seek additional federal and state relief to support service delivery,” she said.
Allen County Auditor Nick Jordan said the county is actually down 1% in spending overall. The county plans to spend $100,000 to add Plexiglas barriers in various county departments, but Jordan said no other major expenses have been brought to his attention.
The Association of Indiana Counties said many counties are seeing increased costs related to the primary election; health department overruns, emergency management, PPE and coroners' services.
Another topic is what to do with increased money for Medicaid.
The federal government increased Indiana's Federal Medical Assistance Percentage, which ultimately means Indiana has to match fewer state dollars to get federal dollars.
Steve Cook, president and CEO of the Indiana Association of Rehabilitation Facilities, said the Family and Social Services Administration sent a proposal to the State Budget Agency regarding increased Medicaid spending but the budget agency denied it.
About 30,000 people with intellectual or developmental disabilities are receiving state aid.
Some are in small group homes; others live on their own but have 24-hour supports and others live at home with family and some services.
This population is rarely talked about when it comes to the coronavirus, but there have been 64 positive cases for the individuals and 51 for staff members, according to the ARC of Indiana. Two individuals and two workers have died.
Cook said a majority of the cases are in four-to-eight-bed group homes.
He noted that Holcomb highlighted helping the state's 100,000 individuals with intellectual or developmental disabilities during his January State of the State address.
“We were thrilled,” Cook said. “But I think he's leaving us behind. We are very confused about the lack of fiscal support.”
In all, Medicaid is spending $100 million a month, Cook said, on the individuals.
That is split with 66% coming from the federal government and 34% from the state. But that ratio can now shift to $28 million from the state with the new match rate.
Cook said families and agencies want that money to stay in the system to help those with intellectual and developmental disabilities.
“We aren't asking for new money,” he said. “But the state wants to use it for other budgetary purposes.”
The State Budget Agency rejected Family and Social Service's original proposal on how to spend the money though the details were not released.
Johnston said the state is trying to balance both the near-term crisis with long-term effects.
“It's something we need to be mindful of as the economy turns south ... what is the right sort of assistance we can provide in the near term but not overextend ourselves when the revenues really start to decline in the coming days,” he said.
Hannah Carlock, director of public policy for the ARC of Indiana, said Indiana has been a national leader of closing state institutions for people with disabilities so they can enjoy a good life in the communities around the state.
But they are concerned that many of the nonprofit providers won't be able to reopen their doors at the end of the crisis.
“This will not only leave Hoosiers unemployed, but will also jeopardize the care and support of the state's most vulnerable population,” Carlock said. “We realize there is a great need for the new dollars coming into our state. We would like to know how those dollars are being spent and make sure that a portion goes to secure the future of services for people with intellectual and developmental disabilities.”