Federal funding has been made available to state and local governments for COVID-19 related expenses, as provided for by the CARES Act. Examples and recommendations for uses of CARES Act funds is provided below, along with additional information on the state’s priorities and strategies in addressing COVID-19.

DHSS plans to hire personnel dedicated to tracking state spending of grant funds and supply chains. While CARES Act funding and other federal awards can be complex, private accounting and budgetary service firms can offer assistance to county governments in navigating spending plans and resource allocation. Additional contracted resources or staff to handle budgetary needs is recommended by CDC and DHSS.

  • Eligible Expenses for County Governments
    • Additional or existing staff salaries and overtime, whose duties have been shifted to mitigating or responding to the COVID-19 public health emergency for costs incurred beginning March 1, 2020, and ending on December 30, 2020, are appropriate expenses for the funds. The reimbursement of partners within your county for COVID-19 costs incurred is encouraged. Examples of which may include, but are not limited to the following:
      • Local Public Health Agencies (LPHAs)
      • Support for community testing events
      • Support for contact tracing
      • Vaccine preparation
      • Personal protective equipment for schools

The following information provides additional details recommended appropriate uses for Federal CARES Act funding that has been made available to state and local governments for COVID-19 related expenses.

Missouri Statewide Testing & COVID-19 Reduction Strategy

Expanding testing capacity and volume is one of the four pillars of Missouri’s “Show Me Strong Recovery” plan. Our goal remains to continue the testing capacity of 7,500 Missourians per weekday using the following five testing strategies areas. See below to learn more about these strategies and how you can help your community through testing. Please also view our Testing Basics and Test Types fact sheets.

  • Community Sampling allows for any Missouri resident, symptomatic or asymptomatic, to be tested without a doctor’s note at no cost to the participant, at one of these testing sites. Community sampling events should be held at regular intervals within your community throughout the year. The Department of Health and Senior Services (DHSS), the Missouri National Guard (MONG), Missouri’s Local Public Health Agencies (LPHAs) and many other partners have hosted community sampling events across the state. See Community Based Testing Checklist for how to organize a community testing event, or contact Lori Brenneke at (573) 751-1928 lori.brenneke@health.mo.gov.
  • Box-It-In Testing for Outbreaks focuses on identifying infections and stopping transmission within a specific environment such as a long-term care facility, congregate living facilities, and even within businesses (see Industry Security testing below). The goal is to execute facility-wide testing of all staff and residents (if a long-term care or congregate living facility) to identify and isolate positive cases as quickly as possible. By "boxing-in outbreaks" in these facilities, this strategy will help keep the virus contained and prevent further spread within local communities. See Box-It-In Strategy which includes a step-by-step process on how to "box-in". Also see Behavioral Health’s letter of support and guidance. For additional information or assistance, contact Jonathan Garoutte at (573) 751-6111 jonathan.garoutte@health.mo.gov.
  • Sentinel Testing strategy focuses on testing vulnerable populations who reside in congregate living settings (such as county jails, group homes for disabled, etc.). Sentinel testing within these facilities will identify and isolate not only symptomatic individuals but also asymptomatic individuals to keep them from unknowingly spreading the virus within the community. Sentinel testing within county jails and courthouse personnel are examples of outbreak prevention within communities. Similar partnerships as mentioned within Community Sampling will be necessary to perform continued sentinel testing within your community. See Sentinel Testing Strategy for more details on how to initiate sentinel testing in their communities or contact Julia LePage at (573) 751-9134 or julia.lepage@dmh.mo.gov.
  • Healthcare Workers and First Responders continue to be tested through the State and Public Health Lab (SPHL) and other selected labs. The need to continue the testing of frontline staff at the local level is an appropriate use of resources to ensure that frontline staff are better protected. Providers are encouraged to continue to call our Hotline at (877) 435-8411 for approval and information on obtaining collection kits from the State and Public Health Lab.
  • Industry Security (including educational facilities) is critical for our economic recovery. Private industries and educational facilities alike will need access to testing in your community.
    • Ongoing, on-demand testing within communities is vital to ensure that testing availability remains accessible and is a critical component to industry security and contact tracing. It is encouraged to arrange an agreement with a LPHA, FQHC, local hospital, health clinic or active testing sites within your community. This agreement should allow the LPHA to allow individuals to obtain a test without a doctor’s order, due to known exposure through contact tracing or through industry security settings. It is appropriate to use CARES Act funds to support on-going, on-demand testing within your community.
  • Resources for Testing
    Testing requires the acquisition of several key resources in order to perform testing successfully and safely: personnel, personal protective equipment, and lab test collection kits/processing. Data collection is another element that is key to tracking the individuals tested, the results notification process, and the aggregation of results data from community testing. Some ideas to acquire testing resources include:
    • Utilize existing healthcare entities already involved in testing in your county. This could be hospitals, federally qualified healthcare centers, the local public health agency, local Medical Reserve Corps units, or other private healthcare providers. These entities may be able to provide all or some of the resources with reimbursement for the service(s).
    • Utilize mobile testing vendors. Provided below is a link to a contact list for mobile vendors already doing business in Missouri that have indicated their desire to provide testing as needed throughout the state.
    • Personal Protective Equipment (PPE) Coordination
      • Local public health agencies can view PPE availability through the Missouri PPE Marketplace. (Purchases are made outside of the portal with the identified vendor). It may also be advantageous for counties/regional groups of counties to collaborate on collective PPE purchases to enhance their buying power.
      • Please note this will be less necessary as test collection types improve (e.g., saliva/cheek swab/self-administered mid-nasal swabs), and full-scale PPE is no longer required for safe testing.
    • Registration and Data Reporting
      • DHSS has developed a registration and data reporting tool via use of REDCap. This system may be utilized to register, make appointments, and collect patient data for community testing efforts. This system may be utilized in return for aggregate results data from the community testing.
      • Access to REDCap -- Contact DHSS Section for Disease Prevention (573) 526-4780
    • Obtaining Laboratory Vendors for Processing
  • Community Partners
    Missouri has been partnering with our Local Public Health Agencies (LPHAs), Federally Qualified Health Centers (FQHCs), Local Hospitals, Clinics and other healthcare systems, as well as active testing sites throughout the state. Through one or all of these partners, appropriate expertise for testing, contact tracing and outbreak containment can be provided. Local funding and support is highly encouraged to these entities to continue ongoing demands for testing, contact tracing and all COVID-19 response. It is also encouraged to reimburse these partners for costs incurred due to COVID-19 response. Reach out to any of your local healthcare partners to learn more about how you can support their efforts.

The costs associated with partnering with a local entity or mobile testing vendor is determined by agreement between the partner/vendor and the county.

Personal Protective Equipment (PPE)

PPE is an integral component for all COVID-19 mitigation and response and an appropriate use of Cares Act funds.

  • Under the pillar of the Show Me Strong Recovery plan, the state continues to make PPE purchases in order to provide for state level testing needs, ensure appropriate PPE at state-run facilities, address critical needs by healthcare providers unable to procure PPE due to supply chain disruption and ultimately to build a State Reserve.
  • Resources for Counties:
    • County Governments can access the PPE Marketplace. (Purchases are made outside of the portal with pre-identified vendors). The purchases that you make can be used to establish or replenish a local/regional supply, and support local entities, including, but not limited to: LPHA’s, Schools, Healthcare Workers and First Responders and Local businesses. It may be beneficial to partner with a neighboring county in order to maximize purchasing power.
    • Guidance on optimization and use of PPE can be found on the State’s PPE webpage.

Contact Tracing

The state has developed a structured approach to contact tracing. Along with a state surge team that provides limited support to control localized outbreaks, DHSS has provided opportunities for financial support for each of Missouri’s 114 local public health agencies to provide additional ongoing in-county support. Please see Local Government COVID-19 Contact Tracing Guidance for additional details.

  • DHSS has created a fact sheet about close contacts that contains information about how a close contact is defined, as well as what happens during contact tracing if you are identified as a close contact.
  • County governments are strongly encouraged to fund contact tracing efforts with CARES Act funding. Contact tracing is a critical piece in the overall COVID-19 reduction strategy.
  • The hiring of additional staff and cross training existing staff are acceptable strategies to help stop the spread of COVID-19 at the community level. LPHAs should create plans to ensure appropriate staffing for contact tracing in a variety of COVID-19 scenarios using CARES Act and other funding provided by DHSS. The surge support provided by DHSS will provide limited surge support to re-inforce LPHA’s box-it-in efforts to control localized outbreaks and resources will be distributed based upon public health priorities. DHSS will provide contact tracing training to local health agencies.

    Contact Craig Highfill at craig highfill@health.mo.gov or (314) 877-0245 for details. Online training can be found at: https://www.coursera.org/learn/covid-19-contact-tracing?edocomorp=covid-19-contact-tracing.

Messaging

The state along with DHSS will continue to provide messaging and public information dissemination. DHSS can provide county governments with a base information package for testing site promotion and COVID-19 prevention methods. Contact the Center for Local Public Health Services at (573) 751-6170 for assistance with messaging and promotion information.

  • County governments may partner with media outlets leveraging CARES Act funding to help with messaging related to COVID-19 prevention, testing opportunities, etc.
  • County governments may also partner with LPHAs and healthcare providers to promote testing sites, vaccinations and many other COVID-19 related responses.

Examples of news releases, social media events, and prevention materials are linked here.

For questions or additional assistance, contact the Center for Local Public Health Services (CLPHS), Tiffany Bayer, at (573) 751-6170 or tiffany.bayer@health.mo.gov.