What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access

Kaiser Family Foundation | By Juliette Cubanski et al. 

On Jan. 30, 2023, the Biden Administration announced its intent to end the national emergency and public health emergency declarations on May 11, 2023, related to the COVID-19 pandemic. These emergency declarations have been in place since early 2020, and gave the federal government flexibility to waive or modify certain requirements in a range of areas, including in the Medicare, Medicaid, and CHIP programs, and in private health insurance, as well as to allow for the authorization of medical countermeasures and to provide liability immunity to providers who administer services, among other things. In addition, Congress also enacted legislation—including the Families First Coronavirus Response Act (FFCRA), the Coronavirus Aid, Relief, and Economic Security (CARES) Act , the American Rescue Plan Act (ARPA), the Inflation Reduction Act (IRA), and the Consolidated Appropriations Act, 2023 (CAA)—that provided additional flexibilities tied to one or more of these emergency declarations, and as such they too are scheduled to expire when (or at a specified time after) the emergency period(s) expires.

This brief provides an overview of the major health-related COVID-19 federal emergency declarations that have been made, and summarizes the flexibilities triggered by each in the following areas:

• Coverage, costs, and payment for COVID-19 testing, treatments, and vaccines
• Medicaid coverage and federal match rates
• Telehealth
• Other Medicaid and CHIP flexibilities
• Other Medicare payment and coverage flexibilities
• Other private insurance coverage flexibilities
• Access to medical countermeasures (vaccines, tests, and treatments) through FDA emergency use authorization (EUA)
• Liability immunity to administer medical countermeasures

This is not meant to be an exhaustive list of all federal policy and regulatory provisions made in response to COVID-19 emergency declarations. For example, we do not cover the entire range of federal and state emergency authorities exercised under Medicaid Disaster Relief State Plan Amendments (SPAs), other Medicaid and CHIP SPAs, and other state-reported administrative actions; Section 1115 waivers; Section 1135 waivers; and 1915 (c) waiver Appendix K strategies. The Centers for Medicare & Medicaid Services maintains a more complete list of coronavirus waivers and flexibilities that have been exercised since early 2020; some state actions to respond to the emergency may have expiration dates that are not tied to the end of the federal emergency declarations. This brief also does not include all congressional actions that have been made affecting access to COVID-19 vaccines, tests, and treatment that are not connected to emergency declarations, such as coverage of COVID-19 vaccines under Medicare and private insurance (see Commercialization of COVID-19 Vaccines, Treatments, and Tests: Implications for Access and Coverage for more discussion of these issues).

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Year-End Funding Package Includes Medicare and Medicaid Policies

Medicare Rights Center | By Lindsey Copeland

In late December, Congress passed an omnibus spending bill (P.L. 117-328) that funds the federal government through the current fiscal year (September 30, 2023) and makes several important changes to Medicare and Medicaid.

Medicare

Medicare Telehealth

PHE Waiver Extension—The bill extends most of the COVID-19 public health emergency (PHE) Medicare telehealth flexibilities through 2024 and directs the Department of Health & Human Services (HHS) to study telehealth utilization and assess potential fraud.

Medicare Mental Health Care

Provider Expansions—Medicare mental health coverage has known gaps, which the spending bill helps close. One long-sought change will allow Medicare Part B to cover services provided by marriage and family therapists and licensed professional counselors beginning January 1, 2024.

Intensive Outpatient Services—To further ease access, the package revises Medicare’s partial hospitalization benefit to establish coverage of intensive outpatient services beginning January 1, 2024.

Crisis Psychotherapy Services—It also increases payments for mobile crisis care (crisis psychotherapy services furnished by a mobile unit or in other non-facility settings) starting on January 1, 2024.

Workforce Development—It provides for 200 new Medicare-supported graduate medical education (GME) residency positions, half of which are allocated for psychiatry and psychiatry subspecialties.

Provider Outreach—To promote uptake, the omnibus requires HHS to educate providers on the availability of crisis psychotherapy services, behavioral health integration services, and opioid use disorder treatment services under Medicare.

COVID Treatments—The bill temporarily (through December 2024) allows Part D plans to cover oral antiviral treatments that have an emergency use authorization (EUA). This update will permit Medicare to cover COVID-19 treatments like Paxlovid once the PHE ends and those products shift to the commercial market.

Medicare Coverage Changes and Extenders

Lymphedema Compression Garments—Under the bill, compression garments for the treatment of lymphedema will be covered under Part B as durable medical equipment (DME) starting in January 2024.

In-home intravenous immune globulin services (IVIG)—It also provides permanent Medicare coverage for items and services related to the administration of IVIG, beginning on January 1, 2024.

Durable Medical Equipment—The omnibus continues the blended payment rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in certain non-competitive bid areas through 2023.

Hospital at Home Waiver—It extends (through December 31, 2024) the Acute Hospital Care at Home initiative.

Medicaid

Medicaid Home- and Community-based Services (HCBS)

Money Follows the Person and Spousal Impoverishment—The bill continues the Medicaid Money Follows the Person program and protections from spousal impoverishment for people receiving HCBS through September 30, 2027. These critical Medicaid policies that we have long supported help older adults and people with disabilities live with choice, dignity, and independence.

Medicaid PHE Coverage

Continuous Coverage Requirement—The omnibus sunsets the Medicaid continuous coverage requirement. Created in 2020 by the Families First Coronavirus Response Act (FFCRA), this provision has allowed states to maintain their Medicaid rolls in exchange for a 6.2% federal match rate (FMAP) bump. The FFCRA tied this coverage policy to the duration of the PHE; it will now end on April 1.

At that time, the enhanced FMAP will begin to reduce gradually, eventually reaching zero on December 31, 2023. The maintenance of effort (MOE) requirements tied to the FMAP increase—that states may not make eligibility standards, methodologies, or procedures for determining Medicaid eligibility more restrictive than they were on January 1, 2020—will continue to apply during the phase-down period.

Medicaid Eligibility and Funding

Enhanced Eligibility Postpartum and for Children—The bill also requires states to give children (under the age of 19) 12 months of continuous coverage in Medicaid and CHIP and permanently extends the American Rescue Plan policy allowing states to provide 12 months of postpartum coverage to pregnant individuals in Medicaid and CHIP.

Funding for the U.S. Territories—The omnibus extends Puerto Rico’s higher federal Medicaid match (76%) through September 30, 2027, and permanently extends a higher federal match (83%) for American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and the U.S. Virgin Islands. These updates will provide much-needed consistency and fiscal stability.