Arkansas received federal approval Wednesday to use $55 million in Medicaid funds to give bonus payments of up to $500 a week to workers in nursing homes and other long-term-care settings, as well as to workers who care for elderly or disabled people at home.
At the request of Gov. Asa Hutchinson, an advisory panel also recommended using up to $80 million in federal coronavirus response funds to provide similar payments to workers in hospitals, as well as to nonclinical staff members, such as janitors and cafeteria workers, in hospitals, nursing homes and other facilities.
Those funds would come from the $1.25 billion the state expects to receive from the $2 trillion Coronavirus Aid, Relief, and Economic Security Act passed by Congress last month.
Larry Walther, secretary of Arkansas' Department of Finance and Administration, said the state received half of its Coronavirus Aid, Relief, and Economic Security allocation -- or $625 million -- Wednesday and expects to receive guidance this week from the U.S. Department of the Treasury on how the funds can be spent.
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The state Coronavirus Aid, Relief, and Economic Security Act Steering Committee also recommended using $73.5 million of the federal funding to reimburse the state for purchases of masks and protective medical gear that it has made for health care workers using money from its budget stabilization trust fund and a covid-19 rainy day fund created by the Legislature during a special session last month.
Both recommendations by the state steering committee, which was appointed by Hutchinson last month, were contingent on confirmation that the payments for hospital workers and support staff members will be allowed under federal rules. The 15-member committee consists of Cabinet secretaries, legislators and a representative of the governor's office.
"This is something we want to have first in the pipeline so we're ready to go whenever we get the authority from Treasury to start releasing some of those funds," Hutchinson said during the steering committee meeting.
From Tuesday morning to Wednesday evening, the state's death toll from the virus rose by two, to 34, as the number of cases rose by 101, to 1,599. The state's first case was reported March 11.
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PAYMENT DETAILS
The Medicaid payments will include $500 a week for full-time nurses, nurse aides, respiratory therapists and other care workers who are not physicians at nursing homes and other facilities where a resident has tested positive for the virus.
Employees working 20-39 hours a week will receive $250, and those working less than that but at least one hour a week would receive $125.
At facilities where no residents have tested positive, full-time workers will receive bonuses of $250 a week, and those working 20-39 hours will receive $125.
The proposal for coronavirus relief funds would provide the same bonuses for hospital workers, with the $500-per-week bonuses going to staff members at hospitals where at least one covid-19 patient is receiving treatment.
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Janitors and other support staff members at hospitals and nursing homes would receive bonuses equal to half of what direct-care workers receive.
All of the bonuses would be for eight weeks, starting retroactively from last week and extending until May 30.
The Medicaid payments, however, could be extended an additional 30 days if the state still has at least 1,000 active covid-19 cases.
Of the cases that had been identified in the state as of Wednesday evening, 1,056 were considered active.
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Meanwhile, 509 people who had gotten the virus were considered to have recovered, meaning at least a week had passed since they fell ill and they hadn't had a fever for at least three days.
REQUESTS PENDING
The Medicaid payment was initially part of a $116 million proposal that included payments for small hospitals, clinics and foster parents, and money that cities could use to move homeless people out of shelters and into hotels or apartments to reduce the risk of transmission.
The federal Centers for Medicare and Medicaid Services has yet to approve those other components of the proposal, Hutchinson said.
Officials with the state Department of Human Services have said the federal government is providing most of the funding, with the state's share coming from money freed up by an increase in the federal match rate for Medicaid under another federal coronavirus measure, the Families First Coronavirus Response Act.
That law increased the federal government's share of most expenses for Arkansas' Medicaid program from about 71% to about 77%.
Human Services Secretary Cindy Gillespie said the Medicaid proposal's bonus payments are for long-term-care workers because Medicaid is the main payer for that type of care, and the Coronavirus Aid, Relief, and Economic Security Act includes other financial support for hospitals.
Trying to fund the bonus payments for hospitals and support staff through the Medicaid program would have slowed down approval for the long-term-care worker bonuses, she said.
Rachel Bunch, director of the Arkansas Health Care Association, said many nursing homes have already offered incentives to employees to keep up staffing levels in the midst of the pandemic.
"This will just really go above and beyond that for them," she said.
She called the bonus payments "an act of acknowledgment of what our direct-care providers do, doing so much to take care of those people that can't take care of themselves."
The Arkansas Hospital Association had asked for the bonus payments to be extended to hospital workers, said Bo Ryall, the association's chief executive.
He said the state's hospitals don't have a manpower shortage, but he's heard of some nurses leaving for states with larger coronavirus outbreaks.
"We're concerned about our workforce seeking other opportunities instead of staying here, because we will have patients," Ryall said.
EXPANDING TESTING
Health care workers accounted for 215 of the state's coronavirus cases as of Wednesday morning, and infections among residents or staff members had been reported in 28 of the state's nursing homes, Department of Health Secretary Nate Smith said.
The number of infections among nursing-home residents had increased by five from a day earlier, to 98, and the numbers of workers at the facilities who had tested positive increased by 17, to 88.
According to coroner reports, eight nursing-home residents have died of their infections.
As the testing capacity of commercial laboratories has increased, Smith said the department has expanded its criteria to recommend testing for any patient with symptoms, as long as the health care provider has adequate testing supplies.
Previously, he said, the department had advised testing only hospitalized patients, patients who were elderly or had chronic health problems or those who had contact with someone who tested positive or had traveled from an area with a large outbreak.
He said wider testing will be especially important as the state considers lifting some of the restrictions it has imposed to slow the spread of the virus.
Those have included closing public schools; limiting restaurants to carry-out, drive-thru and delivery only; and closing movie theaters, hair salons and other businesses.
"As we move toward that post-peak relaxing of these restrictions, we're going to know with more detail, more granularity where we have cases and where we don't," Smith said.
The department's own testing is focused on outbreaks in prisons, nursing homes and other facilities.
But eventually it will need to "go to aggressive case management" and investigate every person who tests positive to see if that person may have spread the virus to someone else.
He said the department still doesn't recommend testing in most cases for patients who don't have symptoms since a negative result wouldn't necessarily mean the person does not have an infection.
PRISON CASES JUMP
Those who tested positive most recently included 42 inmates at the Central Arkansas Community Correction Center, bringing the number there who have tested positive to 59.
The number of staff members who have tested positive remained unchanged from a day earlier at 27.
Richard Richardson, a 60-year-old substance-abuse counselor at the center, died of the virus last week.
At the Cummins Unit in Lincoln County, the number of inmates who have tested positive increased by two, to 46. Two workers at the East Arkansas Community Correction Center, which houses women, in West Memphis have tested positive.
The state's latest virus deaths, meanwhile, included the first one of a Craighead County resident and the sixth of a Jefferson County resident, according to the Health Department.
The state's other deaths include 10 people from Pulaski County; four from Cleburne County; two each from Crittenden, Faulkner and Van Buren counties; and one each from Conway, Drew, Hempstead, Lawrence, Lee, Phillips and Saline counties.
Little River County had been listed on a state website as having one case Monday evening, but the number there was later changed back to zero.
Meanwhile, Jackson County was listed as having its first case Tuesday morning.
Calhoun, Fulton and Montgomery counties remained the only other counties in the state without cases as of Wednesday evening.
In Pulaski County, the number of cases increased by 53, to 353, from Tuesday morning to Wednesday evening.
Among other counties with more than 100 cases, the number increased by six, to 122, in Crittenden County; by two, to 107 in Jefferson County; and by three to 105, in Garland County.
The virus emerged late last year in Wuhan, China, and spreads through respiratory droplets emitted when people sneeze, cough or talk. Studies have indicated that the virus can live for days on surfaces.
Symptoms include fever, cough and shortness of breath. The elderly and people with chronic health conditions are considered most at risk of severe illness, including pneumonia.
A Section on 04/16/2020