For three years, public policies and regulations were adjusted in response to the COVID-19 pandemic. On May 11, 2023, the COVID-19 Public Health Emergency (PHE) in the U.S. officially came to an end. The sunsetting of this emergency declaration means the end of many flexibilities, some of which will impact organizations in the human services sector.

The End of COVID-19 PHE – But Not of COVID

The SARS-CoV-2 virus continues to circulate in the U.S. However, better prevention measures, treatments, and vaccines have made it possible to manage the virus. The CDC says hospital admissions dropped by 4.9% between April 19, 2023, and May 16, 2023, whereas deaths decreased by 11.8% between March 25, 2023, and May 13, 2023.

According to HHS, the COVID-19 response remains a priority, but the government can transition away from the emergency phase. As this happens, some flexibilities and policies will change, whereas other policies will remain unaffected.

Telehealth Flexibilities

During the pandemic, new flexibilities made it easier for people to receive care remotely, which allowed them to access care while practicing social distancing. For example, relaxing HIPAA enforcement meant providers could administer remote care without worrying about compliance. HHS says that during the public health emergency, it exercised enforcement discretion and did not impose penalties for noncompliance with HIPAA rules related to telehealth. This enforcement discretion has ended along with the public health emergency.

Coverage for telehealth also changed in many health programs. With the emergency period ending, there will be several adjustments to telehealth flexibilities:

• Medicare telehealth flexibilities have been extended through December 31, 2024, due to the Consolidated Appropriations Act of 2023. Medicare enrollees can access telehealth services regardless of their geographic location. This means they can access care from the comfort of their own home rather than having to travel to a healthcare facility. Additionally, enrollees can use audio-only technology if they are unable to use both audio and video.
• Medicaid and CHIP telehealth flexibilities will vary by state. In some states, telehealth services were introduced temporarily as part of the COVID-19 emergency period. These policies could change. However, many states were offering telehealth options before the pandemic. In fact, CMS encourages telehealth coverage.
• Private health coverage depends on the carrier. Some carriers may add new stipulations, such as cost sharing or prior authorization requirements.

Medicaid Continuous Enrollment

Originally, Medicaid’s continuous enrollment was set to finish with the end of the COVID-19 public health emergency. However, the Center on Budget and Policy Priorities says a bill passed in 2022 to delink the two programs. As a result, Medicaid continuous enrollment ended on March 31, 2023. Starting on April 1, 2023, states have been able to resume normal, pre-pandemic Medicaid coverage terminations.

KFF says enrollment in Medicaid and CHIP grew by 23.3 million during the pandemic. The continuous enrollment provision likely played a key role in this growth. Millions of people could lose coverage as states roll out terminations.

Medicare and Medicaid Waivers

HHS says CMS used various emergency authority waivers, regulations, and sub-regulatory guidance to facilitate care during the pandemic. Many states, hospitals, and other organizations operated under hundreds of these waivers during the pandemic. Among other things, these waivers helped expand facility capacity.

Many of these waivers are no longer considered necessary and will end with the public health emergency. Some Medicaid waivers ended on May 11, 2023, but others will end after an additional six months.

The sheer number of waivers makes it impossible to cover them all here. However, this FAQ from CMS provides additional information as well as links to relevant factsheets and a roadmap that facilities and providers can use.

COVID-19 Tests and Reporting

During the pandemic, Medicare enrollees were able to access free, at-home COVID-19 tests. This program ended on May 11, 2023. However, Original Medicare enrollees can still access COVID-19 tests with no cost sharing when they order lab tests through an eligible provider. Cost sharing may vary in Medicare Advantage plans.

HHS says Medicaid will continue to provide COVID-19 tests with no cost sharing until September 30, 2024. After this date, coverage will depend on the state.

As of May 11, 2023, private health insurance plans are no longer required to cover COVID-19 tests without cost sharing. However, since some plans may decide to continue offering this coverage, individuals will need to check with their plans.

Furthermore, HHS says it will no longer have the authority to require labs to report COVID-19 data. This may impact the reporting of negative test results, which could, in turn, impact the accuracy of positive test rates. However, hospital data reporting will continue under CMS requirements.

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