State Health and Value Strategies (SHVS), in partnership with Manatt Health, Georgetown’s Center on Health Insurance Reforms (CHIR), State Health Access Data Assistance Center (SHADAC), Bailit Health, and GMMB developed this resource page to serve as an accessible “one-stop” source of COVID-19 information for states. This resource is designed to support states seeking to make coverage and essential services available to all of their residents, especially high-risk and vulnerable people, during the COVID-19 pandemic. SHVS will update this page frequently with new resources as they become available.
| If you have materials you are willing to share with other states through this page, or if there are topics of particular concern that you would like addressed, please contact SHVS. |
The American Rescue Plan Act (ARPA) was signed into law on March 11, 2021 as a signature effort to assist in the recovery from the COVID-19 pandemic and the related economic downturn. Included as part of the sweeping legislation is a program to fully subsidize COBRA coverage for six months starting in April of 2021. This expert perspective provides a short overview of COBRA and mini-COBRA, the major elements of the ARPA COBRA Assistance program, and considerations for state policymakers related to the program.
On Friday, March 12, State Health and Value Strategies hosted the first of three webinars to address key provisions of the American Rescue Plan Act of 2021. The $1.9 trillion budget reconciliation package was signed into law by President Biden on March 11. The bill is wide-ranging, seeking to support Americans as we continue to recover from the fallout of the COVID-19 pandemic and economic downturn. The first webinar explored changes to private insurance, including Marketplaces. Tax expert Jason Levitis and Joel Ario from Manatt Health explored the premium tax credit changes and COBRA subsidy and outlined decision points for state policymakers and consumers.
On Tuesday, March 16, State Health and Value Strategies will host the second of two webinars to address key provisions of the American Rescue Plan package. The $1.9 trillion reconciliation budget bill is moving quickly through Congress. The bill is wide-ranging, seeking to support Americans as we continue to recover from the fallout of the COVID-19 pandemic and economic downturn. Health coverage programs will see the largest changes since the Affordable Care Act, with provisions that will strengthen Medicaid and CHIP, drastically increase affordability in the marketplace, create new coverage opportunities for those that lost jobs, and provide significant federal funding to support states and localities. The second webinar, with experts from Manatt Health, will review key Medicaid provisions and state/local relief funding included in the COVID-19 relief package. Presenters will also discuss considerations for state policymakers as they look to implement the American Rescue Plan, and how some proposals that did not end up in the final bill could foreshadow future policy priorities
The economic shutdown due to COVID-19 prompted an unprecedented spike in unemployment, with more than 33 million people filing claims since mid-March. The Affordable Care Act’s (ACA) marketplaces, along with Medicaid, are important tools in covering the newly uninsured.
The presidential transition and the incoming Biden-Harris administration’s commitment to addressing the equity issues associated withtheCOVID-19pandemicprovide an opportunity to identify programmatic and policy approaches that can ensure the kind of participation in containment and prevention strategies that will address the disproportionate disparities we see every day.
This paper identifies the services that are essential to an equity-centric approach totheCOVID-19pandemic, as well as the infrastructure and workforce needed to ensure these services are available and have an equity focus.It reviews a set of administrative and legislative steps that the new presidential administration can take to strengthen the immediate response to the pandemic and address the long-term health and social needs the pandemic has exacerbated. Finally, it offers a strategy for “building back better” in the long term.
In accordance with the Executive Order issued on January 28 by President Biden, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced a Special Enrollment Period (SEP) for individuals and families for Marketplace coverage in response to the COVID-19 Public Health Emergency, which has left millions of Americans facing uncertainty and exceptional circumstances while millions of Americans have experienced new health problems during the pandemic. This SEP will allow individuals and families in states with Marketplaces served by the HealthCare.gov platform to enroll in 2021 health insurance coverage. Beginning February 15, 2021 and through May 15, 2021, these Marketplaces will operationalize functionality to make this SEP available to all Marketplace-eligible consumers who are submitting a new application or updating an existing application. State-based Marketplaces (SBMs) operating their own platform have the opportunity to take similar action within their states.
Following recent announcements from HHS and CMS regarding distribution of and reimbursement for the COVID-19 antibody therapeutic bamlanivimab, HRSA updated its COVID-19 Uninsured Program FAQs, indicating that it will cover the drug in the same manner as Medicare. Providers may bill the HRSA COVID-19 Uninsured Program for infusion of bamlanivimab, for which Medicare set an initial rate of $309.60 (subject to geographic adjustments). Currently, healthcare providers receive allocations of the drug free, as determined by federal and state health officials (see below for more information). In the future, when healthcare providers begin to purchase monoclonal antibody products, CMS plans to set payment rates in a similar fashion to the rates for COVID-19 vaccines, such as based on 95% of the average wholesale price.
HRSA issued revised FAQs clarifying that the COVID-19 Uninsured Program (the “HRSA Program”) will reimburse providers for the costs of COVID 19 vaccine administration for uninsured individuals, once a COVID-19 vaccine receives either an Emergency Use Authorization (EUA) or full licensure from the FDA (the program previously covered COVID-19 testing and treatment but not vaccine services). Consistent with HRSA’s prior guidance regarding treatment services, it appears that an individual with public or private health coverage will be deemed “uninsured” for purposes of the HRSA Program if the individual lacks specific coverage for the COVID 19 vaccine. Thus, in addition to supporting access for individuals who are fully uninsured (including undocumented immigrants), the HRSA Program could help to address certain gaps in vaccine coverage. Notably, a vaccine authorized via EUA (as opposed to full licensure) may not be covered by Medicare. As for Medicaid, vaccine coverage is required during the federal Public Health Emergency (PHE), but once the PHE ends, each state may decide for itself whether to cover COVID-19 vaccines for “non-expansion” adult populations, including those who are eligible for Medicaid by virtue of advanced age, disability, or parenthood.
Addressing these coverage gaps will provide crucial support for healthcare providers participating in the COVID-19 vaccine distribution effort. The Administration’s September 16 vaccine planning guidance suggests that, although the federal government will bear the costs of acquiring and distributing COVID 19 vaccines (at least at first), the Administration will not necessarily take on the cost of vaccine administration, especially in cases where such costs are covered by public or private payers. Even so, the participation agreement for the COVID 19 vaccination program requires participating providers to administer the COVID 19 vaccine to any eligible individual regardless of coverage or ability to pay. Although the HRSA Program generally links reimbursement to Medicare rates for testing and treatment services, it is not clear how HRSA will set a fee schedule for vaccine administration, particularly if, with respect to a vaccine authorized via EUA, HRSA Program reimbursement becomes available before Medicare coverage kicks in. Whereas Congress appropriated specific funds to cover testing costs in the HRSA Program, the testing and vaccine administration are paid for using the Provider Relief Fund, of which $27 billion remains unallocated to date.
HRSA published updated data regarding providers that received reimbursement from the HRSA COVID-19 Uninsured Program and agreed to HHS’s terms and conditions. As of October 14, $566.1 million has been paid for testing claims and $957.2 million for treatment claims.
HHS’ Office of the Inspector General (OIG) released an updated list of its Active Work Plan Items reflective of OIG’s audits, evaluations, and inspections that are underway or planned in determination of providers’ compliance with temporary authorities during the COVID-19 public health emergency. The newly-announced items include:
– Audit of Health Resources and Services Administration’s COVID-19 Uninsured Program. HHS’ OIG will determine whether COVID-19 testing and treatment services reimbursed by the HRSA COVID-19 Uninsured Program complied with federal requirements. HHS expects to issue its resulting report this fiscal year (FY 2021).
HHS Secretary Azar extended the public health emergency (PHE) declaration, which was set to expire on October 22, through January 20. The PHE, in conjunction with the President’s National Emergency Declaration, authorizes Section 1135 waivers, and several other statutory and regulatory flexibilities related to COVID-19 are tied to the PHE.
HRSA published updated data regarding providers that received reimbursement from the HRSA COVID-19 Uninsured Program and agreed to HHS’s terms and conditions. As of September 24, $445.3 million has been paid for testing claims and $824.8 million for treatment claims.
A new open enrollment landscape created by the continued health and economic impacts of the COVID-19 pandemic, a national movement calling for racial justice, and the concurrent timing of a presidential election year is raising new challenges for states as they plan outreach and enrollment campaigns. Marketplaces are reimagining their campaign strategies to meet this moment, with plans to operationalize virtual activities, communicate with new and existing audiences, and reflect changing consumer behaviors in their outreach tactics. This expert perspective highlights strategies from SHVS’ 2-part webinar series on preparing for OEP 2021 and features several strategies states can pursue to help ensure a successful open enrollment period this year.
The IRS issued interim guidance that states that the Treasury Department and the IRS have determined that the optional Medicaid COVID-19 testing group (under section 6004(a)(3) of the Families First Coronavirus Response Act is not minimum essential coverage (MEC). Therefore:- Individuals who are enrolled in the optional COVID-19 testing group can enroll in a Qualified Health Plan (QHP) and receive APTCs. However, their enrollment in a QHP would mean that the individual would no longer be eligible for the optional COVID-19 testing group. – When the optional COVID-19 testing group expires at the conclusion of the public health emergency (PHE), those individual who were enrolled in the group will not be eligible for a special enrollment period as a result of losing Medicaid coverage.
On Wednesday, July 22, State Health and Value Strategies hosted part II of the Preparing for OEP 2021 webinar series that provided a deep dive into effective strategies to consider as states design their outreach and education campaigns for OEP 2021 in a shifting health care environment. Presenters from GMMB explored how the impacts of COVID-19 should inform the marketplace’s tactical campaign approaches for virtual outreach and partnership engagement, digital and social platform usage, and paid advertising and earned media. Participants also heard insights from several state officials from state-based marketplaces along the way. Topics for discussion included coordinating with state agencies, engaging micro-influencers, leveraging social media live streams, hosting virtual enrollment events, developing advertising buys, and considering new earned media hooks. This webinar included a question and answer session during which webinar participants can pose their questions to the experts on the line.
HRSA published updated data regarding providers that received reimbursement from the Claims Reimbursement and Uninsured Program and agreed to HHS’s terms and conditions as of August 5; $167.7 M has been paid for testing claims and $382.4 M for treatment claims.
HRSA published updated data regarding providers that have received reimbursement from the Claims Reimbursement for COVID-19 Care of the Uninsured Program and agreed to HHS’s terms and conditions as of July 15. As of this cut-off date, 13,901 providers have received $419.1 million in claims reimbursement.
While efforts to reduce the spread of COVID-19 have been difficult in all environments, the conditions for those working in agricultural production raise additional challenges. Migrant and seasonal farmworkers, many of whom travel as crops ripen throughout the spring and summer, live and work under conditions that even before COVID-19 posed risks to their safety and wellbeing. This expert perspective examines approaches to addressing the particular risks of COVID-19 faced by farmworkers, provides a survey of state and local policies and outlines some key themes and recommendations for policymakers as they work to support agricultural workers and stem the spread of COVID-19.
This expert perspective highlights examples employed by DC Health Link, the Oregon Health Authority, and beWellnm and the community-centered outreach they are using to actively enroll and connect consumers to care. The expert perspective also includes best practices surfaced for marketplaces and agencies to adapt their COVID-19 communications and outreach—and beyond—to ensure those with inequitable access to health coverage are prioritized and supported.
HRSA issued an updated FAQs for its Claims Reimbursement for COVID-19 Care of the Uninsured program. The July 7 update clarified the methodology for reimbursing claims attributable to Medicaid enrollees with limited benefits
HRSA published updated data regarding providers who have received reimbursement from the Claims Reimbursement for COVID-19 Care of the Uninsured Program and agreed to HHS’ terms and condition as of July 10. As of this cut-off date, HHS has disbursed $348.1 million to this cohort of 12,659 providers.
CMS issued dozens of new COVID-19 FAQs for state Medicaid/CHIP agencies addressing questions related to a range of topics (e.g., Presumptive Eligibility, premiums and cost sharing, optional COVID-19 testing group and coding guidance)
The COVID-19 pandemic has introduced new challenges for Navigators. To learn more about their experience, and how they are helping consumers manage often unexpected transitions in coverage, this blog post highlights conversations with six navigators across five states using the FFM to hear how they were faring.
HRSA created a Coronavirus-related funding FAQ resource page for health centers, providing new information on required progress reports related to the receipt of Coronavirus-related funding awards. Progress reports must include narrative updates on activities related to testing, maintaining or increasing health center capacity and telehealth, among others. The first progress reports will be available for awardees starting July 1, with a submission date of July 10.
A paper by the Brookings Institute This paper uses survey data to examine how many people exiting employer coverage become uninsured in normal times, and how the share that become uninsured has changed since implementation of the Affordable Care Act. The authors also make a series of policy recommendations to better support enrollment into Medicaid or Marketplace coverage after a loss of job-based insurance.
State-based health insurance marketplaces have created new opportunities for people to get covered and have made extra efforts to reach the uninsured
This Health Affairs blog post highlights states’ policy responses to the COVID-19 pandemic, as well as their proactive approaches to addressing a wide range of health concerns.
An analysis on national and state-level estimates of coverage changes if unemployment rates rise from precrisis levels (around 3.5 percent nationally) to 15 percent, 20 percent, or 25 percent.
CARES Act Provider Relief Fund General Distribution FAQs
This expert perspectives provides an overview of strategies that states can consider to help address gaps in coverage to ensure as many people as possible get access to comprehensive care as the country continues to respond and recover from the COVID-19 health and economic crisis.
On Wednesday, April 29 State Health and Value Strategies hosted a webinar, State Strategies to Support Medicaid/CHIP Eligibility and Enrollment in Response to COVID-19. Many states are experiencing an increase in the volume of Medicaid applications due to the COVID-19 pandemic and the resulting economic crisis. During the webinar experts from Manatt Health reviewed strategies states can use to manage and process an increased number of Medicaid applications, and the federal authorities that permit states to do so. Communications experts from GMMB reviewed strategies for messaging to new and existing enrollees.
This webpage, developed by the Pennsylvania Department of Insurance highlights FAQs and provides coverage information to consumers who have lost their jobs.
The Pathways to Coverage for COVID-19 Testing and Treatment for Adults toolkit provides an overview for states of various coverage pathways for individuals, including those who are uninsured, in need of COVID-19 testing and treatment. The toolkit provides varying pathways for Medicaid expansion and non-expansion states.
The University of Minnesota COVID-19 Health Insurance Model (MN-HIM) estimates the number of people at who lost employer-sponsored health insurance (ESI) during the four-week period ending on April 11, 2020. In developing this model SHADAC aimed to create both national and state-level estimates as well as provide a further breakdown between policyholders (age 18-64) and their dependents (adults and children).
This expert perspective considers the policy implications and challenges for states and discusses potential state measures to address sensitive implementation challenges given interactions with eligibility for health care programs and CARES Act unemployment insurance expansion and stimulus payments.
Webinar recording and slide deck from webinar hosted on March 18, 2020.
An article by CBPP that examines how expanding Medicaid in the public health crisis could allow people to enroll in Medicaid coverage as early as June or July. In addition, retroactive coverage for people signing up this summer and found to be eligible could cover medical costs — including COVID-19 treatment — incurred up to three months prior to actual enrollment.
This FAQ answers common provider questions regarding the provision of methadone and buprenorphin, including through the use of telehealth, for the treatment of opioid disorder during the COVID-19 crisis.
Recommendations and guidance on COVID-19 response for service providers working with homeless populations, including overnight emergency shelters, day shelters, and meal service providers.
HRSA announces $1.3 billion in awards to 1,387 health centers across the United States with funding provided by the Coronavirus Aid, Relief and Economic Security (CARES) Act. This interactive map provides a summary of the CARES Act funding awarded to health centers in each state and US territory.
This expert perspective, written by experts at Manatt Health, discusses strategies state Medicaid and CHIP agencies can pursue as part of their response to COVID-19.
This page includes guidance and templates for the Medicaid State Plan Disaster Relief SPA and CHIP Disaster Relief SPA.
California guidance to providers to prevent discrimination related to screening and treatment for COVID-19
Arizona was the first state to have its Disaster SPA approved by CMS on 4/1/2020. The SPA includes several provisions including waiving copays, premiums and deductibles for all members and provision of continuous eligibility for children under the age of 19.
This letter to behavioral health managed care plans outlines efforts from NC DHHS to provide flexible funding to stabilize providers and respond to the changing needs of consumers.
This guidance allows practitioners further flexibility in prescribing and dispensing buprenorphine to new and existing patients with opioid use disorder via telephone without examination in person or via telemedicine.
Information on federal tax provisions, guidance, and operational changes responding to COVID-19.
Plain-Language Information about Coverage Options, Eligibility, and COVID-Related Benefits
This guidance advises that Opioid Treatment Programs on providing medications to patients who are quarantined with COVID-19.
This guidance details infection control and social distancing recommendations for state psychiatric hospitals.
This guidance advises outpatient providers to utilize telehealth, whenever possible, reschedule non-urgent appointments, reach out to high risk patients for COVID-19, eliminate cancellation/no show fees.
This FAQ addresses general questions associated with award and management of SAMHSA discretionary grants that may arise in relation to COVID-19.
Compilation of COVID-19 FAQs on private insurance issues.
Recordings and transcripts of CMS calls on COVID-19 with states and other stakeholders
Compilation of resources for state on Medicare, Medicaid, and CHIP, including transcripts and recordings of all-state calls
Resources on waivers and flexibilities available to states and providers
MA developed an All Provider Bulletin that summarizes the State’s Hospital-Determined Presumptive Eligibility process.
A state-by-state compendium of actions related to COVID-19 coverage.
DC Health Link declares COVID-19 Special Enrollment Periods.
Explains that uninsured residents can apply and enroll in coverage.
This page includes guidance and a template for COVID-19 1115 waiver demonstrations.