AAlmost since the emergence of COVID-19, the US has treated the disease as both a national and a public health emergency. It will end on May 11, 2023, the Biden administration announced. vaccines, boosters, tests and treatments.
The declaration of COVID-19 as a public health emergency (PHE) in January 2020 allowed the federal government—through the Department of Health and Human Services (HHS)-led COVID-19 response—to access funds and resources , to pay for everything from personal protective equipment like masks, tests and vaccines and other ways to respond to the pandemic. Under PHE, the government could also change Medicare and Medicaid reimbursement policies to increase access to treatments and other resources critical to controlling the spread of COVID-19. Two months later, President Trump declared a national emergency related to COVID-19, which opened up additional funding for the response, including continued coverage for people under Medicaid and expanded funds for hospitals to care for patients with COVID-19.
The declarations enabled “a public health approach to healthcare during the pandemic,” said Dr. Josh Scharfstein, associate dean for public health and community engagement at the Johns Hopkins Bloomberg School of Public Health. “They helped a lot of people get services. Now we’re back to the health approach to health care, and that’s putting all the weaknesses of our system into play.
Sharfstein notes that when emergency declarations end, it’s not just access to COVID-19 services that will be affected. Funding provided through the declarations made it possible to continue Medicaid coverage for millions of people even if their eligibility changed; the Kaiser Family Foundation (KFF) estimates that five to 14 million people could lose Medicaid coverage if states decide they are no longer eligible when that provision ends. “The majority of them are expected to be black and Latino, so there is concern that health disparities will worsen,” said Dr. Jose Figueroa, assistant professor of health policy and management at the Harvard TH Chan School of Public Health. .
Here’s what else will change when national and public health emergencies end in May.
COVID-19 vaccines and boosters will continue to be covered for people with private insurance when administered by in-network providers, but according to a KFF analysis, people may have to pay out-of-pocket if they get their vaccines from out-of-network providers their network.
People with Medicare will continue to receive free vaccines that are covered by Medicare Part B through the CARES Act, a $2.2 trillion economic stimulus bill passed by Congress in 2020. Medicaid beneficiaries will also continue to receive free vaccines .
Uninsured people will no longer have access to free vaccines through state Medicaid programs, which received expanded federal funding to cover these services for the uninsured.
tests for COVID-19
Currently, people with private insurance or Medicare can order up to eight rapid home tests per month and be reimbursed. After PHE ends, insurers can continue to cover COVID-19 tests, including over-the-counter at-home tests, but only if they are distributed by a narrower set of in-network providers.
Medicare beneficiaries will also have to start paying for a portion of all tests. Medicaid will continue to pay for doctor-ordered COVID-19 tests, but each state will decide whether to cover at-home tests.
Read more: When should you use home tests for COVID-19? Here’s what the experts say
Treatment of COVID-19
Privately insured individuals will continue to receive coverage for treatment of COVID-19, including widely used antiviral therapies such as Paxlovid.
People with Medicare Part D will be covered for antiviral treatment until the federal supply runs out. Once those doses are gone, beneficiaries will have to pay for a portion of that drug treatment.
Medicaid will only reimburse for treatments that are approved by the US Food and Drug Administration (FDA). Whether drugs that are under FDA emergency use authorization are covered will vary from state to state.
Emergency Use Authorizations (EUAs)
Dual emergencies aren’t the only ones available to respond to COVID-19: The HHS Secretary also granted EUA authority to the FDA to streamline the availability of new drugs for COVID-19. The end of the dual emergencies does not affect EUAs that the FDA has granted to some COVID-19 vaccines and antiviral drugs such as Paxlovid.
An EUA emergency declaration is issued by the Secretary of HHS and remains in effect until the Secretary decides to terminate it. If an emergency EUA ends, then any medicines authorized under it may no longer be available. The drugs will need to get full FDA approval to go back on the market. In a statement, the FDA said that if that happens, it will allow enough time for the transition to ensure drug approvals are forthcoming.
Most of the Medicare coverage for telehealth services that was expanded and authorized during the pandemic will end when PHE completes the KFF reports. The only exceptions are permanent changes for beneficiaries seeking help for mental health and substance use. For these services, out-of-state providers can treat patients in different states, and audio-only services are also consistently covered.
For Medicaid recipients, services and coverage will vary by state.
The 20% increase in Medicare reimbursement that hospitals received for COVID-19 patients will end when PHE expires. This may indirectly affect patients hospitalized for COVID-19, who may see higher costs reflected in their medical bills.
As people must pay for health services related to COVID-19, the virus may find new ways to spread and potentially even evolve into more disease-causing variants. “That means there will be less testing in this country and probably less treatment because not everyone can afford it,” Figueroa says. “Will this change the trajectory of the pandemic? That is something we will have to watch.”
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