Cory Caldwell, MHA, is NACHC’s Manager for Federal Policy. NACHC’s Director of Policy and Regulatory Affairs, Vacheria Keys, contributed to this article.
Can it be true? Is the COVID-19 Public Health Emergency ending? After nearly three years and 12 extensions, President Joe Biden has officially announced the end of the COVID-19 Public Health Emergency (PHE). The White House’s Statement of Policy explains that the PHE and National Emergency will end in a matter of months on May 11, 2023. Below is our breakdown of how these changes will affect health centers and patients.
National Emergency vs. Public Health Emergency: What’s the Difference?
The COVID-19 Public Health Emergency was first declared by the U.S. Department of Health and Human Services (HHS) on January 31, 2020. The declaration allowed the Secretary of Health and Human Services (HHS) to provide flexibility to state and local health departments in their pandemic response. As the COVID-19 virus continued to spread, President Donald Trump declared the COVID-19 National Emergency on March 31, 2020. The move directed the HHS Secretary to temporarily waive or modify requirements related to Medicare, Medicaid, and State Children’s Health Insurance Programs (CHIP) and HIPPA.
An emergency declaration declared through the Stafford Act by President Trump also provided needed resources through a 75% federal match for disaster-related costs from the Federal Emergency Management Agency (FEMA) and helped states activate operation centers, the use of the National Guard, and measures to protect public health and safety.
Why Ending the PHE Impacts Community Health Centers
The PHE and National Emergency helped federal and state governments to implement policies or relax existing policies so that providers, including health centers, could nimbly respond on the front lines of the COVID-19 pandemic. These PHE flexibilities also helped boost access for patients by eliminating fees for COVID-19 related services, expanded the use of telehealth, and permitted a variety of health care providers to address growing workforce challenges. Below is a high-level review of flexibilities health centers should be aware of over the next few months. View details in our fact sheet about the unwinding of the Public Health Emergency.
What This Means for COVID-19 Vaccines, Testing, and Treatment
Throughout the COVID-19 pandemic, health centers have benefited from federal programs that provide free COVID-19 vaccines, testing supplies, and treatments. Congress has not heeded the Biden Administration’s request to continue providing free COVID-19 related supplies. When the federally purchased supply is depleted, the COVID-19 vaccine and treatments will thus transition to the commercial market. As a result, patients may face cost-sharing and health centers will undoubtedly incur costs to acquire and stock COVID-19 vaccines, testing supplies, and treatments. NACHC encourages health centers to consider any financial and operational implications when the COVID-19 vaccine enters the commercial market. Below is a summary of coverage based on insurance type:
| Insurance Type | COVID-19 Vaccine | COVID-19 Testing | COVID-19 Treatment |
| Medicare | Covered without cost-sharing due to Inflation Reduction Act | Cost-sharing | Cost-sharing |
| Medicaid | Covered without cost-sharing | No cost-sharing (at-home test) until September 2024 | No cost-sharing (at-home test) until September 2024 |
| Private Insurance | Depends on the health plan | Cost-sharing | Cost-sharing |
It is important to note, that patients with temporary Medicaid coverage created through the State PHE flexibilities will lose COVID-19 testing services without cost sharing. Currently, 15 states have adopted this coverage option.
Expanded Scope of Practice
HHS has amended the Public Readiness and Emergency Preparedness Act during the pandemic. This action expanded who could order and administer COVID-19 vaccines. They include dentists, pharmacists, midwives, paramedics, EMTs, physician assistants, respiratory therapists, podiatrists, optometrists, and veterinarians. The amendment to the act is scheduled to last until October 1, 2024.
Telehealth
Before COVID-19, health centers were hampered by regulatory and statutory restrictions in providing telehealth services. Thanks to broad telehealth flexibilities, granted by the PHE
98% of health centers rapidly deployed and utilized telehealth services at the start of the pandemic. Telehealth is a critical tool that enables health centers to meet patients where they are at, without creating additional barriers to care during the COVID-19 pandemic.
With the recent passing of the Consolidated Appropriations Act, 2023 (CAA, 2023) many of the telehealth flexibilities authorized during the COVID-19 PHE were extended until December 31, 2024. This includes:
- Health centers serving as distance site providers for telehealth services.
- The ability to provide services using audio-only communication platforms.
- Waiving in-person requirements for mental health visits.
- Virtual supervision for “incident to” providers.
Most importantly, health centers are waiting for the Health Resources and Service Administration’s (HRSA) finalized policy on program requirements. Many health centers have expanded the care they provide outside of their normal service area due to the availability of telehealth. For health centers to continue these expanded services, HRSA will need to remove the requirement for patients to be physically located within the health center’s service area to boost telehealth and support a patient’s choice for a health home. HRSA will need to clarify that both “established patients” and new patients can access services via telehealth when physically located outside of the service area at the time of the telehealth visit.
Track What’s Happening in Your State
NACHC encourages health centers to review 1115 and 1135 waivers implemented by states during the pandemic. States across the nation took advantage of the expedited Medicaid processes to make it easier for providers to respond to the COVID-19 virus. 1115 waivers are used to waive key provisions of the Medicaid statute and will expire 60 days after the PHE expiration. 1135 waivers are used to waive certain Medicare, Medicaid, CHIP, or HIPPA requirements and will expire at the end of the PHE on May 11, 2023. It is important to also track any state or local waivers related to state licensure requirements. Waivers that modified state licensure requirements to practice telehealth may expire with the PHE’s end.
As of this month (February) states will begin the redetermination process, and as early as April 1, 2023, states terminate coverage for their Medicaid beneficiaries if they no longer meet eligibility requirements. States will be given 12 months to initiate and 14 months to conduct renewals for all their Medicaid beneficiaries. NACHC has developed resources for health centers and state primary care associations focusing on the Medicaid Redeterminations. Please visit the following blog post about Medicaid redetermination by NACHC’s Federal Policy team for more information.
PHOTO: Courtesy of Lowell Community Health Center.