What Changes When the COVID Emergency Ends in May?

WASHINGTON -- The Biden administration plans to end the COVID-19 public health emergency (PHE) in May, but that may not make much difference because some of the regulations that normally would be affected have already been dealt with in other ways, experts say.

"There are certainly implications for Medicaid eligibility and what Medicaid covers, but those were unwound in the omnibus legislation anyway, so it's not like the end of PHE is the thing that's pushing things over the cliff," said Jeffrey Levi, PhD, professor of health policy and management at George Washington University here. He was referring in part to a section of the omnibus budget bill passed in December that allows states to begin disenrolling in April an estimated 18 million people who were permitted to stay on Medicaid specifically because of the pandemic; the funding states received from the federal government to help cover those extra enrollees is also being phased out.

In addition to that, many pandemic-related measures such as free COVID vaccines and treatments are coming to an end not because the PHE is ending, but because Congress is no longer funding them, Levi said. "The administration has asked for funding and hasn't gotten it ... People are going to be pretty shocked when things like [nirmatrelvir-ritonavir] Paxlovid are no longer free."

Administration Responds to House Resolutions

On Monday, the Office of Management and Budget (OMB) issued a statement which noted that "The COVID-19 national emergency and public health emergency (PHE) were declared by the Trump Administration in 2020. They are currently set to expire on March 1 and April 11, respectively. At present, the Administration's plan is to extend the emergency declarations to May 11, and then end both emergencies on that date."

The OMB issued the statement in response to two resolutions from House Republicans that called for ending the COVID national emergency and the PHE immediately, rather than giving several months' notice. "The risk presented by COVID has decreased significantly since 2020 through innovations in vaccines and treatments and through natural immunity," Rep. Cathy McMorris Rodgers (R-Wash.), chair of the House Energy and Commerce Committee and a supporter of the measures, said in remarks to the House Rules Committee.

"Nothing worth doing is without risk -- there is a risk to driving to work, playing in a rec league soccer team with friends -- and COVID-19 is now one of those risks that Americans can review and balance for themselves," she said. "The American people have moved on from the government making that risk assessment for them and want their lives to get back to normal."

But the Biden administration disagreed. Ending these emergencies prematurely, the OMB statement continued, "would create wide-ranging chaos and uncertainty throughout the healthcare system -- for states, for hospitals and doctors' offices, and, most importantly, for tens of millions of Americans."

For example, states now have several months to plan the Medicaid disenrollments mentioned above, but "if the PHE were suddenly terminated, it would sow confusion and chaos into this critical wind-down," the statement said. "Due to this uncertainty, tens of millions of Americans could be at risk of abruptly losing their health insurance, and states could be at risk of losing billions of dollars in funding. Additionally, hospitals and nursing homes that have relied on flexibilities enabled by the emergency declarations will be plunged into chaos without adequate time to retrain staff and establish new billing processes, likely leading to disruptions in care and payment delays." The House passed both measures Wednesday evening largely along party lines, although their fate in the Senate is less certain.

Other Steps Taken

In addition to Medicaid, Congress and the administration "have taken steps to delink certain flexibilities from the PHE in recent months, with some of the big-ticket items being addressed separately through legislation and rulemaking," Heather Meade, principal, and her colleague, senior manager Laura Dillon, both of the consulting firm Washington Council Ernst & Young, told MedPage Today in an email. "For example, the year-end omnibus bill included several provisions to extend flexibilities granted during the PHE, including extending certain telehealth waivers, the Acute Hospital Care at Home waiver program, and a provision allowing high-deductible health plans to offer telehealth before the deductible through calendar year 2024."

In conjunction with the Medicaid wind-down, "CMS recently announced they will create a 16-month special enrollment period that will allow people who lose their Medicaid coverage to enroll in a marketplace plan throughout the redetermination period," Meade and Dillon noted. "The omnibus package also includes a new policy requiring that all states must cover children for 12 months in Medicaid and CHIP [Children's Health Insurance Program] regardless of changes in circumstances."

Hospitals also have their concerns as the PHE ends, according to Stacey Hughes, executive vice president of government relations and public policy for the American Hospital Association. "Hospitals and their caregivers continue to navigate a host of weighty challenges, including workforce shortages and financial challenges, cost increases for equipment and drugs, disrupted supply chains and sicker patients," she said in a statement. "These issues will require continued attention and investment from the federal government ... We should preserve many of the best care innovations that served us well during the pandemic, like expanded use of telehealth and the development of hospital at home programs."

Telehealth Concerns

Telehealth is another area Congress addressed in the omnibus bill, adding a provision that extended through the end of 2024 some telehealth flexibilities started during the pandemic. But telehealth providers still have other concerns about the end of the PHE.

"The ATA [American Telemedicine Association] and ATA Action implore our government leaders to provide a sense of certainty to a huge cohort of individuals requiring access to important medications for substance use disorders and other necessary drugs via telehealth after May 11," Kyle Zebley, the ATA's senior vice president for public policy, and executive director of ATA Action, said in a statement. "Unfortunately, flexibilities allowing for remote prescribing of controlled substances, as part of the Ryan Haight Act, currently expire with the PHE. Without a plan in place, these vulnerable populations will be left out in the cold."

The Ryan Haight Act required the Drug Enforcement Administration (DEA) to release its rules for special registration for telemedicine, which might solve the problem, but even though the act was passed in 2008 and reiterated by statute in Congress in 2018, "we have yet to see [those rules] published," said Zebley. "There is now an extreme sense of urgency with the public health emergency ending in only a few months."

Comment