On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.
About State Health and Value Strategies
State Health and Value Strategies (SHVS) is a program committed to providing technical assistance to support state efforts to enhance the quality and value of health care by improving population health and reforming the delivery of health care services. SHVS connects states with experts and their peers to develop tools to undertake new reform initiatives and strives to meet states where they are by providing state-specific technical assistance and guidance. The program engages state officials, providing lessons learned, highlighting successful strategies, and bringing together states and stakeholders motivated to improve health care through quality, value, and payment reforms.
SHVS works with states across the country on technical assistance projects that involve payment and purchasing reforms, data and analytics, and stakeholder engagement. Projects include the creation of a data quality roadmap for Medicaid, stakeholder engagement to better integrate behavioral and substance use disorder care, and strategies to help states reduce the misuse and overuse of Medicaid services to lower costs and improve patient outcomes.
The program also develops policy briefs and other resources to guide state innovation and provide tools for state officials to meaningfully advance quality and value initiatives.
About the Team
The following team members at the Princeton School of Public and International Affairs manage the State Health and Value Strategies Program:
Heather leads SHVS and assists states in their efforts to transform health and health care by providing targeted technical assistance to state officials and agencies. She is a Professor of the Practice at Princeton University’s School of Public and International Affairs, where she teaches courses on health policy and administration, and is a faculty affiliate of the Center for Health & Wellbeing. She served as New Jersey’s Commissioner of Health and Senior Services from 2008-2010, overseeing a cabinet-level agency with a budget of $3.5 billion and staff of 1,700, responsible for public health services, regulation of health care institutions, senior services, and health care policy and research. She received her JD, cum laude, from the New York University School of Law, and her BA, cum laude, from Duke University.
Dan assists in managing and coordinating the technical assistance providers serving the states and works with states to identify their assistance needs and policy goals. He was deeply involved in the implementation of the Affordable Care Act at the state level as Deputy Chief of Staff for Rhode Island’s Lieutenant Governor. Dan also served as the principal subject matter expert for the Rhode Island Healthcare Reform Commission on Health Insurance Exchange and project director for the State Innovation Model (SIM). Dan serves as a Lecturer in Public Affairs at the School of Public and International Affairs at Princeton University. He received a MBA from Providence College and his BA from Brown University.
Sally supports the delivery of technical assistance to states and works with subject matter experts to develop and disseminate products to assist states in their efforts to transform their health care systems. Sally oversees the development of technical assistance content to increase access to, and innovation within, state Medicaid programs. She has worked in both state and local government in New Jersey, New York and California. Sally comes to Princeton after serving in the New Jersey Office of Management and Budget with responsibility for the Department of Health and the Department of Children and Families. Sally holds an MPP from the University of California, Berkeley, Goldman School of Public Policy, as well as a BA from Brown University.
Sonia supports the delivery of technical assistance to states and works with subject matter experts to develop and disseminate products to help states transform health and health care. Sonia oversees content related to the regulation of and access to commercial health insurance. She comes to Princeton after working with the Health Division at the National Governors Association Center for Best Practices, where she focused on issues related to payment and delivery system transformation, rural health, the health workforce, and complex care individuals. Sonia holds a master’s degree in public health with a concentration in health policy from The George Washington University and a bachelor’s degree in health promotion and behavior from the University of Georgia.
Stephanie handles day-to-day operations at SHVS, managing the ongoing administration of contracts with the program’s technical assistance providers; tracking and providing reports on the grant program; planning conferences, webinars, and other events; and monitoring program resources. Stephanie has previous financial risk management and operations experience in managerial roles at CLS Bank International and Mizuho Capital Markets Corporation in New York. She received an MS in Foreign Service from Georgetown University and her BA from the University of Pennsylvania.
Becky coordinates project management functions of SHVS, assisting in a policy role and in the delivery and tracking of technical assistance delivered to states via subject matter experts. Becky has interned with various nonprofit organizations including Lutheran Settlement House and the National Alliance on Mental Illness (NAMI) and comes to Princeton after serving as Career Development Coordinator at the University of Pennsylvania’s Biomedical Graduate Studies program. Becky holds an MS in Social Policy as well as a BA in Communication and Public Service from the University of Pennsylvania.