On January 30, 2023, the Biden Administration said that it will end COVID-19 emergency declarations on May 11, 2023.  The federal government has been paying for COVID-19 vaccines, some tests, and certain treatments under the public health emergency declaration. Many of those costs now will be transferred to private insurance and government health plans. For example, people with private insurance or Medicare coverage have been eligible for eight free over-the-counter COVID-19 tests per month.  Once the emergency ends on May 11, 2023, those individuals may end up paying out of pocket costs for COVID-19 tests going forward.  Further, Pfizer and Moderna have already announced that the commercial prices of their COVID-19 vaccines will likely be between $82 and $140 per dose, although the Affordable Care Act will require most plans to continue providing vaccines at no cost to participants. 

The end of the national emergency declaration will bring other changes affecting group health plans, including the termination of certain deadline extensions.  During the national emergency, plan participants have had as much as one year longer to elect and pay for COBRA coverage, enroll for coverage as a result of a special enrollment event, and submit health plan claims and appeals.  We will be describing more these deadline extensions and other health plan changes more thoroughly in an upcoming alert.

Increases in Medicare payment rates for hospital inpatient services related to COVID-19 will expire along with the public health emergency period.  The federal government will also phase out enhanced Medicaid funding and will no longer condition certain federal matching funds on states’ continuous coverage of Medicaid beneficiaries and maintenance of pre-COVID premium levels and eligibility standards.  As a result, a number of states will likely discontinue Medicaid coverage for millions of beneficiaries.  A host of state-specific Medicaid (and CHIP) initiatives approved by the federal government via waiver authority will also expire at the end of, or just after, the public health emergency.  These include waivers related to application processes, eligibility criteria, deductibles, other cost sharing, enrollment fees and premiums, drug coverage, provider qualifications (including authority for out-of-state providers to provide various services) and other benefits. 

Through at least 2024, the Medicare program will continue its coverage of expanded telehealth: services (such as mental health and audio-only), eligible practitioners (such as physical therapists, occupational therapists and speech language pathologists), geographic areas and originating sites.  States retain flexibility to expand Medicaid coverage for similar telehealth services. 

Ballard Spahr regularly works with its employer and health care clients to assist them with COVID-19 related regulations and other aspects of labor and employment laws at the federal, state and local government levels.