FEMA finds that health self-insurance claims paid on behalf of its employees are not eligible emergency protective measure in response to the COVID-19 pandemic. Appeal Letter Rayana Gonzalez Deputy Commissioner for Disaster Recovery Programs New York State Division of Homeland Security and Emergency Services 1220 Washington Ave Building 7A, Floor 4 Albany, NY, 12242 Anthony Bates Village Manager Village of Endicott 1009 East Main Street Endicott, NY 13760 Re: Second Appeal –Village of Endicott, PA ID: 007-24515-00, FEMA-4480-DR-NY, Grants Manager Project (GMP) 683878, Immediate Threat Dear Rayana Gonzalez and Anthony Bates: This is in response to the May 25, 2025 letter from New York State Division of Homeland Security and Emergency Services, which forwarded the referenced second appeal on behalf of the Village of Endicott (Applicant). The Applicant is appealing the U.S. Department of Homeland Security’s Federal Emergency Management Agency’s (FEMA) denial of $241,002.27 for healthcare claims of its employees due to the coronavirus (COVID-19) pandemic. As explained in the enclosed analysis, I have determined that the Applicant has not demonstrated that healthcare claims paid on behalf of its employees are eligible emergency protective measures in response to the COVID-19 pandemic. Accordingly, I am denying this appeal. This determination is the final decision on this matter pursuant to 44 C.F.R. § 206.206. Sincerely, /S/ Robert M. Pesapane Director, Public Assistance Enclosure cc: Andrew D’Amora Acting Regional Administrator FEMA Region 2 Appeal Analysis Background On March 20, 2020, the coronavirus (COVID-19) pandemic resulted in a major disaster declaration for the state of New York, with an incident period of January 20, 2020, to May 11, 2023. The Village of Endicott, a local government, requested Public Assistance (PA) funding for, among other items, healthcare claims of its employees. The Applicant directly pays the medical costs incurred by its employees and eligible dependents through a contract with Excellus Blue Cross Blue Shield (Excellus). Specifically, the Applicant requested PA reimbursement of $241,002.27 for payments it made for medical claims of its employees, including COVID-19 testing and vaccination, administered by third parties between January 20, 2020, and July 1, 2022. On July 25, 2024, FEMA issued a Determination Memorandum denying the Applicant’s claim for medical self-insurance, finding that it was not tied to the performance of eligible emergency protective measures for COVID-19.[1] First Appeal In a letter dated September 20, 2024, the Applicant appealed FEMA’s determination, stating that FEMA should find the costs eligible. The Applicant asserted that it was responsible for the health of staff and their dependents and paid for all of their COVID-19 medical costs. The Applicant cited to regulation and policy, stating that it allows for reimbursement for medical care.[2] The Applicant included a spreadsheet showing detailed costs of COVID-19 related costs (diagnostic, antibody tests, vaccinations, etc.) per participant. The New York State Division of Homeland Security and Emergency Services (Recipient) forwarded the Applicant’s appeal with a letter in support, on November 15, 2024. On January 27, 2025, the FEMA Region 2 Regional Administrator denied the Applicant’s first appeal. FEMA found that the documentation showed that the claim was not for costs for eligible emergency work but rather for payment that the Applicant, as a self-insured employer, paid for treatment provided to its employees by a third party. FEMA found that the payment of employee healthcare and claims under the plans the Applicant offered are not an eligible emergency protective measure. Second Appeal In a letter dated March 27, 2025, the Applicant submitted a second appeal. The Applicant states that the costs are eligible under FEMA policy, as the costs are all for medical treatment of COVID-19 cases. The Applicant cites to language in FEMA policy stating local government entities may contract with for-profit hospitals to carry out eligible emergency protective measures and FEMA will reimburse the eligible applicant for the cost of eligible work, and the applicant will then pay the private entity for provision of services.[3] The Applicant asserts that its agreement with its third-party administrator is akin to this, as the third-party administrator is solely an intermediary, and services are paid for and billed to the Applicant. In addition, the Applicant notes that diagnostic testing is an eligible item of work under FEMA’s Coronavirus (COVID-19) Pandemic: Safe Opening & Operations Work Eligible for Public Assistance Policy, while vaccination is eligible under FEMA Policy 104-21-0004, Coronavirus (COVID-19) Pandemic: Medical Care Eligible for Public Assistance (Interim) (Version 2) (Medical Care Policy). The Recipient forwarded the appeal, with its support, in a letter dated May 25, 2025. Discussion FEMA may provide funding for emergency protective measures that are necessary to saves lives and protect public health and safety.[4] For emergency protective measures to be eligible, the Applicant is responsible for showing the work is required due to an immediate threat resulting from the declared incident.[5] FEMA may only provide assistance for medical care in response to COVID-19 declared events that is provided in accordance with a COVID-19 specific policy.[6] FEMA’s Medical Care Policy applies to state, local, tribal and territorial government entities, and PNP organizations that own or operate medical facilities.[7] Under FEMA’s Medical Care Policy, eligible medical care activities and associated costs in primary medical care facilities include: emergency medical transport related to COVID-19; triage and necessary medical treatment of COVID-19 patients; and purchase, lease, and delivery of specialized medical equipment necessary to respond to COVID-19.[8] Work and associated costs to support the distribution and administration of COVID-19 vaccines may be eligible as well.[9] The Applicant requested reimbursement for the cost of healthcare claims it paid for its employees which were generated between January 20, 2020, and July 1, 2022.[10] The Applicant’s documentation does not demonstrate that the claimed costs are tied to eligible work performed by the Applicant at its own primary medical care facility. Instead, the Applicant’s documentation shows the claims are for payments, as a self-insurer, to third-party entities that provided testing and treatment for the Applicant’s employees and dependents.[11] Payment of employee healthcare, including COVID-19 testing and vaccination, under the plans the Applicant offered its employees is not an eligible emergency protective measure under FEMA’s Medical Care Policy or any other FEMA COVID-19 policy.[12] Conclusion