In several states, nursing home staff and residents make up nearly half of residents who have died from COVID-19, including 55 percent of deaths caused by the coronavirus in Massachusetts. While hospitals’ personal protective equipment (PPE) shortages have been highlighted, less attention has been paid to the critical need for PPE and infection control expertise at nursing homes. In response, states are launching rapid-response initiatives to assess and stabilize patients and provide infection control recommendations and support.
The COVID-19 pandemic is shining a light on well-established racial disparities in health care access and quality, and in social and economic factors affecting health status and outcomes. The racial inequities exposed by case identification and death rates data give states opportunities to improve their responses and interventions.
As state and local data becomes available, Louisiana and Illinois governors have highlighted racial disparities in COVID-19 cases and deaths. This aligns with governors’ recent public statements about equity – 22 governors mentioned the need for educational, economic, and social equity in their state of the state addresses earlier this year.
State public health agencies are working around the clock to inform the public about the pandemic by regularly monitoring and reporting data, which is one of their core functions. An analysis by the National Academy for State Health Policy (NASHP) of state public health websites found that 25 states (AL, AR, AZ, CA, CT, GA, ID, IL, IN, LA, MA, MD, MI, MN, MS, NY, NC, OH, OK, SC, TN, TX, VA, WA, and WI) and Washington, DC are reporting COVID-19 data by race and/or ethnicity.
Among the findings:
- Six states report case data (laboratory-confirmed positive cases), three report mortality data, and 17 report both cases and mortality by race and/or ethnicity.
- States use a variety of categories to report race and ethnicity data. For example, Louisiana reports race data for the following categories: American Indian/Alaska Native, Asian, black, Native Hawaiian/Pacific Islander, other, unknown, and white. Louisiana reports ethnicity data as either Hispanic/Latino or non-Hispanic/Latino. Connecticut reports Hispanic, non-Hispanic white, non-Hispanic black, non-Hispanic Asian, non-Hispanic other, and non-Hispanic unknown.
- Eighteen states report a large proportion of unknown (or missing) race/ethnicity.
- Fourteen states illustrate racial or ethnic disparities where the percentage of deaths or cases for one population is disproportionately high, compared to the demographic breakdown of the state. For example, Mississippi reported that 72 percent of its deaths from COVID-19 have been in the African American population, despite the fact that African Americans make up only 38 percent of the state’s overall population.
State health secretaries and legislators also are emphasizing the importance of identifying disparities to understand and respond to the pandemic and promote health equity. Recently, Massachusetts’ Health and Human Services Secretary, MaryLou Sudders said, “I want to be clear, obtaining racial and ethnic data on cases of COVID-19 is crucial for examining where and on whom the burden of illness and death is falling…It’s actually essential for the commonwealth response to the pandemic and important information for all of us to understand.”
There are additional opportunities for states to monitor and address COVID-19 disparities. Gov. Andrew Cuomo of New York has committed to collecting more comprehensive data about COVID-19 in minority communities. Publicly reporting COVID-19 testing, hospitalization, and recovery by race and ethnicity could further allow state and local policymakers, providers, and other stakeholders to monitor and ensure equity in access to resources for prevention and treatment in order to improve outcomes.
State and city leaders can harness COVID-19 data to tailor their current responses to the pandemic and continue to identify strategies to meet the health and health-related social needs of communities of color. States use race/ethnicity data in a number of ways, including targeting or soliciting funding, tailoring stakeholder outreach and engagement, informing public health initiatives, and strengthening governmental processes to address disparities strategically and comprehensively.
In response to data in her state, Gov. Gretchen Whitmer established the Michigan Coronavirus Task Force on Racial Disparities to develop recommendations for addressing disparities “right now as we work to mitigate the spread of COVID-19 in Michigan.” Task Force chair, Lt. Gov. Garlin Gilchrist II, tweeted, “COVID-19 is a constant reminder of how dangerous racial disparities and inequality are for people of color. 14% of our population is Black, but more than 40% of deaths are in Black communities. I’m working alongside @GovWhitmer to make Michigan a leader in addressing this.”
City leaders also are taking action. Chicago Mayor Lori E. Lightfoot announced a multi-pronged strategy to “address systemic health inequities within the COVID-19 crisis.” Specifically, the mayor in collaboration with nonprofit partners is:
- Establishing a Racial Equity Rapid Response Team to engage community members;
- Conducting regional briefings in targeted communities and with street outreach workers; and
- Calling for more detailed data collection.
Importantly, the city’s health department signed a public health order enhancing data-sharing requirements for certain facilities to support COVID-19 tracking.
States can incorporate lessons into their existing state initiatives to ensure access to coverage and address health equity through accountable health models, Medicaid managed care contract language for social determinants of health, unique data-sharing agreements, and workforce strategies. As the Coronavirus Aid, Relief and Economic Security Act (CARES Act) funding is made available to states and hospitals, leaders can use the funds to support communities and populations disproportionally affected by COVID-19 due to structural and social inequities. States’ efforts to address health equity will continue throughout and beyond this pandemic. NASHP will continue to track states’ public reporting of COVID-19 by race and ethnicity.
|States Publicly Reporting COVID-19 Data by Race/Ethnicity*|
|State||Data Reported||Categories Used to Define Race/Ethnicity|
|AL||Cases**||Race: Asian, Black, White, Other/Unknown
Ethnicity: Hispanic/Latino, Not Hispanic/Latino, Unknown
|AR||Cases and Mortality||Black, White, American Indian, Asian, Pacific Islander, Multiracial, Other, Missing|
|AZ||Cases and Mortality||White Non-Hispanic, Hispanic or Latino, Native American, Black Non-Hispanic, Asian/Pacific Island, Other Non-Hispanic, Unknown|
|CA||Cases and Mortality||Latinos, Whites, African Americans/Blacks, Asians, Multiracial, American Indians or Alaska Natives, Native Hawaiians or Pacific Islanders, Other|
|CT||Cases and Mortality||Hispanic, Non-Hispanic White, Non-Hispanic Black, Non-Hispanic Asian, Non-Hispanic Other, Non-Hispanic Unknown|
|DC||Cases and Mortality||Race: Unknown, White, Black/African American, Asian, American Indian/Alaska Native, Other/Multiracial, Refused During the Interview
Ethnicity: Unknown, Hispanic or Latinx, NOT Hispanic or Latinx, Refused During Interview
|GA||Cases||Race: Black or African American, White, American Indian/Native American, Asian, Multiracial, Native Hawaiian/Pacific Islander, Other, Unknown
Ethnicity: Hispanic/Latino, Non-Hispanic/Latino, Unknown
|ID||Mortality||Race: White, Black, American Indian/Alaska Native, Asian/Pacific Islander, Other Race/Multiple Race, Race Information Pending
Ethnicity: Non-Hispanic, Hispanic, Ethnicity information Pending
|IL||Cases and Mortality||White, Black, Hispanic, Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, Other, Left Blank|
|IN||Cases and Mortality||Race: White, Black or African American, Asian, Other, Unknown
Ethnicity: Not Hispanic or Latino, Hispanic or Latino, Unknown
|LA||Mortality||Race: American Indian/Alaska Native, Asian, Black, Native Hawaiian/Pacific Islander, Other, Unknown, White
Ethnicity: Hispanic/Latino, Non-Hispanic/Latino
|MA||Cases and Mortality||Hispanic, Non-Hispanic White, Non-Hispanic Black/African American, Non-Hispanic Asian, Non-Hispanic Other, Unknown, Missing|
|MD||Cases and Mortality||African-American, Asian, White, Other, Data not Available|
|MI||Cases and Mortality||Race: American Indian or Alaska Native, Asian/Pacific Islander, Black or African American, Caucasian, Multiple Races, Other, Unknown
Ethnicity: Hispanic/Latino, Non-Hispanic/Latino, Other, Unknown
|MN||Cases and Mortality||Race: White, Black, Asian, Native Hawaiian/Pacific Islander, American Indian/Alaska Native, Other, Unknown/Missing
Ethnicity: Hispanic, Non-Hispanic, Unknown/Missing
|MS||Cases and Mortality||Black or African American, White, Other|
|NY||Mortality||Hispanic, Black, White, Asian|
|NC||Cases and Mortality||Race: American Indian/Alaska Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, White, Other
Ethnicity: Hispanic, Non-Hispanic
|OH||Cases and Mortality||Race: White, Black, Other, Unknown
Ethnicity: Non-Hispanic or Non-Latino, Hispanic, Latino, Unknown
|OK||Cases and Mortality||Race: American Indian/Alaska Native Only, Asian Only, Black Only, White Only, Other/Multiple Races
Ethnicity: Hispanic or Latino (can be any race)
|SC||Cases||Race: African American, White, Asian, American Indian or Alaska Native, Unknown, Other|
|TN||Cases||Race: White, Black or African American, Other/Multiracial, Asian, Pending
Ethnicity: Not Hispanic or Latino, Hispanic, Pending
|TX||Cases||Asian, Black, Hispanic, Other, Unknown, White|
|VA||Cases||Race: Black or African American, White, Other, Not Reported|
|WA||Cases and Mortality||Hispanic, Non-Hispanic American Indian or Alaska Native, Non-Hispanic Asian, Non-Hispanic Black, Non-Hispanic White, Non-Hispanic Native American or Other Pacific Islander, Non-Hispanic Multiracial, Non-Hispanic Other Race, Unknown|
|WI||Cases and Mortality||Race: American Indian, Asian or Pacific Islander, Black, White, Multiple or Other Races, Unknown
Ethnicity: Hispanic or Latino, Not Hispanic or Latino, Unknown
*As of April 12, 2020. View an updated interactive map highlighting state efforts to track COVID-19 case and death rates by race and ethnicity here.
** Cases in this table refer to laboratory-confirmed positive COVID-19 cases.
Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.
As coronavirus (COVID-19) hospitalizations and ICU bed demand surge across the country, 13 states have quickly acted to implement temporary, targeted suspensions of their certificate of need (CON) requirements for construction or expansion of new health-care facilities to remove regulatory barriers to address this critical health care need.
CON laws are state regulatory mechanisms to help determine whether building or expanding health care facilities and services in a given area is needed. Currently, 35 states have CON statutes. Generally, a health care facility submits a CON application to a state agency when it proposes to build an additional health care facility, provide a new lines of services, or increae the number and type of beds it offers. The state then reviews and determines whether to approve the proposed change.
A central assumption behind state CON legislation is that overbuilding and redundancy in health care facilities leads to higher health care costs. As a result, CON requirements can be useful tools to achieve health care cost containment. However, states are also working to ensure these cost containment tools do not inadvertently create barriers in their response to the COVID-19 crisis.
Thirteen states have taken steps to mitigate these potential barriers. Twelve state governors (CT, GA, IN, IA, LA, MD, MI, NJ, NY, SC, TN, and VA) have issued executive orders that suspend their states’ CON requirements. These suspensions are temporary and targeted:
- They last only for the duration of the public health emergency in their respective states; and
- Authorize suspensions of CON requirements only to the extent needed in order to respond to COVID-19.
Vermont enacted legislation on March 30, 2020, to provide authority to the Green Mountain Care Board to waive CON requirements.
Six states (GA, MD, MI, NY, VT, and VA) have temporarily expedited their CON approval process, but have not suspended it outright. For example, since Maryland Gov. Larry Hogan’s March 5, 2020, emergency declaration, which included a general authority allowing the Health Services Cost Commission to waive its CON statute and regulations as necessary to respond to COVID-19, the commission has granted seven expedited emergency CON applications within one to two days of their receipt. One expedited approval allows for the creation of two intensive care units, one containing 48 beds, by converting a conference room and office space, which can be re-assembled after the current state of emergency ends.
Another expedited approval allows conversion of a former nursing home and existing business center into 72 lower-acuity beds. The commission has also suspended the need for any applying facility to file a formal CON application until 30 days past the end of the emergency declaration. These emergency CONs will remain in effect for a maximum of 165 days or until 30 days after the termination of the state of emergency.
Similarly, Vermont’s Green Mountain Care Board recently issued guidance outlining an expedited review process. Applications for an emergency CON must include a description of how the project will support or enhance the state’s ability to manage the COVID-19 emergency. The board will review applications without the typical public notice or holding a public hearing and must issue a verbal decision within 24 hours. An emergency CON will only be effective until the public health emergency has lifted, then applicants will need to re-apply for a CON under the non-emergency process.
Michigan’s temporary suspension of CON allows its Department of Health and Human Services to issue an emergency CON necessary to respond to COVID-19 without following the statutory procedural requirements. Virginia’s executive order similarly authorizes its
|State Suspensions of their Certificates of Need (CON)|
|State||Executive Order||Legislation||Suspension Expires when Public Health Emergency Terminates||Expedited CON Approval Available||Written Notice by Facilities to State – No Prior Approval Required||State Has Plan to Return Capacity to Pre-Emergency Levels|
|Maryland||X||30 days after termination of the emergency||X||X – Will permit retention of additional capacity for good cause.|
commissioner of the Department of Health to approve any increase in hospital or nursing home bed capacity needed as a result of COVID 19 – its CON regulatory requirements notwithstanding. New York’s Commissioner of Health is also authorized to approve temporary changes hospitals need to make in response to an increase in patients needing a bed without following the traditional CON procedural requirements in order to respond to COVID-19.
Georgia’s Executive Order suspends its CON statute and rules in cases where such suspensions would permit capable facilities to expand capacity, offer services, or make expenditures necessary to assist with the needs of the public health emergency. In order to implement this, Georgia’s Department of Community Health (DCH) is requiring heath care facilities to submit written requests for suspensions of specific provisions of the CON statute and a description of the changes they seek to make. DCH is also requiring written reports confirming the actions health care facilities have taken to assist, aid, or cope with the emergency, as well as a final reporting to be provided upon the expiration of the emergency. DCH will accept these reports for 90 days following the end of the public health emergency.
No Prior Approval Required
Two states, Connecticut and New Jersey, are allowing facilities to make relevant changes that would have required CON approval without first obtaining prior approval, so long as they report the changes in writing to the regulating authority. In Connecticut, hospitals and outpatient surgical facilities that would previously have sought a CON waiver for a temporary increase in bed capacity or to temporarily suspend services now have to notify the department about the temporary increase in licensed bed capacity or suspension of services in writing.
Similarly, in New Jersey, prior department approval of temporary waivers for exceeding licensed bed capacity, bed additions, physical space requirements or changing staff qualification requirements is no longer required. New Jersey inpatient facilities that make relevant changes in response to COVID-19 are required to provide written reports to the department about which if any of the actions were taken, the duration of the implementation, and any adverse outcomes attributable to them.
In Iowa, South Carolina, Indiana, Louisiana, and Tennessee, the temporary CON suspension guidance has been more general, indicating only that these states suspend statutes and/or regulations implementing CON laws to the extent necessary to allow hospitals to temporarily increase their beds at an existing location or establish new locations, to the extent these are necessary for the treatment of COVID-19 patients. Indiana’s CON law and its emergency waiver from those requirements apply only to nursing facilities.
Similarly, Louisiana’s Facility Need Review (FNR) process applies to adult residential care facilities, home- and community-based service providers, adult day health care, hospice providers and behavioral health services. Louisiana has suspended its Department of Health’s requirement to review all FNR applications within 30 days as a means to reduce workload for LDH staff that have unprecedented other duties.
What Happens When the Crisis Abates?
CON structures that are elastic enough to permit the easy expansion and contraction of health care capacity are useful for both addressing public health emergencies and as ongoing state tools to monitor health care capacity, need, and cost. Consistent with this approach, Connecticut, Maryland, and New Jersey have indicated how or whether capacity and services will be expected to return to prior levels after the current crisis abates. Connecticut requires that any hospital wishing to retain the additional beds or suspend particular services established during the emergency will have to file a CON application consistent with the established statutory and regulatory process.
Maryland will allow extensions of the emergency CON granted beyond the end date for good cause shown, although there is no current guidance as to what criteria will be considered in that determination. New Jersey will require that once the emergency is mitigated, inpatient facilities must return to previously licensed capacity and operate within all licensure standards. These are important considerations for states, given that unneeded capacity can contribute to high health care costs and states will likely be balancing health care costs and lower revenue streams in the coming months.
As additional states consider loosening CON requirements or extending their emergency declarations in order to respond to COVID-19, they may consider framing CON suspensions in a manner that:
- Permits quick action;
- Is targeted to waive only those provisions necessary to respond to COVID-19;
- Is temporary – lasting only for the duration of the public health emergency;
- Provides a process to reduce capacity back to pre-emergency levels; and
- Providing an avenue for determining whether there is sufficient justification to retain the additional capacity created during the emergency.
During this public health emergency, new federal laws (HR 6201, HR 748) are making significant steps to eliminate consumer cost-sharing for coronavirus (COVID-19) testing, diagnosis, and prevention while states are working to increase insurance access and surprise billing protections.
The recently passed Families First Coronavirus Response Act includes several provisions that expand the ability of Medicaid and the Children’s Health Insurance Program (CHIP) to cover COVID-19 testing and testing-related services with no out-of-pocket cost to consumers. The law also includes an option allowing states to extend Medicaid coverage to uninsured individuals for testing and testing-related services. States’ medical and administrative costs for this will be fully matched by the federal government.
However, high costs associated with medical treatment pose significant challenges for the millions of uninsured and underinsured individuals across the country, and these measures may not protect Americans from costs associated with treatment and management of the virus, including prescription drugs, physicians’ visits, hospitalizations, and specialty care. Consumers need health coverage to ensure there is no barrier to receiving the care they may need.
As the pandemic worsens, state agencies are taking action to maximize access to coverage, including private insurance, as one means to protect consumers from the severe financial burden that may result from necessary medical care. This includes increasing access to qualified health plans (QHPs) sold through the health insurance marketplaces. Under requirements set by the Affordable Care Act (ACA), QHPs must cover essential health benefits, including emergency room services, hospitalizations, prescription drugs, preventive services, and mental health services critical to combatting and managing the outbreak. QHPs also must follow cost-sharing restrictions, including the provision of preventive services at no out-of-pocket cost, and the prohibition on annual and lifetime limits on spending.
State-based marketplaces (SBMs) are working diligently to leverage available flexibilities to ensure that consumers in their states are able to enroll in and maintain QHP coverage. Eleven SBMs have opted to open temporary special enrollment periods (SEPs) so uninsured individuals can apply for coverage. This is in addition to actions taken by all SBMs to promote other SEPs available to consumers, including an SEP trigged by loss of minimum essential coverage (such as employer-sponsored coverage).
SBMs are rapidly tweaking tools, outreach strategies, and operations to ensure optimal customer service while also taking steps to comply with physical distancing guidance issued by state public health officials. DC Health Link, in Washington, DC, has created a table to educate consumers about how COVID-19-related services are covered under their health plans. Nevada Health Link has provided a comprehensive listing of state and federal resources available to consumers. Several SBMs are also coordinating closely with insurers who can leverage payment and grace period deadline extensions to help ensure consumer coverage is not disrupted during the pandemic.
In addition to increasing access to coverage, states are also moving forward to enact protections against the practice of surprise balance bills, or unexpected medical bills usually received because an enrollee unknowingly received out-of-network care. Surprise billing laws foremost seek to protect consumers from paying extreme bills incurred when they receive out-of-network services either unknowingly or because there was no other choice of provider or facility. Surprise billing protections will be even more important to ensure that consumers are protected from unprecedented costs in the event they require COVID-19 treatment.
Health systems are rapidly changing in response to the pandemic – states are setting up make-shift clinics, expanding telehealth services, authorizing more providers to be reimbursed for services, and relaxing provider licensing requirements. Many of these actions are necessary to increase provider capacity to meet the rapidly accelerating need for emergency health care services. However, insurers typically operate by only covering care administered by a limited network of providers. And, in some cases, insurers may include a facility, such as a hospital, in their network, but not actually cover all the providers who work there or services performed at that facility — including specialists or laboratory services. Even in normal circumstances, these situations leave insured individuals vulnerable to surprise medical bills. As states rush to expand health care capacity and consumers have increased urgency to seek care, consumers are increasingly susceptible to receiving care from an out-of-network provider or at an out-of-network facility.
Under the ACA, insurers are required to cover out-of-network emergency services as if delivered in-network. That same protections does not extend outside of an emergency setting, though several states have passed laws to protect consumers from surprise bills, including those incurred when a consumer had no other choice of where to receive treatment.
Recently, on March 18, 2020, Maine took emergency action to enact LD 2105, which incorporated surprise billing protections in the case of emergency services into state law. The law also includes billing protections for uninsured individuals as well as those covered by self-insured plans.
In Virginia, SB 172 has been sent to the governor. Like Maine’s law, the bill incorporates protections in the event of emergency care into state law. The bill also adds new protections in the case of out-of-network surgical or ancillary services provided at an in-network facility.
Without additional federal action, states will continue to take the lead in doing what is best for their citizens, including finding innovative strategies to ensure individuals have the best possible access to available services, while also protecting them from undue financial strain. The National Academy for State Health Policy will continue to monitor and report on the situation as it evolves.
Below are examples of how states can address new needs, including housing, food, transportation, education, and employment, and how the CARES Act can support and amplify their work.
Housing: Homeless or housing-insecure individuals are at unique risk and more susceptible to the spread of COVID-19 because they have limited places to self-quarantine or isolate. These individuals may not have access to running water to practice safe hand-washing techniques. Title XII of the CARES Act includes funding to help sustain and expand states’ investments in homeless services and other emergency measures to ensure those individuals are able to stay healthy and to lessen the risk of community spread. These funds are intended to prevent, prepare for, and respond to COVID-19 and include appropriations of:
- $4 billion in Homeless Assistance Grants, available until Sept. 30, 2022;
- $1.25 billion to the Tenant Based Rental Assistance program, available until expended;
- $1 billion to the Project Based Rental Assistance program, available until expended;
- $6.85 million to the Public Housing Operating Fund, available until Sept. 30, 2021; and
- $5 million to the Office of Public and Indian Housing, available until Sept. 30, 2021.
The CARES act also appropriates funds for communities at higher risk of infection from COVID-19, including, under Title X, a $14.4 billion investment for veterans who are homeless or at risk of becoming homeless and under Title XII, $50 million directed to Housing for the Elderly, and $15 million to housing for people with disabilities, with funds available through Sept. 30, 2023.
- Examples of states’ current investments in shelter and emergency housing:
- California has authorized $150 million to protect homeless Californians from the spread of COVID-19. About $100 million is directed towards local government for shelter support and emergency housing to address COVID-19 in the homeless population and $50 million is directed to purchase trailers and lease rooms in hotels, motels, and other facilities in partnership with cities and counties throughout the state for immediate isolation placements for homeless individuals.
- Washington State’s Department of Commerce announced it is making $30 million available to use to expand shelters, buy more cleaning supplies, and other strategies, such as leasing motel rooms.
- State and federal initiatives to halt eviction processes:
- States, including New York, California, Maryland, and North Carolina, have implemented differing versions of a moratorium on evictions of residential and commercial tenants to ensure rent-insecure individuals do not lose their housing during this crisis and become more at risk. California’s order instructs its Public Utilities Commission to oversee customer service protections for services such as water, Internet, gas, and cell phone services.
- The US Department of Housing and Urban Development announced on March 18, 2020, an immediate foreclosure and eviction moratorium for single family homeowners with FHA-insured mortgages until the end of April.
- The CARES Act (Title IV Sec. 4024) also requires a temporary (120-day) pause on evictions proceedings, for any covered housing program as defined in section 41411(a) in the Violence Against Women’s Act, any rural housing voucher program, or has a federally backed mortgage loan.
Education: Most states (48 states and Washington, DC as of March 29, 2020) have closed schools and many are working to implement distance learning to comply with the CDC’s guidelines restricting social interactions. Distance learning is a strategy to keep not only children safe, but also their families, teachers, and administrators. However, it is important to consider that not all children and families have the appropriate technology or Internet capabilities at home to continue their education. School shutdowns illuminate the country’s “digital divide” – those who have access to the Internet and technology and those who do not – and demonstrates the inequities between wealthy and poor school districts, which can perpetuate and possibly worsen socio-economic and other disparities for individuals who have faced discrimination and are already underserved.
The CARES Act (Title VIII Sec. 18001) appropriates $30.75 billion in grants to school systems and higher education institutions to remain available through Sept. 30, 2021 through the Education Stabilization Fund, which provides emergency funds to aid in the continuation of educational services and supports both domestically and abroad. The act directs 1 percent of these funds for grants to states with the highest COVID-19 burden.
- Using state and federal funds allocated through public-private partnerships and local jurisdictions, many school districts, including in Connecticut, Florida, and Montgomery County, Maryland are distributing laptops and other technology as well as information about Wi-Fi hotspots to students, and encouraging parents of students with disabilities to reach out for extra support. New York City is prioritizing iPad distribution for students in temporary housing. Every district is trying to address the challenge of the digital divide in their community, including making hard-copy resources available for students who do not have immediate access to the Internet, and providing free Wi-Fi hotspot services from buses.
- The US Department of Education (DOE) announced it will approve waivers for any state that is unable to assess their students through standardized tests and report cards for the remainder of the school year due to the ongoing COVID-19 emergency. This change was implemented to protect student’s health and safety. DOE has approved these waivers in several states, including Arkansas, Colorado, Florida, Georgia, Indiana, Michigan, Oklahoma, Pennsylvania, Tennessee, and Washington State, and more states are considering this option.
- Virginia and Kansas have already announced their schools will be closed for the remainder of the school year, and other states may also close schools.
Food: Assuring access to healthy food, a critical determinant of health, is a challenge during a pandemic. States have determined that grocery stores are essential businesses, and food store workers are considered part of the critical infrastructure. To ensure underserved individuals maintain their ability to access healthy food in a safe way consistent with CDC guidelines, states are implementing various strategies. Additionally, the largest anti-hunger federal initiative is the Supplemental Nutrition Assistance Program (SNAP), and to ensure continuation of SNAP funding, the CARES Act (Title VI Division B) directs $15.8 billion to remain available until Sept. 30, 2021. Of this amount, $15.5 billion must remain in a contingency reserve until the secretary deems the funds necessary. The CARES Act (Title VI Division B also appropriates $8.8 billion to Child Nutrition Programs, also available until Sept. 30, 2021. Several state and strategies to ensure at-risk populations have access to nutrition are listed.
- Providing meal delivery services:
- The school lunch program is the second-biggest anti-hunger initiative after SNAP. To ensure students who receive free or reduced-price lunches at schools do not go hungry while state-mandated school shutdowns are in place, at least 25 states were approved for US Department of Agriculture (USDA) waivers that authorize school meal distribution. Maryland and Florida have developed websites with interactive maps of the states’ locations for grab-and-go meals. Cities and counties are working in collaboration with states to ensure all students are able to get their meals, even if they are living with at-risk relatives. Loudoun County in Virginia, Wayne Township in Indiana, and Cambridge, Massachusetts are all using school buses to deliver meals to those students.
- Arizona, California, Ohio, and Texas governors all directed their National Guard units to be on alert to aid in food delivery for vulnerable populations, including elderly individuals.
- The CARES Act (Title VI Division B) appropriates $100 million for the USDA Food Distribution Program directly to Native American reservations.
- Arizona and Iowa’s approved 1135 waivers for Medicaid Emergency Authority both expand eligibility for home-delivered meals. Arizona’s waiver expands access to all eligible populations, and Iowa’s waiver expands eligibility to non-waiver members who are home-bound and waiver members even if the waiver does not have meals as an allowable service.
- Modifying restaurant services:
- Most states (42 states and Washington, DC as of March 25) have halted “dine-in” options for restaurants and bars to slow and limit the spread of the coronavirus. For example, the Colorado Department of Public Health, like many other states, issued a public health order to close bars, restaurants, and other establishments though they are still permitted to provide delivery service, window service, and drive-through services with precautions.
Transportation: Access to transportation services is an important determinant of health, but to aid in social distancing and limit spread, states are recommending people limit their use of public transportation by working remotely and using telemedicine services to reduce unnecessary travel so that public transportation can be safer for those who depend on it, such as transit operators, essential health care workers, and grocery store employees. The CARES act (Title XII) also appropriates $25 billion in funding, available until expended, to support this the infrastructure of operating expenses for transit agencies related to the response of to the coronavirus public health emergency.
- Modifying public transportation services:
- Relaxing telehealth requirements
- States are rapidly relaxing telehealth requirements to address coronavirus symptoms. For example, the Massachusetts Department of Public Health issued guidance that all insurers are required to cover medically necessary telehealth services in the same manner they cover in-person services. Texas and Michigan have issued guidance that allows providers to establish patient-physician relationships via telemedicine, including phone calls. Other states, including Louisiana and West Virginia, are relaxing Medicaid requirements to allow emergency and non-emergency evaluation visits to be conducted via telemedicine. These changes are vital to ensure that everyone in the state can still access health services while taking precautions against unnecessary potential viral spread.
- The CARES Act (Part II Sec. 4213) reauthorizes Health Resources and Services Administration’s (HRSA) grant programs that promote telehealth services, which offers flexibility for Medicare patients at risk of contracting COVID-19, and aids in screening patients avoiding their exposure to others.
- The CARES Act (Part II Sec. 4214) also reauthorizes HRSA grant programs that strengthen rural community health through quality improvement, increased access to care, and improvement in coordination to care. This is especially important because rural residents are disproportionately older and more likely to have a chronic disease, which increases their risk for coronavirus.
Employment benefits: Many states, including Maryland, New Jersey, and North Carolina, have implemented telework policies and are encouraging all employers to allow telework opportunities to aid in social distancing. However, many state employees, including sanitation workers, health workers, and retail workers do not have the ability to work remotely, and require protection and benefits to ensure they stay healthy and able to do their jobs. Many retail workers are part-time hourly employees and do not have access to sick leave so states are taking initiatives to create equitable policies for their more vulnerable residents who are providing critical services during this pandemic. The federal government is following states’ lead in developing policies to support individuals with benefits and supports that are essential to respond to the pandemic.
- Classifying emergency workers:
- Minnesota and Vermont have classified grocery store workers and food distribution workers as essential personnel. This change classifies grocery and food distribution workers as first responders, critical to their states’ response to coronavirus. This classification qualifies them for special child care provisions. This is especially important because these workers tend to be paid hourly, and often do not have access to comprehensive benefits.
- The CARES Act (Title VIII) proposes an additional $3.5 billion in funding to states and territories, available through Sept. 31, 2021, through the Child Care and Development Block Grant to provide childcare assistance to low-income families. The funds may also be used for continued payment and assistance to child care providers to health care employees, emergency responders, sanitation workers, and other employees deemed essential to the response to coronavirus.
- Paid sick leave:
- Several states have paid sick leave policies in place. When Colorado declared a state of emergency on March 10, 2020, the declaration allowed workers in certain covered industries, including hospitality, food services, child care, education, transportation, and home health, up to four days of sick leave when experiencing flu-like symptoms and awaiting test results for COVID-19.
- The CARES Act (Subtitle C Sec. 3602) authorizes paid sick leave benefits for employers with employees who are sick or seeking care for coronavirus or need to take leave to care for quarantined individuals, including their children. The payments are capped at $511 per day per employee who is sick or seeking care, and $200 a day for employees who are caring for a sick family member.
- Unemployment benefits:
- States are creating unemployment compensation benefit plans. For example, Alabama and Pennsylvania have implemented a policy to allow individuals who are employed but unable to work because of COVID-19 to file for unemployment benefits.
- The CARES ACT (Title II Sec. 2102) creates a temporary Pandemic Unemployment Assistance program to provide payment to individuals who are not eligible for traditional unemployment benefits (e.g., self-employed, independent contractors, those with limited work history, and others) and are unable to work as a direct result of the coronavirus public health emergency for reasons including:
- They are seeking a COVID-19 diagnosis;
- Are providing care for someone sick with COVID-19;
- Are providing care to a child or someone in their household who is unable to attend school or another facility that has been closed because of c COVID-19;
- Are unable to get to work because of a COVID-19-related quarantine. Individuals who have the ability to telework with pay or are receiving paid sick leave or other paid leave benefits do not qualify for these funds.
- These funds are available to those who experienced unemployment, partial unemployment, or inability to work from Jan. 27 through Dec. 31, 2020.
State policymakers have led the way in taking aggressive steps to address the impact and stop the spread of COVID-19. They have recognized that vulnerable populations need special attention and protections and have launched efforts to address a myriad of health-related social needs. The federal government is adding needed support through the CARES Act, which will allow states to invest in their residents’ social and medical needs. Many of these efforts are stop-gap measures in a time of crises and raise questions about how policies will continue to address the health and social disparities that the crisis exacerbates after the immediate emergency period is over.
In a Washington Post op-ed, Richard Besser, president of the Robert Wood Johnson Foundation, notes, “Every long-term solution must be viewed through the health equity lens, for if they are not, we’ll be setting the stage for our next public health failure.” States are working hard to address both health and health-related social needs emerging from COVID-19, and the National Academy for State Health Policy will continue to track implementation of state’s critical policies to assist states with replication.
Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.
To help states address the coronavirus (COVID-19) pandemic, the Families First Coronavirus Response Act (FFCRA) provides all states and territories with a temporary and retroactive 6.2 percentage-point increase in Medicaid’s federal medical assistance percentage (FMAP) — which determines the federal government’s share of Medicaid expenditures. Last week, the Centers for Medicare & Medicaid Services (CMS) released guidance on the implementation of the increased FMAP. This Q&A highlights some of its main points.
For what time period is the 6.2 percentage-point FMAP increase in place?
The increased FMAP is retroactive to Jan. 1, 2020. Because the Secretary of the Department of Health and Human Services (HHS) declared a public health emergency for COVID-19 on Jan. 31, 2020, the increased FMAP is available for qualifying expenditures that were incurred on or after Jan. 1, 2020. The guidance indicates that expenditures are considered to be incurred not based on the date of service, but instead on when the state makes a payment to a provider. The increased FMAP will continue through the last day of the calendar quarter in which the public health emergency ends.
Do states have to meet certain requirements to receive the FMAP increase?
Yes. States must meet the following conditions to receive the FMAP increase:
- States need to maintain Medicaid eligibility standards, methodologies, and procedures that are no more restrictive than those that were in place as of Jan. 1, 2020;
- States cannot charge higher premium amounts than those in place as of Jan. 1, 2020;
- States must continue to provide Medicaid coverage to all individuals enrolled on or after March 18, 2020, until the last day of the month when the emergency period ends, regardless of any changes in individuals’ circumstances that otherwise would result in termination (unless an individual voluntarily dis-enrolls or moves out of state); and
- States must provide Medicaid coverage without cost sharing for COVID-19 testing and treatment, such as vaccines, equipment, and therapies, during the emergency period.
States are also not permitted to require political subdivisions of the state to pay a greater amount of the non-federal share of expenditures than what was required as of March 11, 2020.
How will CMS verify state compliance with the requirements for receiving the increased FMAP?
Rather than having to submit a demonstration of compliance prior to drawing down the funds associated with the increased FMAP, CMS is asking states to attest to their compliance with the requirements. By virtue of drawing down the funds, states will be considered as “attesting” that their state is eligible for the increased FMAP. A state will be required to return the funds if CMS finds that a state’s attestation is incorrect.
What types of Medicaid expenditures qualify for the FMAP increase?
The FMAP increase applies to all Medicaid expenditures that use the regular FMAP rates. The guidance indicates that the increased FMAP is available for Medicaid Disproportionate Share Hospital (DSH) expenditures as well as any Medicaid waivers or demonstrations that use the regular FMAP.
What types of Medicaid expenditures do not qualify for the FMAP increase?
Some of the key Medicaid expenditures that the increased FMAP does not apply to include:
- Administrative expenditures;
- Expenditures related to the Affordable Care Act’s Medicaid expansion population; and
- Other expenditures that are matched at a higher rate than the regular FMAP, such as family planning services, health home services, etc.
For a full list of Medicaid expenditures that the FMAP increase does not apply to, see pages 1-2 of the guidance.
What must states do to document which expenditures they are claiming are at the increased FMAP rate, and which are matched at other rates?
CMS is requiring that states document expenditures in ways that isolate the expenditures that are eligible for the increased FMAP. CMS is in the process of modifying reporting forms (e.g., CMS-64 and CMS-37) to accommodate FFCRA changes and will be offering states additional guidance and training related to reporting requirements.
Does the FMAP increase apply to the Children’s Health Insurance Program (CHIP)?
Yes, but not as a direct 6.2 percentage-point increase added onto states’ current enhanced CHIP federal matching rates (called the EFMAP). States’ EFMAPs for CHIP are calculated by using the regular FMAP as a base, and therefore because the FFCRA increases the FMAP, the EFMAPs increase accordingly. Given this, all states’ EFMAPs will increase by 4.34 percentage points through the public health emergency period, in addition to the 11.5 percentage-point increase in the EFMAP that is currently in place for federal fiscal year (FFY) 2020 and was provided for by the 2018 CHIP reauthorization law.
Below is an example of how the increase will apply (with the inclusion of the FFY 2020 11.5 percentage-point increase). In this case, a state’s federal CHIP match rate will increase from 76.5 percent to 80.84 percent:
Example of the impact of the 6.2 percentage-point FMAP increase on CHIP’s EFMAP
|Without 6.2 percentage-point FMAP increase||With 6.2 percentage-point FMAP increase|
|EFMAP for CHIP in FY 2020||76.5% (65% + 11.5%)||80.84% (69.34% + 11.5%)|
This is a modified version of the table included on page 3 of the CMS guidance. The EFMAP without the 11.5 percentage-point increase will be used for optional breast and cervical cancer expenditures.
Do the requirements to maintain coverage to receive the increased FMAP apply to CHIP?
No — states are not required to maintain coverage in CHIP to receive the increased FMAP. However, states are required to comply with the maintenance of effort provisions within the 2018 CHIP reauthorization law.
Can states continue to conduct Medicaid eligibility redeterminations or address enrollees’ changes in circumstances that may affect eligibility during the emergency period?
Yes, states are permitted to do so, however, to receive the increased FMAP, states are not allowed to terminate coverage for any individual who was enrolled in Medicaid on or after March 18, 2020, until the last day of the month in which the emergency period ends (unless the individual requests a voluntary termination or is no longer a state resident). Also, if a state receives information during the emergency period that would make an individual eligible through a different eligibility category, the state could move that individual to another eligibility group, if it provides additional benefits. However, states would not be able to do this if such a change would result in reduced benefits for the enrolled individual.
How and when will CMS provide the FMAP increase?
CMS will automatically provide the FMAP increase, and states do not need to submit a state plan amendment to receive the increase. The guidance indicates that CMS is in the process of providing the funds, and that states should have received them in their Payment Management System accounts by March 25, 2020 for the Jan. 1-March 31, 2020 time period. For the quarter that begins April 1, CMS intends to provide the funding for the increased match as close to that date as possible.
Across the nation, states are taking steps to curb the spread of the coronavirus (COVID-19) and meet their residents’ unique needs by restricting social interaction based on the severity of their outbreaks, offering “grab and go” lunches for children whose schools have closed, loosening licensing standards to increase the provider workforce, and offering opioid use disorder treatment and Naloxone through “lock boxes” to reduce in-person clinic visits.
Nearly every state has issued emergency declarations. These highlights from Delaware and Connecticut’s declarations reflect the actions many states are taking:
- Require the state’s National Guard to take precautionary and responsive actions to help the state’s effort to contain the virus, which in some states includes delivering meals to low-income children and enforcing curfews;
- Closing schools, limiting public gatherings to certain sizes, and allowing the state to conduct public meetings electronically;
- Prohibit price gouging, or an excessive price increase of goods or services; and
- Establish visitor restrictions at all nursing and convalescent homes.
Legislators in Alabama even introduced legislation SJR 40 recommending individuals fist-bump rather than shake hands.
States Impose Varying “Shelter in Place” and “Social Convenings” Restrictions
While the federal government’s restrictions on gatherings ranged from a maximum of 50 – from the US Centers for Disease Control and Prevention (CDC) – to President’s Trump recommended 10, states’ restrictions have varied based on the severity of their statewide and regional outbreaks.
California Gov. Gavin Newsom called for “profoundly significant steps,” including the isolation at home of all residents 65 years and older and those with chronic conditions statewide. The CDC simply encouraged older adults to avoid crowds. On Monday, Newsom and local authorities ordered six counties in the San Francisco Bay Area to “shelter in place.”
Other states have imposed curfews and ordered restaurants and bars to close or offer only “to-go” meals.
States Feed Students from Shuttered Schools
The US Department of Agriculture has granted “congregate meal waivers” to all states and Washington, DC to continue to serve students meals if schools are closed and provide more flexibility across its 15 nutrition programs. More than two-thirds of the 31 million US students who regularly eat school lunches depend on a free or reduced-price school lunch as a main source of their daily nutrition, according to the School Nutrition Association.
Many states are working to develop creative approaches to feed students in a way that enables students to practice social distancing. Tacoma, in Washington State, offers drive-through-style lunch, along with the next day’s breakfast, over the course of two hours each day. North of Seattle, another district is employing its now out-of-use school buses and their drivers to deliver the meals to pick-up sites or bus stops, and in some cases to homes.
New Mexico is keeping all of its school cafeterias open and officials are working to organize “grab and go” food options. The state is also working with its National Guard and others to help distribute meals to students who can’t come in. It is also keeping its school-based childcare centers open.
More States Implement Drive-Through Testing Innovations
Across the nation, drive-through testing sites are underway in a patchwork approach. Some, such as Kaiser Permanente in Redwood City, CA, are only testing their insurance plan enrollees.
New York plans to open a drive-through facility in Long Island this week after the success of its New Rochelle mobile testing center, which served 150 cars and tested 263 people in its first day. Once fully operational, the facilities will test up to 500 people per day. Drive-through mobile testing facilities help keep people who are sick or at risk of having contracted coronavirus out of health care facilities where they could infect other people.
States are hoping the federal government will pick up the tab for establishing these mobile testing centers. Florida Sen. Rick Scott, who is under self-quarantine after potential exposure, wants the US Department of Health and Human Services to reimburse states for mobile testing sites. He introduced the Coronavirus Mobile Collection Site Act last week in the US Senate and hopes to make it part of the House’s recent legislation that is now coming to the Senate.
Keeping the Public Informed
Many states’ governors are holding daily press briefings and creating webpages with toll-free information numbers designed to keep the public informed about the number and location of infections in their state and to share strategies and information to help limit its spread. Examples of webpages dedicated to information and prevention include Nebraska, New Mexico, and South Carolina.
Nearly every state has also convened coronavirus response teams charged with coordinating the state’s response across departments, local agencies, and health authorities to limit the spread of the virus.
Expand States’ Health Care Workforces
With health care workers in short supply – especially as providers themselves become infected with the coronavirus – states are looking into loosening regulation and licensing requirements to expand their workforces. On March 13, 2020, the Centers for Medicare and Medicaid Services (CMS) issued new guidelines temporarily waiving requirements that out-of-state providers be licensed in the state where they are providing services through Medicaid when they are licensed in another state (see additional information below). Massachusetts has recently moved to allow medical professionals from other states to obtain a Massachusetts license in 24 hours.
Ensure Continued Opioid Use Disorder (OUD) Treatment and Naloxone Access
Using guidelines developed for emergencies such as hurricanes, the Substance Abuse and Mental Health Services Administration (SAMHSA) is encouraging states to ensure delivery of medication-assisted treatment (MAT) to individuals with OUD who may be quarantined and unable to attend their state-run opioid treatment program. Each State Opioid Treatment Authority is responsible for implementing a disaster plan to address COVID–19. For additional guidance on developing and implementing disaster plans, read SAMHSA’s TAP 34: Disaster Planning Handbook for Behavioral Health Treatment Programs.
Meanwhile, the Indiana Division of Mental Health and Addiction is collaborating with the nonprofit Overdose Lifeline to create lock boxes that provide both the anti-overdose medication Naloxone and MAT during the COVID-19 outbreak. The lock boxes are designed to help reduce the number of visits to treatment programs to avoid further spread of the virus.
Health Insurance Marketplaces
In response to health emergencies in their states, Maryland, Massachusetts, New York, Rhode Island, Connecticut, Nevada, and Washington State’s health insurance marketplaces have opened a temporary and limited special enrollment period during which uninsured individuals can enroll in coverage. Other state marketplaces have existing special enrollment periods available to the uninsured, including California and Washington, DC. In other states, individuals may currently qualify for a special enrollment period triggered by circumstances, such as a change income or employment status.
Several marketplaces (California, Washington, DC, Maryland, Minnesota, and Nevada) have also developed new resources to help consumers navigate their coverage during this time, including resources that detail how COIVD-19 services may be covered under their current insurance plans and links to where consumers can go for more information about their coverage and care.
SNAP Flexibility for Quality Control Interviews
In response to requests from states, USDA is allowing states to conduct telephone interviews instead of face-to face-interviews for Supplemental Nutrition Assistance Program (SNAP) Quality Control (QC) purposes. States must notify USDA’s Food and Nutrition Services in advance if they choose to implement this flexibility and must follow all other requirements for the QC interview as specified in SNAP regulations. This flexibility applies to any QC case reviews conducted in March, April, and May 2020. All states have the ability to request this waiver.
Resources for State Medicaid and Children’s Health Insurance Programs (CHIP)
CMS has created a toolkit on legal authorities and flexibilities available to state Medicaid and CHIP agencies to respond to disasters and emergencies with information on flexibilities related to eligibility and enrollment, benefits, cost-sharing and financing, expanding provider workforces. It includes information on state plan amendments, 1115 demonstrations, 1135 waivers, and Appendix K of 1915(c) waiver applications. As a companion to this toolkit, CMS has created a COVID-19-specific FAQ for state Medicaid and CHIP agencies. The FAQ includes options for telehealth, and flexibility on eligibility, cost sharing, and financing issues. CMS said waiver reviews will be expedited. On March 13, 2020, CMS approved Florida’s first-in-nation coronavirus-related 1135 waiver application, which enables the state to:
- Waive prior authorization requirements to remove barriers to needed services;
- Streamline provider enrollment processes to ensure access to care for beneficiaries;
- Allow care to be provided in alternative settings in the event a facility is evacuated to an unlicensed facility;
- Suspend certain nursing home screening requirements to provide necessary administrative relief; and
- Extend deadlines for appeals and state fair hearing requests.
In general, Section 1135 waivers are designed to ensure, “Sufficient health care items and services are available to meet the needs of Medicare, Medicaid, and CHIP beneficiaries,” according to CMS guidance. The following are examples of flexibilities that states and territories may seek through a 1135 waiver request:
• Waive prior authorization requirements in fee -for-service programs;
• Permit providers located out of state/territory to provide care to another state’ s Medicaid enrollees impacted by the emergency;
• Temporarily suspend certain provider enrollment and revalidation requirements to increase access to care;
• Temporarily waive requirements that physicians and other health care professionals be licensed in the state in which they are providing services, so long as they have an equivalent licensing in another state; and
• Temporarily suspend requirements for certain pre-admission and annual screenings for nursing home residents
Across the country, every state is taking action to ensure accessible coronavirus (COVID-19) testing and treatment, engaging in cross-agency collaboration, employing unique approaches to testing, and preventing price-gouging on drugs and medical supplies. Here’s a sampling of what states are doing.
Testing and Quarantine Initiatives
Washington State: With the most coronavirus infections in the country, Washington is replicating drive-through testing practices used in South Korea and Great Britain. Employees of the University of Washington’s medical system can now get tested for coronavirus and influenza A and B without leaving their cars. The system’s medical center in Seattle turned a hospital garage lot into a drive-through clinic that can test a person every five minutes. People with symptoms register online and get an appointment for testing and typically get results within a day or so. Individuals don’t have to sit in a waiting room where they spread or contract the infection, and the ventilation of the open air reduces possible exposure for health care workers. The university also plans to work with the Bill and Melinda Gates Foundation to provide coronavirus testing kits that patients can use at home.
The state has also purchased a hotel and is converting a former youth detention center to house individuals and families placed in quarantine.
Rhode Island: Five experts from the US Centers for Disease Control and Prevention’s epidemic intelligence service are “embedded” with state health officials, according to Rhode Island’s Department of Health director to help the state build its response capacity. Specifically, the CDC officials are helping trace those who have come in contact with people who have tested positive for the virus since returning from a trip to Europe. The trip, by students and staff of a Catholic high school in Pawtucket, stopped in Italy. Gov. Gina Raimondo has also set up a 24/7 public hotline staffed with health care professionals for those with questions about the coronavirus or how to self-quarantine.
Nationwide, many states are ramping up their cross-agency state and local collaboration to spearhead efforts to control the infection by ramping up coordination among all state and local agencies. As one example, Maryland’s Institute for Emergency Medical Services Systems and its Department of Health, in partnership with the state’s hospital association, are coordinating around surge planning, including ambulance re-routing plans, suspension of voluntary admissions, and developing enhanced methods of medical monitoring for home-bound patients with mild to moderate symptoms.
Medicaid, Insurance Coverage, and Family Leave
Several states have issued some type of directive or emergency order for the insurance plans they regulate. Washington State specifically noted that short-term plans must abide by the order. States operating state-based insurance marketplaces also encouraged residents to check their insurance exchanges’ websites to see if they could be eligible for Medicaid or a special enrollment period.
Kentucky’s Medicaid enrollees will no longer be required to get prior authorizations to be tested or treated for coronavirus and, via an executive order, the state’s Department of Insurance would require private insurers to eliminate copays and other charges.
Michigan Gov. Gretchen Whitmer announced the state Medicaid program is waiving all copays and cost-sharing for testing and health care treatment related to the coronavirus.
Washington State Insurance Commissioner Mike Kreidler issued an emergency order to state health insurers requiring them to waive copays and deductibles for any consumer requiring testing. Insurers also must allow a one-time early refill for prescription drugs, and suspect prior authorization requirement for treatment or testing. In addition, if an insurer does not have enough medical providers in its network to provide testing and treatment, it must allow enrollees to be treated by another provider within a reasonable distance at no additional cost.
Nationwide, Blue Cross Blue Shield Association (BCBS) announced its 36 BCBS companies will waive prior authorizations and increase coverage for COVID-19 and increase access to prescription drugs, enhanced telehealth, and other clinical support systems. The actions will apply to fully-insured, individual, and Medicare members. It also expressed a commitment to working with state Medicaid and Children’s Health Insurance Program agencies to ensure that beneficiaries have access to needed testing and services.
California Gov. Gavin Newsom has directed commercial and Medi-Cal (Medicaid) health plans to waive cost-sharing for all medically necessary screening and testing related to the coronavirus. The California Employee Development Department announced that those unable to work due to exposure to COVID-19 may file a disability insurance claim and those caring for a family member exposed to the virus may apply for paid family leave.
Nevada Gov. Steve Sisolak adopted an emergency regulation to ensure residents with health insurance policies regulated by the state Division of Insurance can obtain medical services and prescriptions related to the coronavirus at normal costs. This emergency regulation prohibits insurers from imposing out-of-pocket costs for a provider, urgent care center, or emergency room visit testing. Insurers also cannot charge Nevadans for the test. Health insurers must provide information on patients’ available benefits, possible telehealth services and preventative measures related to the novel coronavirus.
New York Gov. Andrew Cuomo announced a directive requiring health insurers to waive cost-sharing associating with novel coronavirus testing, including emergency room, urgent care, and office visits. In addition, New Yorkers receiving Medicaid coverage will not have to pay a copay for any testing related to COVID-19. Health insurers must also keep people informed about their available benefits, offering telehealth services when possible.
California Attorney General Xavier Becerra issued a price gouging alert, reminding residents that the state’s anti-price-gouging law protects people impacted by an emergency from illegal price gouging on drugs, medical supplies, food, gas, and other essential supplies.