On Monday, January 30, the Associated Press (AP) reported that President Joe Biden will end two national emergencies addressing COVID-19 on May 11. 
 
“The move to end the national emergency and public health emergency declarations would formally restructure the federal coronavirus response to treat the virus as an endemic threat to public health that can be managed through agencies’ normal authorities,” said AP.
 
“This wind down would align with the Administration’s previous commitments to give at least 60 days’ notice prior to termination of the (public health emergency),” said an administration policy statement from the White House.
 
The end of these emergency declarations would mean that Americans will have to pay for COVID-19 testing and treatments, according to CNN.
 
Because of these public health emergency declarations, the U.S. government has been able to provide Americans with free COVID-19 tests, vaccines, and treatments including social safety net benefits in the midst of the pandemic. 
 
Medicare and Medicaid Programs
The public health emergency has provided additional funding for hospitals treating COVID-19 patients—a 20 percent increase in Medicare’s payment rate. Medicare Advantage plans were also required “to bill enrollees affected by the emergency and receiving care at out-of-network facilities the same as if they were at in-network facilities,” but this will soon end when the public health emergency expires, reported CNN. 
 
With the emergency declarations ending, Medicare beneficiaries would have to pay for out-of-pocket costs for at-home testing and treatment, but vaccines will continue to be covered at no charge.
 
On the other hand, state Medicaid programs will continue covering physician-ordered COVID-19 tests as well as no-cost vaccines. However, enrollees may have to pay out-of-pocket for treatments. 
 
Private Insurance
For those with private insurance, vaccines will continue to be provided for free by in-network providers, but lab tests may incur charges. 
 
Monoclonal antibody treatments have also been prepaid by the federal government, thus Americans with private insurance did not have to cover the expense. However, an office visit or administration of treatment may need to be charged. These treatments are not tied to the public health emergency and will still be free of charge until federal supplies run out. 
 
COVID-19 vaccinations will remain free of charge for those with insurance despite the termination of these public emergency declarations due to various federal laws which include the Affordable Care Act, the Inflation Reduction Act, the 2020 relief package, and other pandemic-era measures.
 
The Uninsured
Access to no-cost testing, treatments, and vaccines were provided for the uninsured through a different pandemic relief program. However, federal funding for the program ended in the spring of 2022 and the uninsured have had difficulties obtaining free services since.
 
What’s Next
According to CNN, the U.S. federal government “has been preparing to shift COVID-19 care to the commercial market since last year, in part because Congress has not authorized additional funding to purchase additional vaccines, treatments, and tests.” 
 
Announcements from Pfizer and Moderna have already been made, stating that commercial prices for COVID-19 vaccines will range from $82 to $130 per dose, as reported by Kaiser. 
 
The good news is, “several of the most meaningful pandemic enhancements to public assistance programs are no longer tied to the public health emergency,”says CNN. In December 2022, Congress “severed the connection as part of its fiscal year 2023 government package.”
 
Of great significance is the processing of Medicaid redeterminations at the state level, where residents who no longer qualify will be disenrolled beginning April 1. States have 14 months to review eligibility of beneficiaries. 
 
According to an analysis made by the Department of Health and Human Services (HHS) in August 2022, about 15 million could be disenrolled from Medicaid when the continuous enrollment requirement expires—with an estimated 8.2 million no longer qualifying and 6.8 million who are eligible but may still lose coverage.
 
However, there is reprieve for those who may be disenrolled from Medicaid —they can still qualify for other coverage.
 
Additionally, Congress has extended some pandemic flexibilities which were included in the government funding package.
 
For example, telehealth visits at home will continue until 2024. Beneficiaries are also able to use smartphones and still avail a wider array of services through telehealth.
 
With regards to the impact of these public emergency declarations to the U.S. Food and Drug Administration (FDA), the FDA has assured that existing emergency use authorizations (EUA) for COVID-19 vaccines, tests, or treatments will remain unaffected and that the agency may still continue to issue these EUAs.  
 
“Importantly, the ending of the public health emergency declared by HHS under the Public Health Service Act will not impact FDA’s ability to authorize devices (including tests), treatments or vaccines for emergency use. Existing emergency use authorizations (EUAs) for products will remain in effect and the agency may continue to issue new EUAs going forward when criteria for issuance are met,” FDA told CNN in a statement.

The beginning of the COVID-19 public health emergency “has allowed the FDA to provide important tools and flexibilities to manufacturers, healthcare facilities, providers, patients, and other stakeholders,” FDA further stated.

Apart from the public health emergency, the HHS has issued two emergency declarations which are not tied to the public health emergency but also provide broad access to COVID-19 medical measures. These include emergency use authorizations (EUA) for tests, treatments, and vaccines. The HHS has yet to determine when these separate declarations will end. 

Under these HHS emergency declarations, many tests have been made available to the public including remdesivir which has been approved to treat COVID-19, as well as other treatments with EUAs. 

Because a provision was put in place by Congress as part of the fiscal year 2023 government spending, oral antiviral drugs with EUAs like Paxlovid are still available and will remain covered by Medicare. Paxlovid is still waiting for full FDA approval. 

Under normal circumstances, Medicare does not typically cover treatments with EUAs, but the public health emergency has allowed them to do so. 

HHS has also issued a declaration providing liability immunity to pharmacists who administer COVID-19 vaccines to children and to healthcare providers who provide vaccinations to individuals outside of the state in which they are licensed. This declaration is due to expire in October 2024. 

The May 11th deadline is already an extension as the White House attempts “to ensure an orderly wind-down of key authorities that states, healthcare providers, and patients have relied on throughout the pandemic.”

Currently, the Biden administration is “actively reviewing flexible policies that were authorized under the public health emergency to determine which can remain in place after it is lifted on May 11,” said CNN.