On May 11, 2023, the federal Public Health Emergency (PHE) for COVID-19 expired. Some Medicaid services, such as telehealth flexibilities, will not be affected and have been extended through December 31, 2024, as indicated in The Consolidated Appropriations Act of 2023.

There are certain Medicare and Medicaid waivers, broad flexibilities for health care providers, and coverage for COVID-19 testing that will be affected.

To better assist with the impact PHE unwinding will have on different areas of people’s health, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) updated its Coverage to Care (C2C) resources to help the consumers you serve understand their health coverage.

Updated C2C Resources Available

Ahead of PHE Unwinding, these resources will help consumers prepare to transition forward and continue to feel confident in how they will receive coverage for COVID-19 testing and telehealth services.

The following resources are now available on the C2C website:

• C2C COVID Overview Factsheet Explains basics of health coverage for protecting you and your family, Medicare updates, Medicaid renewal (new!), and more.
• C2C Telehealth Patient Toolkit Serves as a guide to explain telehealth basics and help patients and their families properly navigate telehealth services.
• C2C Telehealth Provider Toolkit Provides informational tips to assist providers with implementing telehealth services to their patients.

Spread the Word: Renewing Medicaid/CHIP Coverage

Additionally, to ensure Medicaid and CHIP beneficiaries are up to date on the Medicaid continuous enrollment condition that expired on March 31^st, CMS has created many resources, including the Anticipated 2023 State Timelines for Initiating Unwinding-Related Renewals as of February 24, 2023 (PDF, 93 KB, 2 pp).

For the most updated information about Medicaid and CHIP renewal processes, we encourage all enrollment assisters and outreach workers to communicate with Medicaid and CHIP beneficiaries the following three important messages:

• Update your contact information – Make sure the state Medicaid agency or CHIP program has your current mailing address, phone number, email address, or other contact information so they can contact you about your Medicaid or CHIP renewal
• Check your mail – State Medicaid agencies or CHIP programs will mail you a letter about your Medicaid or CHIP coverage
• Complete your renewal form (if you get one) – Fill out the form and return it to the state Medicaid agency or CHIP program right away to help avoid a gap in your Medicaid or CHIP coverage

Make sure to review the updated communications toolkit, Medicaid and CHIP Continuous Enrollment Unwinding (PDF, 3.2 MB, 21 pp) and the Medicaid Unwinding Toolkit Supporting Materials (ZIP, 47 MB) to help inform people with Medicaid or CHIP about steps they should take to renew their coverage or find other health care options. *People who no longer qualify for Medicaid or CHIP are advised to visit Healthcare.gov to find out if they are eligible to enroll in a Marketplace plan.

Preparing for Medicaid Unwinding is important for all. To learn more about the Unwinding and Medicaid and CHIP Renewals, visit CMS OMH at https://www.cms.gov/about-cms/agency-information/omh/resource-center/moving-forward-after-covid-19-public-health-emergency..

 This Center for Medicaid & CHIP Services (CMCS) Informational Bulletin (CIB) lists the end dates of certain COVID-19-related Medicaid and CHIP coverage and enhanced federal funding if the COVID-19 Public Health Emergency (PHE) ends on May 11, 2023, as expected. As part of their response to the COVID-19 PHE, states adopted many temporary flexibilities to support providers and individuals enrolled in Medicaid and CHIP, such as coverage of COVID-19 testing, treatment, and vaccinations.  The bulletin provides key dates to assist states with returning to routine Medicaid and CHIP operations.  About a quarter of rural adults under age 65 are covered by Medicaid.

In response to the unprecedented nature of COVID-19, the federal government declared numerous types of emergencies, Congress enacted several pieces of legislation, and various executive actions were taken and waivers issued, which, collectively, established time-limited flexibilities and provisions designed to protect individuals and the health system during the pandemic. The effective end dates of many, though not all, of these flexibilities and provisions are tied to the public health emergency (PHE) declaration made pursuant to Section 319 of the Public Health Service Act, first declared in January of 2020.  Others are linked to the public health emergency declaration made under Section 564 of the Federal Food, Drug and Cosmetic (FD&C) Act; the declaration made under the Public Readiness and Emergency Preparedness (PREP) Act; and emergency and major disaster declarations made under the Stafford Act. In some cases, subsequent legislation has either delinked provisions from these declarations or otherwise changed their duration.

The Biden Administration recently announced that it will end the PHE on May 11, 2023 and FEMA has announced that the emergency incident period under the Stafford Act will also end on that date. Other related emergency declarations or provisions have already ended or are ending soon. The following table (Table 1) provides a timeline identifying key health-related flexibilities and provisions specified by these various measures, the specific measure that determines their end date, and their end date (an end date for the Section 564 declaration has not yet been announced).

In addition to the end of the flexibilities detailed in Table 1 below, there are also expectations that the federal supply of COVID-19 vaccines could be depleted or need to be replaced by an updated booster dose sometime this year and, similarly, the federal supply of COVID-19 treatments will also be depleted. At a result, COVID-19 vaccines and treatments are transitioning to the commercial market. Importantly, this change is not tied to the end of the public health emergency.

Click here to see the list of deadlines in the referenced table.

The Biden administration has announced the launch of a $1.1 billion public-private partnership called “Bridge Access Program” aimed at giving uninsured individuals access to COVID-19 vaccines and treatments by the U.S. Department of Health and Human Services (HHS). At the end of the Public Health Emergency, the financial obligation of paying for these vaccines and treatments shifts to the private sector. Most people should continue to pay nothing out-of-pocket for vaccines but out-of-pocket expenses for treatments such as Paxlovid may change. The program has two components which include ensuring safety net programs like Community Health Centers will receive vaccines purchased at a discounted rate from the CDC and HHS will contract with pharmacies that will allow them to continue to provide COVID-19 treatments like Paxlovid free of charge to the uninsured.

The Department of Health and Human Services is planning for the federal Public Health Emergency for COVID-19 (PHE), declared under Section 319 of the Public Health Service Act, to expire at the end of the day on May 11, 2023. Today, the Centers for Medicare & Medicaid Services (CMS) issued FAQs on CMS Waivers, Flexibilities, and the End of the COVID-19 PHE. The FAQs will help you prepare for the expiration of the COVID-19 PHE and are relevant for all CMS programs; including, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and private insurance.

CMS resources for the expiration of the COVID-19 PHE:

• Fact Sheet: What Do I Need to Know? CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency
• FAQs on CMS Waivers, Flexibilities, and the End of the COVID-19 PHE
• CMS Current Emergencies Web Page

 From the RUPRI Center for Rural Health Policy Analysis: In December 2022, the proportion of the population ages 12+ with a completed primary COVID-19 vaccination (i.e., have a second dose of a two-dose vaccine or one dose of a single-dose vaccine) was 75.5 percent in metropolitan counties, 60.9 percent in micropolitan counties, and 56.8 percent in noncore counties.

 The latest feature article in The Rural Monitor shares what’s known about the post-COVID illness that’s estimated to affect as many as 3 million in rural areas.  As of December 2022, data from the Centers for Disease Control and Prevention show that the top five states for self-reported symptoms are mostly rural: Montana, Wyoming, Mississippi, Kentucky, and Alaska.

  The National Association of Rural Health Clinics first describes some of the COVID-related waivers and flexibilities that applied widely – such as those reducing barriers to telehealth – and then those that were specific to RHCs.  These include relaxed requirements that physicians provide medical direction to nurse practitioners and justification to provide home nursing services, among others.  These waivers will end with the public health emergency.