President Biden’s decision to lift the COVID-19 public health emergency means a sweeping series of changes to the health care system — ranging from free mail-order COVID-19 tests to new rules for nursing home admissions — will come to an end May 11.
Many of the emergency provisions eased regulations and provided resources to speed up access to care, in ways that proved effective and popular, and in many cases were complemented by additional measures taken by state governments. Some, such as insurance coverage for telehealth, have already been extended, and industry groups are lobbying to preserve other measures. Some COVID-related services will remain in place under state or federal law.
As a result, Massachusetts providers and health officials are still sorting through the effects of ending the emergency, as state laws, state decisions about Medicaid, and other federal decisions come into play.
“There’s a lot of wait-and-see,” said Jose Francisco Figueroa, assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health.
When it comes to Medicaid programs, which were allowed to eliminate copays and waive certain requirements, “there’s still wiggle room on what the state can decide to keep versus not to keep,” Figueroa said. Massachusetts has long had a generous Medicaid program, called MassHealth, he noted.
State officials said it’s too soon to know the impact of ending the public health emergency, because there are many variables and the federal government may retain certain aspects.
Dr. Davidson H. Hamer, professor of global health at the Boston University School of Public Health, said the biggest changes will be the loss of COVID-related services now provided for free by the federal government. “Cost is going to trickle down to the individual or their employer,” he said.
In Massachusetts, however, state law already mandates that health insurers cover all medically necessary COVID-19 services, without any copays or deductibles, spokespeople for health insurers said.
“Massachusetts has its own protections in place to ensure that consumers aren’t paying out of pocket for a lot of these COVID-related health expenses,” said Amy McHugh, spokeswoman for Blue Cross Blue Shield of Massachusetts. “COVID-19 vaccines will continue to be free for those with insurance even when the public health emergency ends because of various federal laws, including the Affordable Care Act.”
Paxlovid, an antiviral that alleviates COVID-19, must also be covered, she said.
The federal program allowing people to order eight rapid tests through the mail will end, however. But there may be ways to buy the tests at pharmacies and charge them to health insurers.
Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said insurers are required to cover both PCR and rapid antigen tests.
Still, Pellegrini added in a statement, ending the public health emergency “will have a considerable impact on health care costs, as pharmaceutical and vaccine manufacturers seek to significantly increase prices for COVID-19 vaccines, boosters, treatments, and tests as pricing protections tied to the PHE expire.”
Moderna and Pfizer have said they’re considering charging $110 to $130 per vaccine dose, far more than the federal government paid.
Here are some aspects of health care likely to be affected:
Nursing homes: The public health emergency waived a requirement that patients must have stayed at least three days in a hospital before Medicare will pay for their nursing home stay. That allowed patients to be admitted to a nursing home after only a short hospital stay, or even after a visit to the emergency room, said Mary Moscato, president of Hebrew SeniorLife Health Care Services.
Eliminating this waiver will lead to longer stays in already overcrowded hospitals, Moscato said. But she is hopeful the nursing home industry will persuade the federal government to make the waiver permanent.
Hospitals: The Massachusetts Health & Hospital Association also expressed concerns about reinstating the three-day rule. Other provisions that could be lost when the public health emergency expires include enhanced payments for COVID-19 patients, flexibility to use alternative spaces for care, and changes to telehealth rules.
Michael Sroczynski, the MHA’s senior vice president and general counsel, said the waivers and increased flexibility “were a critical part of our pandemic response. And they have become an essential tool in addressing the capacity and workforce crises that have emerged in the time since.”
“We are now working to get a full grasp on which federal measures are of greatest concern heading into this transition, and will be collaborating closely with state officials and our federal delegation to ensure that Massachusetts is set up for success,” Sroczynski said.
Telehealth for mental health and addiction treatment: Remote visits with mental health providers will continue to be covered by Medicare at least until 2024. After that, patients will be required to see their provider in person at least once every 12 months, said Dr. Miriam Komaromy, medical director of Boston Medical Center’s Grayken Center for Addiction.
Several other telehealth flexibilities instituted during the pandemic will continue, with Medicare paying for video- or audio-based treatment at home and other locations.
And, a pandemic-era change that allowed telehealth prescriptions for buprenorphine, a medication for opioid use disorder, has already been extended through 2024. But a proposed rule change would make it permanent, “so the PHE ending should not (theoretically) have an impact,” Komaromy said in an e-mail.
MassHealth: During the pandemic, state Medicaid programs were barred from removing anyone from their rolls after March 18, 2020. MassHealth swelled to 2.3 million people, the largest number ever. But now, starting April 1, the program must resume checking all enrollees’ eligibility. This change is not caused by the expiration of the public health emergency but had already been required by Congress.
MassHealth will also face questions about whether to eliminate other pandemic-era changes, such as the elimination of cost-sharing and waiving prior-authorization requirements.
Data collection: That will get harder, said Lawrence O. Gostin, professor at Georgetown Law. The public health emergency gave the Centers for Disease Control and Prevention “enhanced authority to collect data from the states and private health systems,” he said.
When the emergency declaration expires, in order to gather infectious disease data, the CDC will have to make separate agreements with hundreds of states and hospitals, “often with arduous negotiation and for different diseases,” Gostin said.