COVID Emergency Orders Ending: What’s Next?

Feb. 1, 2023 – It’s the end of an era. The Biden administration announced Monday that it will be ending the twin COVID-19 emergency declarations, marking a major change in the 3-year-old pandemic.  . The orders spanned two presidencies. The Trump administration’s Health and Human Services Secretary Alex Azar issued a public health emergency in January 2020. Then-President Donald Trump declared the COVID-19 pandemic a national emergency 2 months later. Both emergency declarations – which remained in effect under President Joe Biden – are set to expire May 11.  Read on for an overview of how the end of the public health emergency will trigger multiple federal policy changes.  Changes That Affect Everyone There will be cost-sharing changes for COVID-19 vaccines, testing, and certain treatments. One hundred-percent coverage for COVID testing, including free at-home tests, will expire May 11.  Telemedicine cannot be used to prescribe controlled substances after May 11, 2023. Enhanced federal funding will be phased down through Dec. 31, 2023. This extends the time states must receive federally matched funds for COVID-related services and products, through the Consolidated Appropriations Act of 2023 .  Otherwise, this would have expired June 30, 2023. Emergency use authorizations  for news COVID-19 treatments and vaccinations will not be affected and/or end on May 11. Changes That Affect People With Private Health Insurance Many will likely see higher costs for COVID-19 tests, as free testing expires and cost-sharing begins in the coming months. COVID-19 vaccinations and boosters will continue to be covered until the federal government’s vaccination supply is depleted. If that happens, you will need an in-network provider. You will still have access to COVID-19 treatments – but that could change when the federal supply dwindles. Changes That Affect Medicare Recipients Medicare telehealth flexibilities will be extended  through Dec. 31, 2024, regardless of public health emergency status. This means people can access telehealth services from anywhere, not just rural areas; can use a smartphone for telehealth; and can access telehealth in their homes.  Medicare cost-sharing for testing and treatments will expire May 11, except for oral antivirals.  Changes That Affect Medicaid/CHIP Recipients Medicaid and Children’s Health Insurance Program (CHIP) recipients will continue to receive approved vaccinations free of charge, but testing and treatment without cost-sharing will expire during the third quarter of 2024. The Medicaid continuous enrollment provision will be separated from the public health emergency, and continuous enrollment will end March 31, 2023. Changes That Affect Uninsured People The uninsured will no longer have access to 100% coverage for these products and services (free COVID-19 treatments, vaccines, and testing).  Changes That Affect Health Care Providers There will be changes to how much providers get paid for diagnosing people with COVID-19, ending the enhanced Inpatient Prospective Payment System reimbursement rate, as of May 11, 2023. Health Insurance Portability and Accountability Act (HIPAA) potential penalty waivers will end. This allows providers to communicate with patients through telehealth on a smartphone, for example, without violating privacy laws and incurring penalties. What the Experts Are Saying  WebMD asked several health experts for their thoughts on ending the emergency health declarations for COVID, and what effects this could have. Many expressed concerns about the timing of the ending, saying that the move could limit access to COVID-related treatments. Others said the move was inevitable but raised concerns about federal guidance related to the decision.  Q: Do you agree with the timing of the end to the emergency order? A: Robert Atmar, MD, a professor of infectious diseases at Baylor College of Medicine in Houston: “A lead time to prepare and anticipate these consequences may ease the transition, compared to an abrupt declaration that ends the declaration.”  A: Georges C. Benjamin, MD, executive director of the American Public Health Association: “I think it’s time to do so. It has to be done in a great, thoughtful, and organized way because we’ve attached so many different things to this public health emergency. It’s going to take time for the system to adapt. CDC data collection most likely will continue. People are used to reporting now. The CDC needs to give guidance to the states so that we’re clear about what we’re reporting, what we’re not. If we did that abruptly, it would just be a mess.” A: Bruce Farber, MD, chief public health and epidemiology officer at Northwell Health in Manhasset, NY:  “I would have hoped to see it delayed.” A: Steven Newmark, JD, chief legal officer and director of policy at the Global Healthy Living Foundation: “While we understand that an emergency cannot last forever, we hope that expanded services such as free vaccination, promotion of widespread vaccination, increased use of pharmacists to administer vaccines, telehealth availability and reimbursement, flexibility in work-from-home opportunities, and more continues. Access to equitable health care should never backtrack or be reduced.” Q: What will the end of free COVID vaccinations and free testing mean?  A: Farber: “There will likely be a decrease in vaccinations and testing.The vaccination rates are very low to begin with, and this will likely lower it further.” A: Atmar: “I think it will mean that fewer people will get tested and vaccinated,” which “could lead to increased transmission, although wastewater testing suggests that there is a lot of unrecognized infection already occurring.”  A: Benjamin: “That is a big concern. It means that for people, particularly for people who are uninsured and underinsured, we’ve got to make sure they have access to those. There’s a lot of discussion and debate about what the cost of those tests and vaccines will be, and it looks like the companies are going to impose very steep, increasing costs.” Q: How will this affect higher-risk populations, like people with weakened immune systems?  A: Farber: “Without monoclonals [drugs to treat COVID] and free Paxlovid,” people with weakened immune systems  “may be undertreated.” A: Atmar: “The implications of ongoing widespread virus transmission are that immunocompromised individuals may be more likely to be exposed and infected and to suffer the consequences of such infection, including severe illness. However, to a certain degree, this may already be happening. We are still seeing about 500 deaths/day, primarily in persons at highest risk of severe disease.” A: Benjamin: “People who have good insurance, can afford to get immunized, and have good relations with practitioners probably will continue to be covered. But lower-income individuals and people who really can’t afford to get tested or get immunized would likely become under-immunized and more infected.  “So even though the federal emergency declaration will go away, I’m hoping that the federal government will continue to encourage all of us to emphasize those populations at the highest risk – those with chronic disease and those who are immunocompromised.” A: Newmark: “People who are immunocompromised by their chronic illness or the medicines they take to treat acute or chronic conditions remain at higher risk for COVID-19 and its serious complications. The administration needs to support continued development of effective treatments and updated vaccines to protect the individual and public health. We’re also concerned that increased health care services – such as vaccination or telehealth – may fall back to pre-pandemic levels while the burden of protection, such as masking, may fall to chronic disease patients, alone, which adds to the burden of living with disease.” Q: What effect will ending Medicaid expansion money have?  A: Benjamin: Anywhere from 16 to 20 million people are going to lose in coverage. I’m hoping that states will look at their experience over these last 2 years or so and come to the decision that there were improvements in healthier populations. Q: Will this have any effect on how the public perceives the pandemic?  A: Farber: “It is likely to give the impression that COVID is gone, which clearly is not the case.” A: Benjamin: “It’ll be another argument by some that the pandemic is over. People should think about this as kind of like a hurricane. A hurricane comes through and tragically tears up communities, and we have an emergency during that time. But then we have to go through a period of recovery. I’m hoping people will realize that even though the public health emergencies have gone away, that we still need to go through a period of transition … and that means that they still need to protect themselves, get vaccinated, and wear a mask when appropriate.” A: Atmar: “There needs to be messaging that while we are transitioning away from emergency management of COVID-19, it is still a significant public health concern.”