Marie Flores, MD, right, examines patient Karla Olguin at an AltaMed clinic in Pico Rivera, California, in August 2021. Once policies put in place under COVID-19 emergency declarations end, up to 14 million Medicaid participants could lose coverage.
Photo by Christina House, courtesy Los Angeles Times/Getty Images
Emergency measures put into place by federal officials during the COVID-19 pandemic have allowed leaders to implement a host of temporary policies, from loosening telehealth restrictions and protecting Medicaid coverage to greater vaccination authority for pharmacists and easier interstate licensing of health workers.
But with the expiration of the federal COVID-19 public health emergency declaration expected in mid-May, health leaders could lose some important strategies, flexibilities and programs that are protecting the nation’s health. While ending the declaration will not mean the pandemic is over, many of the stop-gap policies will come to an end.
Most of the concerns center around Medicaid. A March 2020 emergency measure barred states from removing people from the federal health program, creating continuous enrollment. The move eliminated holes in the Medicaid renewal process that often result in people losing coverage, allowing people to receive much-needed health care as COVID-19 swept the nation.
Nearly 20 million people joined Medicaid during the pandemic, bringing total enrollment to 90 million by September 2022. Once the public health emergency ends, between 5.3 million and 14.2 million enrollees could lose coverage, according to a February analysis by KFF.
Travel nurse Tiquella Russell, of Texas, prepares to give a COVID-19 vaccination at a clinic in South Los Angeles in February 2021. Emergency declarations put into place during the pandemic relaxed rules for interstate licensing of nurses to meet increased demand, but such declarations are coming to an end.
Photo by Mario Tama, courtesy Getty Images
“For the vast majority of people, especially people who are poor, those who are uninsured, it will be a disaster,” Marina Chilton, PhD, MPH, a health management and policy professor at Drexel University’s Dornsife School of Public Health, told The Nation’s Health.
Medicaid agencies can aid enrollees by streamlining renewals, performing outreach to update contact information and opening paths for enrollees to low-cost insurance on the marketplace, according to recommendations from the Center on Budget and Policy Priorities.
The Centers for Medicare and Medicaid Services made it mandatory for states to create a plan to prepare for the end of the public health emergency. States that have shared plans include California, Iowa, Michigan, Nevada and Washington, according to a tracker from the Georgetown University Health Policy Institute’s Center for Children and Families. Plans involve operating call centers to reach enrollees to update contact information and offering communications toolkits.
Kansas and Tennessee have already created and deployed social media campaigns aimed at Medicaid participants. The Kansas effort led to a 15% to 20% rise in enrollees updating information, CMS said.
As many as 100,000 people may fall off New Mexico’s Medicaid program after the public health emergency ends. To address the problem, the state has freed up tax dollars to underwrite health exchange policies for qualifying enrollees to transition to, according to state officials.
Some state Medicaid agencies plan to partner with community health centers to help conduct outreach and organize education events in low-income communities.
Emergency measures during the pandemic removed some regulatory barriers to telehealth visits, and uptake of the service soared.
Photo by FatCamera, courtesy iStockphoto
Among other social safety net programs that expanded during the pandemic was the federal Supplemental Nutrition Assistance Program, which shores up food security for low-income households. Many SNAP enrollees received the maximum allowable benefit for household size. But with the public health emergency’s end, a large number of enrollees may lose about $82 per month in benefits.
To alleviate issues, policymakers could pursue streamlining SNAP access, increasing monthly benefits and eliminating the three-month time limit.
Given that half of Medicaid users are also enrolled in SNAP, 45 million people could experience a one-two punch by losing both services, Chilton said.
But the overlap could also help enroll Medicaid beneficiaries after the public health emergency ends.
Given the nature of its social service, SNAP leads to regular contact between staff and enrollees. Consequently, SNAP roll sheets are more up to date than Medicaid’s and could be used to contact people signed up for both programs. CMS recommended that Medicaid agencies automatically renew enrollees who are under age 65 and already part of SNAP.
A new law passed in December may help soften some of the transition to the end of the public health emergency. Passage of the Consolidated Appropriations Act 2023 was a boon to public health, increasing funding for the Centers for Disease Control and Prevention by $760 million for fiscal year 2023. Other provisions will strengthen the public health workforce and infrastructure, and address data modernization and health disparities and inequities.
The law also extended the deadlines of some policies enacted during the pandemic.
Telehealth services were expanded under the emergency through waivers and policies that relaxed barriers to care. The change allowed people to have safe virtual care during the pandemic, with 37% of U.S. adults using telehealth services in 2021. A late 2021 survey by the American Medical Association found that 85% of physicians were using virtual appointments, and patients who used telehealth overwhelmingly reported they had better access to care with the service. The December appropriations act continues the telehealth allowances through 2024.
The act also continues some federal social services. For example, all children will remain covered under Medicaid and the Children’s Health Insurance Program for 12 months, according to Georgetown’s Center for Children and Families. The policy will take effect in January 2024 and will run through that year.
States will also have the option to continue a year’s worth of postpartum care for Medicaid or CHIP enrollees. And CHIP federal funding will be extended two years.
The policies put into place under the appropriations act show that Congress can work together to protect public health, said Joshua Sharfstein, MD, vice dean of public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health. He pointed to the legislation’s support for CDC, telehealth, addiction treatment, and mental, behavioral and community health.
“There’s a window after one crisis, where you can learn the lessons,” Sharfstein told The Nation’s Health. “I think to some extent the omnibus (spending bill) reflects the lessons that have been learned so far.”
Not all new policies that came into place during the pandemic will be extended, however. The federal government will no longer be picking up the tab for COVID-19 vaccinations, testing and treatment. And while most people with health insurance will continue to have coverage, people who are uninsured will pay out of pocket, unless they qualify for a waiver or another benefit.
“What’s going to happen is people who don’t have much money are not going to get tested or treated,” Chilton said. “They’ll show up to work infected, they’ll get on the bus infected, they’ll get on the subway infected.”
In addition, ending the federal public health emergency creates concern that momentum will stall not only in preventing COVID-19 infections, but also preparing for future outbreaks.
The next pandemic could easily be an infectious disease more transmissible and deadly than COVID-19, Mark Keim, MD, MBA, chief executive officer of DisasterDoc LLC and author of a new APHA Press book on emergency health told The Nation’s Health.
“There’s still a lot that we have to learn and a lot that has not been fixed,” Keim said.
For more information, visit www.cbpp.org and www.cms.gov.
- Copyright The Nation’s Health, American Public Health Association
