Simplifying Healthcare: PHE is Ending – Here’s What You Need to Know

The Public Health Emergency declared during the early days of the COVID-19 pandemic set into motion new and consistently evolving requirements and rules under the purview of several federal authorities and all impacted by the end of the PHE in May.?

So, 3 years later, where does that leave us???

I’m sure many of you have heard that the Biden administration announced its intent to end the national emergency and public health emergency declarations on May 11th, 2023, as they relate to the COVID-19 pandemic. These declarations were first announced in the early days of 2020 and extended twice, followed by several additional pieces of legislation enacted by Congress – 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 Consolidation Appropriations Act (CAA) – all providing additional expansions and flexibilities as a result of these emergency declarations and set to expire alongside or shortly after the PHE ends.???

Not sure what to make of this news or what this means for you, your community, HCPs, and providers? Let’s talk about what will change on May 11th.??

Here’s What to Know?

With all of these moving parts across communities, systems, coverage plans and supplies, here is the TL; DR –??

COVID-19 Vaccines, Tests and Treatments?

Vaccines and boosters will continue to be covered for those in-network with private insurance. People with Medicare under Medicare Part B and Medicaid beneficiaries will also continue to receive free vaccines through the CARES Act. You will need to make sure you understand which providers are in-network to ensure the highest level of coverage.?

Uninsured people will no longer be able to access free vaccines through state Medicaid programs, which had received expanded federal funding due to the PHE declaration. However, there has been an indication that the federal government will make vaccines available to public health departments for those that are uninsured. More to come on this soon.?

In terms of rapid and at-home tests, coverage under private insurance and Medicare will continue but may vary across plans and providers (so make sure you understand coverage under your health plan and know the network status of test providers you choose to use).? Medicare beneficiaries will have to start paying for a portion of any tests obtained. Medicaid will keep paying for tests that are ordered by a doctor, but coverage of at-home tests will vary across states.??

For COVID-19 treatments like Paxlovid and other antiviral therapies, privately insured people will continue to be covered. Those with Medicare Part D will also be covered until the federal supply is depleted, at such time Medicare beneficiaries will be required to pay for a portion of this treatment. Medicaid will only reimburse treatments based on FDA approval, though coverage may vary across states. You may want to check your plan formulary for coverage status and any copays you might have for these treatments going forward.?

Emergency Use Authorizations (EUAs)?

Good news – no immediate changes here concerning the end of the PHE and EUAs for COVID-19 treatments. These are usually issued by the HHS Secretary separate of PHE declarations and remain in effect until the HHS Secretary ends it.??

Medications authorized under the EUA might cease to be available if the EUA declaration were to end. In the event that this happens, the FDA announced in a statement that it would confirm approvals of these drugs prior to the EUA ending.??

Telehealth?

Unfortunately, most telehealth services covered by Medicare that were expanded during the pandemic will end alongside the end of the PHE in May. There are several exceptions including coverage for beneficiaries seeking mental health and substance use assistance. Beneficiaries can still seek care across state lines, and audio-only services will continue to be covered. Services and coverage will vary across states for those with Medicaid coverage so ensure you check with your plan to determine what might be covered moving forward.??

Hospital Care?

Over the course of the pandemic, hospitals have been receiving a 20% increase in Medicare reimbursements for COVID-19 patients, but that will cease come May. Those hospitalized for COVID-19 might see higher costs reflected in their medical bills once the PHE ends.??

Additional Resources?

There are many different resources outlining the impact of the ending of the PHE. Check out the resources that are available for you to explore as they relate to changes in federal-and state-level Medicare and Medicaid COVID-19 coverage and reimbursements:??

• Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap (U.S. Department of Health & Human Services)??
• COVID-19 Resources for Consumers and Patients (Centers for Medicare & Medicaid Services)?
• Coronavirus resources (Benefits.gov)??
• Medicare & Coronavirus (Medicare.gov)??
• Coronavirus Disease (Medicaid.gov)??
• What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access (Kaiser Family Foundation)?

Looking Ahead + Final Thoughts ?

While the past three years have been highly stressful for all of us, the Public Health Emergency did have several positive impacts including ensuring equitable access to COVID testing and treatment; so, there are very real concerns around continued access and cost shares for those services. I would also hate to see us take a step backwards in telehealth access and coverage as this expanded needed access to services for so many including those that are disproportionately impacted.? We also need to have very thoughtful conversations around the millions of people that gained coverage who will now be losing it and how we ensure we are addressing those coverage gaps in a meaningful way.????

We want this crisis to have meant something in terms of learnings and meaningful change. The pandemic exposed the disparities in healthcare access and outcomes that we already knew were there and brought them front and center. Let’s commit to continuing to innovate and lead the change necessary to tackle the impact these disparities have on the health of our communities.?

It's easy to come together during a crisis – it’s not as easy to stay united as it’s seemingly ending. The end of the PHE should not result in a return to the past. Let’s continue to drive forward equitable access to coverage and health care and continue to focus on improving the health of all communities.?

If you have any questions, I recommend you stay close to your HCP, your insurance provider, and your local and federal government resources. While the COVID-19 emergency has ended, I will caution that the need to proactively take care of ourselves and the health of our local and global communities doesn’t disappear here. Please remember to follow guidance and best practices as they evolve, ask your health care provider all questions you might have, and above all, prioritize your and your family’s health and well-being.??

Until next month. ?

- Ruth ?? ?

Have an idea for a future topic or questions in the world of healthcare? I’d love to hear from you!?