The Covid Public Health Emergency Ends and A New Era Begins

The Biden Administration is set to officially conclude the COVID public health emergency on May 11. In addition to anticipated changes to Medicaid and telehealth, various healthcare innovations are poised to persist and drive progress in the field. 

First declared in early 2020, the emergency gave the federal government the power to waive or modify certain regulations, for both private and public insurance programs, but especially for Medicare, Medicaid, and telemedicine. The goal was to help the nation fight the biggest threat to public health seen in the last hundred years, as well as provide more opportunities to get care in a time of unprecedented shutdowns and closings.   

Here is a look at some of the changes to come.

Covid-19 Vaccines 

Still free. 

Covid-19 vaccines, including boosters, supplied by the federal government will remain free for people with and without insurance.  The federal supply is expected to last through the fall.  The vaccines will still be available free of charge to those with public or private insurance since full coverage is guaranteed for CDC recommended vaccines. 

For the uninsured, the Biden administration announced a $1.1 billion program to ensure access to free coronavirus vaccines and treatments through December 2024.

Coronavirus Testing

This area will experience the biggest impact including the end of free coronavirus tests, both at-home and in the labs.  

At-home Tests:  During the public health emergency, insurers were required to reimburse for up to eight antigen tests per person per month.  After May 11, those with Medicare or private insurance will no longer be guaranteed free at-home tests.   For Medicaid recipients, at-home tests will be free through September 2024.

Some states have used Medicaid temporarily during the emergency to help those without insurance get free Covid testing and treatments, however, this program will no longer be available.

Uninsured and other people who cannot afford at-home tests may still be able to find them at a free clinic, community health center, public health department, library, or other local organization.

PCR Tests: Will be subject to plan requirements.

If a healthcare provider orders a test to be done in a lab, those with insurance may or may not have coverage depending on the plan.  In many cases, there will probably be some cost-sharing to cover the visit and/or the vaccine.

COVID Treatments

Any pharmaceutical treatment doses, such as Paxlovid, purchased by the federal government will remain free to all, regardless of insurance coverage, based on availability. The United States has millions of doses of oral antivirals which are expected to last months.

Those on Medicare will not face any cost-sharing for Covid treatments purchased by the federal government. 

Medicaid and Children’s Health Insurance Program (CHIP) recipients will also not face cost-sharing through Sept 2024.  

Private insurers were never required to waive cost-sharing for hospitalizations or out-patient visits and that will continue based on individual plan requirements.

Telemedicine

Telemedicine was a valuable tool in providing access to much needed healthcare services during the emergency.  However, some of the flexibility granted during the emergency may be changing. 

 As an example, providers were allowed to write prescriptions via telemedicine for controlled substances — such as the attention-deficit/hyperactivity disorder drug Adderall; the addictive painkiller OxyContin; and the anti-anxiety medicine Xanax. 

However, in-person visits will be required after May 11. 

Audio-only platforms were also allowed and have been extended to December 2024.  

Other innovations have become permanent, including allowing beneficiaries to receive mental or behavioral health care via telehealth in their homes.

Because of the pandemic, states across the country loosened license requirements so that providers with equivalent licenses in other states could practice remotely. This would continue only if states amended their own policies.

Telehealth service providers will also need to go back to using “HIPAA compliant” technologies that comply with federal privacy and security rules, which were waived during the public health emergency. 

Medicaid

During the emergency, states were able to receive additional funding to provide more Medicaid coverage to more enrollees, because eligibility renewals and redeterminations were put on hold.  An analysis from the Kaiser Family Foundation found Medicaid/CHIP enrollment increased 29% from February 2020 to November 2022.   Some people removed from the Medicaid rolls “will be able to get insurance under the health exchanges, but when states do those redeterminations, we’re going to find a lot of people who will lose coverage,” says Dr. Georges Benjamin, executive director of the American Public Health Association.

However, some people may lose Medicaid because of a new job. Matthew Buettgens, a senior fellow in the Health Policy Center at the nonprofit think tank, The Urban Institute, says “For a lot of them, the reason why they are no longer eligible for Medicaid is because their income has increased and they have gotten new jobs,” Buettgens says. “So we’ve seen employment largely recover from where it was early in the pandemic.”

Final Thoughts 

• The biggest impact will be higher costs of Covid testing which will make it more difficult to get a timely diagnosis and possibly control transmission.
• More significant changes will be seen when the federal supply of vaccines, tests and treatments run out.  At that point, Congress will have to decide if and how to fund more of these supplies.
• Continuous enrollment in Medicaid has led to a record low of 8% uninsured in this country.  The Kaiser Family Foundation (KFF) has estimated that millions of people will lose insurance coverage during this unwinding period now that the public health emergency has ended.

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