With the COVID-19 public health emergency (PHE) slated to end in May, several pandemic-era healthcare provisions and waivers, including for vaccines, telehealth, insurance coverage, and more, will also end—leaving patients with higher costs and more difficulty accessing care.

COVID-19 PHE to end in May

On Monday, the Office of Management and Budget (OMB) announced that the national COVID-19 PHE, which was first declared by the Trump administration in January 2020, will end on May 11.

Administration officials want to provide extra time for the emergency orders to lapse in order to give health systems and medical providers time to prepare for the changes. OMB said that abruptly ending the emergencies would cause "wide-ranging chaos and uncertainty throughout the health care system."

With the PHE coming to an end, several waivers and rules aimed at ensuring care during the pandemic will also be reversed unless Congress chooses to extend them for a longer period of time. Several key areas of healthcare that will be affected include:

COVID-19 tests, treatments, and vaccines

During the pandemic, the federal government purchased supplies of COVID-19 tests, treatments, and vaccines and made them available to the public free of charge. Medicare and private insurers were also required to cover up to eight at-home COVID-19 tests per month.

The federal government plans to continue providing tests, vaccines, and treatments at no charge while supplies last, but after that, cost-sharing is expected to begin, at least for individuals with private insurance. For those on Medicaid, COVID-19 testing, vaccines, and treatments will be covered for a year after the end of the PHE.

Although COVID-19 vaccines are expected to be covered by most insurers, people will likely pay at least some or all of the cost of tests and treatments, depending on how their insurance chooses to cover them. People could also see higher insurance premiums if the treatment costs are substantial.

Uninsured individuals will likely face the most difficulty accessing COVID-19 therapeutics after the end of the PHE since they will have to pay out-of-pocket for care. "Unless it's a federally purchased vaccine or treatment or test, the uninsured do not have any guarantee for coverage," said Jennifer Kates, an SVP at the Kaiser Family Foundation.

According to health officials, the administration is working on initiatives to help uninsured Americans with COVID-19 health costs, but so far, no details have been provided.

Providers

With the end of the PHE, hospitals will no longer receive a 20% increase in Medicare reimbursements for treating COVID-19 patients. According to Stacey Hughes, EVP at the American Hospital Association (AHA), the end of these payments will likely add to hospitals' financial difficulties as they struggle with both workforce shortages and inflation.

There could also be workforce changes as pandemic waivers for staffing flexibilities end. For example, the waivers allowed nurse anesthetists, as well as NPs in some settings, to work without physician supervision, and physicians' whose privileges expired or new physicians without full approval could continue to practice at hospitals to alleviate workforce shortages.

Hospitals will also lose flexibility with certain administrative tasks, such as extended timelines to complete medical records and waivers for utilization review requirements. HHS will also begin penalizing hospitals for not complying with certain HIPAA requirements again.

AHA said it will continue to ask Congress for assistance with workforce challenges, growing supply costs, sicker patients, and more to help hospitals transition through the end of the PHE and beyond.

Telehealth

Congress and the Biden administration have extended some telehealth provisions through 2024, but not every pandemic-era policy will continue in the long term. For example, Medicare currently pays the same rate for telehealth and in-person visits, but this will end this year unless lawmakers choose to extend the policy.

The waiver of in-person requirements for the prescriptions of controlled substances, including opioids, is also ending, which could make it difficult for patients who sought care virtually during the pandemic to continue accessing their treatments.

According to Kyle Zebley, an SVP at the American Telemedicine Association, patients affected by this change "will have to find in-person care in an overburdened health-care system with too few providers."

Currently, some telehealth companies are working to facilitate in-person meetings to allow patients to continue their care. They are also advocating for lawmakers and regulators to make this waiver permanent.

In a statement, an official from the Drug Enforcement Administration, which oversees the prescription of controlled substances, said the agency plans to announce new proposals related to telehealth soon.

Insurance coverage

In 2020, states that received enhanced Medicaid funding were prohibited from dropping individuals from the program while the PHE was in place. During the pandemic, Medicaid enrollment increased significantly, and over 91 million people were enrolled in either Medicaid or CHIP as of October.

The continuous coverage requirement is now ending March 31, and HHS estimates that around 15 million people will lose health benefits as states begin their redetermination processes to evaluate eligibility. If someone is ineligible for Medicaid, they will have until July 31, 2024, to sign up for coverage via the federal Affordable Care Act (ACA) marketplace.

"We have been working on several fronts to prepare for this and to ensure the transition is as seamless as possible," said Cecile Erwin Young, executive commissioner of Texas Health and Human Services. "Our priority right now is to promote awareness and to help our clients understand the timeline and the steps that need to be taken to redetermine eligibility."

Currently, states are working with several organizations, including Medicaid plans, hospitals, insurance marketplaces, and nonprofit groups, to reach people who are at risk of losing coverage. They are also planning media campaigns through social media, television, radio, and billboards to raise awareness among enrollees.

According to Kaiser Health News, some states are also planning specific programs to assist individuals who are no longer eligible for Medicaid.

Pharmacist authorities

During the pandemic, pharmacists gained additional powers through the Public Readiness and Emergency Preparedness (PREP) Act. Under the PREP Act, HHS allowed pharmacists and pharmacy technicians to order and administer COVID-19 tests, vaccines, and treatments for patients as young as three.

These flexibilities are active through Oct. 1, 2024, but since pharmacists typically operate under state laws, it is not clear what will happen once the federal PHE ends.

So far, industry groups like NCPA and the National Association of Chain Drug Stores have been urging both state and federal lawmakers to make these expanded authorities permanent after the PHE ends.

In the Senate, HELP Committee leaders said they wanted to make this issue a priority.

"I'd like to say that those things that actually worked from the PHE can actually be continued either by state or by federal law," said Sen. Bill Cassidy (R-La.), an incoming ranking member on the committee. "If you can teach somebody how to give a vaccine safely, they've been doing it safely throughout the PHE and they can continue to do so, then that's a reasonable thing." (Goldman/Devereaux, Modern Healthcare, 1/31; Aboulenein, Reuters, 2/1; Galewitz, Kaiser Health News, 2/2; Bendix, NBC News, 1/31; Raman et al., Roll Call, 2/2; Seitz, Associated Press, 1/31; Gilbert, Washington Post, 1/31; Payne, Politico, 1/31)