On January 30, 2023, the Biden administration announced that it would end public health emergency (and national emergency) declarations on May 11, 2023. Here’s what major health policies will and won’t change when the public health emergency ends
what is changing: Nothing. Availability, access and costs of COVID-19 vaccines, including boosters, are determined by federally purchased vaccine supplies, not public health emergencies.
what is the same: As long as there is a federally purchased vaccine, the Covid-19 vaccine will be free for all people, regardless of insurance coverage. Providers of federally purchased vaccines are not permitted to charge or deny vaccines to patients based on the recipient’s coverage or network status.
Although a federal rule temporarily required private insurers to reimburse out-of-network providers for vaccine administration during public health emergencies, the end of these payments will not affect vaccine access by insurers as long as the federal supply lasts, because vaccine providers are not permitted to provide coverage to recipients or Deny federally purchased vaccines to anyone based on network status and incur no out-of-pocket costs.
Because of the Affordable Care Act and other recent legislation, even after the federal supply of vaccines runs out, vaccines will be available for free to most people with private and public insurance. However, cost can become a barrier for uninsured and underinsured adults when federally purchased doses run out, and privately insured individuals must ensure their provider is in-network. To learn more about what happens after the federal vaccine supply dries up, see our overview of the commercialization of the COVID vaccine and the expected increase in the cost of the COVID vaccine.
Importantly, the Food and Drug Administration’s (FDA) emergency use approvals for the COVID-19 vaccine (and treatments and tests) will remain in effect, as they are tied to a separate emergency declaration, not the public health emergency that expires in May. .
Home covid test
what is changing: At-home (or over-the-counter) tests can be more expensive for people with insurance. After May 11, 2023, people with traditional Medicare will no longer receive free, in-home exams. Those with private insurance and Medicare Advantage (private Medicare plans) will no longer be guaranteed free home tests, but some insurers may continue to cover them voluntarily.
For those using Medicaid, home tests will be covered at no cost until September 2024. After that date, home test coverage will vary by state.
A temporary Medicaid coverage option adopted by 15 states gave uninsured people access to Covid-19 testing services, including home testing, without cost-sharing but that program would end in public health emergencies.
what is the same: Uninsured people in most states are already paying full price for home testing because they were not eligible for temporary Medicaid coverage for COVID testing services. The uninsured and other people who cannot afford home tests can still find them at a free clinic, community health center, public health department, library or other local organization. Additionally, some tests are provided by mail through the federal government, although supplies are dwindling.
PCR and rapid tests are ordered or administered by a health professional
what is changing: While most insured people will still have coverage for COVID tests ordered or administered by a health professional, these tests may no longer be free.
- For people on traditional Medicare, there is no cost for the test, but there may be cost-sharing for associated doctor visits.
- For people with Medicare Advantage and private insurance, both tests and associated doctor visits may be subject to cost-sharing, depending on the plan. Additionally, some insurers may begin to limit the number of tests they cover or require tests to be performed by in-network providers. People with grandfathered or non-ACA-compliant plans will have no guarantee of coverage for the test and may have to pay full price.
- For people with Medicaid, free testing will continue until September 2024, after which states may limit the number of tests covered or impose nominal cost-sharing.
- Uninsured people in the 15 states that adopted the temporary Medicaid coverage option will no longer be able to receive cost-sharing Covid-19 testing services, including home testing, as the program ends with public health emergencies.
what is the same: Uninsured people in most states were not eligible for the temporary Medicaid pathway for COVID testing and so would continue to pay full price for the test unless they could get tested through a free clinic or community health center.
what is changing: People with public coverage may begin new cost-sharing for pharmaceutical Covid treatments (unless these doses are purchased by the federal government, discussed below). Medicare beneficiaries may face cost-sharing requirements for some COVID pharmaceutical treatments after May 11. Medicaid and CHIP programs will continue to cover all pharmaceutical treatments with no cost-sharing through September 2024. After that date, these treatments will continue to be covered; However, states may impose usage limits and nominal cost sharing.
what is the same: Any pharmaceutical treatment dose (such as paxlovid) purchased by the federal government is free to all regardless of insurance coverage. It is based on the availability of federal supplies and is not affected by the end of a public health emergency.
Most insured persons already face cost-sharing for hospitalizations and outpatient visits related to Covid treatment. Private insurers are never required to waive cost-sharing for any COVID treatment. While some have done so voluntarily, most insurers have already phased out these waivers more than a year ago.
what is changing: Some of the flexibility associated with providing health care through telehealth will end during a public health emergency.
- During the public health emergency, providers writing prescriptions for controlled substances were allowed to do so via telemedicine, but after May 11 an in-person visit would be required.
- Because of the pandemic, all states and DC have temporarily waived some aspects of state licensure requirements to allow providers with equivalent licenses in other states to practice remotely via telehealth. Some states have tied these policies to the end of federal public health emergencies so that those policies may expire unless those states change their policies.
- The Department of Health and Human Services temporarily waived penalties against providers using technology that does not comply with federal privacy and security rules in the provision of telehealth services during public health emergencies. Implementing these rules would limit the production of so-called “HIPAA compliant” technologies and communications to telehealth when a public health emergency ends.
what is the same: Expanded telehealth for Medicare beneficiaries once associated with public health emergencies but due to recent legislation, will remain unchanged until December 31, 2024. Most private insurers already covered telemedicine before the pandemic. In Medicaid, states have broad authority to cover telehealth without federal approval. Most states have made, or plan to make, some Medicaid telehealth flexibility permanent.
Overall, the broader impact from the end of the public health emergency is likely to be higher costs for Covid testing – both at-home tests and those performed by physicians. As many Americans delay or go without needed care due to cost, the end of free Covid testing could have a major impact on people’s ability to diagnose Covid in a timely manner or prevent infection. Other changes in health policy that relate to public health emergencies, national emergencies and other declarations are discussed in more detail in our previous overview.
Further, and potentially more significant, changes will come when federal supplies of vaccines, treatments and tests are cut off, though the timing of that has yet to be determined and is not tied to a public health emergency. The Biden administration has announced that it has no more funding for vaccines, tests or treatments and that Congress must make more funds available.
Importantly, continued enrollment for Medicaid enrollees — which has led to record-high enrollment in Medicaid — was once linked to the end of a public health emergency. However, recent legislation doubled this provision from a public health emergency and will end continuous enrollment on March 31, 2023. States can begin disenrolling people from Medicaid as early as April 1, 2023, although most states will take a year to complete these disenrollments. KFF estimates that millions of people will lose Medicaid coverage during this deregulated period