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 rollout of vaccines designed to end the coronavirus (COVID-19) crisis has begun in earnest across the United States. Currently, each state is responsible for determining how to allocate, distribute, track, and report its vaccine allotment from the federal government, although the federal government is expected to take on a larger role under a new Biden administration. Since the beginning of the pandemic, Black, Indigenous, and other people of color have been disproportionately impacted by both higher risks of infection and poorer health outcomes, and many are concerned that an inequitable or inefficient distribution of the COVID-19 vaccine may further widen health inequities among these populations. One way to help ensure the equitable administration of COVID-19 vaccine is to track vaccine administration disaggregated for key subpopulations, such as gender, race and ethnicity, and geography (e.g., urban vs. rural). This expert perspective reviews the data states are currently publically reporting related to vaccine administration and provides an interactive map that explores the extent to which all 50 states are reporting vaccine administration data breakdowns by age, gender, race, ethnicity, provider type, and level of geography. The expert perspective also discusses what current data sources states are using to provide this information and provides an overview of options states can consider to collect information about the administration of COVID-19 vaccine in populations via survey data.
This paper identifies the services that are essential to an equity-centric approach to the COVID-19 pandemic, 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.
The Department of Health announced that it is providing free, safe and effective vaccinations to help prevent future COVID-19 infections. The state published a vaccination plan that establishes priorities for who should receive the first-available vaccine doses.
The Oregon Health Authority finalized its recommendations for who will be the first to receive doses of new COVID-19 vaccines. With a focus on health equity, the plan adds more granularity to federal recommendations and outlines specific populations within the broad groups—and in a wide range of health settings—that should be the focus for vaccination given the limited availability of the vaccine
Governor John Carney and the Delaware Division of Public Health announced Delaware’s plans to distribute the Pfizer BioNTech COVID-19 vaccine that was granted Emergency Use Authorization by the U.S. Food & Drug Administration. The Division of Public Health is responsible for providing the framework for acquiring and distributing the vaccine and has devised a three-tier strategy for distribution.
HHS OIG issued a report summarizing its findings on the impact of the COVID-19 pandemic on opioid treatment programs (OTPs), derived from interviews with 142 programs through June 22. OTPs reported challenges related to:
(1) maintaining pre-pandemic service levels;
(2) managing impacts on facility operations;
(3) implementing and using telehealth;
(4) obtaining treatment medications, personal protective equipment, and cleaning supplies;
(5) maintaining patient participation in OTP activities;
(6) dealing with limitations posed by existing Federal guidance;
(7) providing take-home doses to patients; and
(8) implementing governmental guidance.
The report also itemizes the countermeasures that OTPs have taken since the COVID-19 pandemic, which include:
(1) encouraging or requiring various personal safety measures for patients and staff;
(2) implementing or expanding the use of telehealth to continue providing services;
(3) increasing the number of take-home doses to reduce the number of patients visiting facilities;
(4) making physical changes to facilities and increasing staffing flexibilities; and
(5) ensuring that patients received treatment medications.
The report is intended to support HHS’s goal of reducing opioid morbidity and mortality and to help SAMHSA by providing information on the impact that the COVID-19 pandemic has had on OTPs. However, HHS OIG acknowledged that the report reflects the challenges of OTPs as of June 2020 and may not reflect the current environment.
OSHA issued guidance and an accompanying one-pager describing which OSHA standards have been cited most frequently during COVID-19 related inspections. OSHA based the guidance documents on data from citations resulting from complaints, referrals and fatalities in facilities inclusive of hospitals, nursing homes, and long-term care facilities. Based on these citations, the documents highlight lessons learned and best practices for other facilities to follow to avoid similar citations.In the press release, DoL indicated that OSHA offers on-site consultations offers no-cost and confidential occupational safety and health services to small- and medium-sized businesses to identify workplace hazards, provides advice for compliance with OSHA standards, and assists in establishing and improving safety and health programs. On-Site Consultation services are separate from enforcement and do not result in penalties or citations.
With several COVID-19 vaccine candidates in clinical trials, acclaimed California physician scientists will review vaccine process for safety before vaccine is distributed in California. State also details how safety, equity and transparency will guide COVID-19 vaccine planning and eventual distribution
In September, Governor Andrew M. Cuomo announced that New York State will form an independent Clinical Advisory Task Force comprised of leading scientists, doctors, and health experts who will review every COVID-19 vaccine authorized by the federal government, and will advise New York State on the vaccine’s safety and effectiveness in fighting the virus.
The Governor’s COVID-19 Vaccine Advisory Group advises the governor on preparations for a COVID-19 vaccine, including the optimization of a statewide vaccine distribution strategy, and communicating critical medical information about the vaccine with the state’s residents.
The group is administered by staff from the Connecticut Department of Public Health. Meetings are open to the public and available to watch online at https://ct-n.com/
This expert perspective provides a roadmap for states to assess their vaccine coverage policies in Medicaid and, if necessary, to close any coverage gaps that might otherwise inhibit vaccine uptake during a crucial period of mass immunization.
OSHA issued respiratory protection guidance focused on protecting workers in nursing homes, assisted living and other long-term care facilities (LTCFs) from occupational exposure to SARS-CoV-2. The guidance advises the use of cloth face coverings, facemasks, or surgical masks by healthcare providers at all times while inside long-term care facilities (LTCFs), including in breakrooms or other spaces where they might encounter other people. Healthcare providers who are in close contact with a LTCF resident with suspected or confirmed coronavirus infection must use a NIOSH-approved N95 filtering facepiece respirator or equivalent or higher-level respirator, as required by OSHA’s Respiratory Protection standard. The guidance further indicates that employers should reassess their engineering and administrative controls, such as ventilation and practices for physical distancing, hand hygiene, and cleaning/disinfecting surfaces, to identify changes that could avoid over-reliance on respirators and other personal protective equipment.
The National Academies National Academies of the Sciences, Engineering, and Medicine (NASEM) published “A Framework for Equitable Allocation of COVID-19 Vaccine”. The 236-page report, which was commissioned by the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC), builds on the shorter “discussion draft” that NASEM released in early September . Four risk-based criteria informed NASEM’s recommendations for how to prioritize vaccine allocation across populations: (1) risk of acquiring infection, (2) risk of severe morbidity and mortality, (3) risk of negative societal impact, and (4) risk of transmitting infection to others. Based on these criteria, NASEM recommends the followed phased approach for vaccine allocation (which closely resembles the phases outlined in the discussion draft):
– Phase 1a (representing an estimated 5% of total U.S. population): First responders, as well as high-risk health workers involved in direct patient care and facility services (e.g., transportation or environmental services).
– Phase 1b (est. 10% of U.S. population): People with two or more health conditions that put them at significant risk of severe illness or death from COVID-19 (per CDC guidelines), as well as older adults living in nursing homes and other congregate settings.
– Phase 2 (est. 30–35% of U.S. population): K–12 teachers, school staff, and child care workers; critical workers in high-risk settings who cannot avoid a high risk of exposure to COVID-19 (e.g., workers in the food supply system or public transit); all older adults not included in Phase 1; people health conditions that put them at moderately higher risk of severe COVID 19 consequences (per CDC guidelines); and people in homeless shelters, group homes for individuals with physical or mental disabilities, incarcerated individuals and detention staff (if not already included in Phase 1).
– Phase 3 (est. 40–45% of U.S. population): Children and young adults under age 30, as well as any essential workers at increased risk of exposure who are not covered in Phases 1 and 2.
– Phase 4: Everyone living in the United States. Individuals who do not fall into the preceding phases include adults between the ages of 30 and 65 who do not work in essential occupations or industries.
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.
States quickly mobilized to implement emergency federal authorities (e.g., Section 1135 waivers, 1915(c) Waiver Appendix K, emergency Section 1115 waivers) and state-level regulatory flexibilities to respond to the COVID-19 pandemic; now they must determine which flexibilities to scale back or sustain, taking into account fiscal implications. The interaction of the stimulus package dates, the Public Health Emergency, and the President’s National Emergency Declaration, among other factors, are complex, and states are actively grappling with decision making regarding which flexibilities they need and want to keep, and how. This Excel workbook is intended to serve as a tool for states as they strategize about reopening and plan for the next phase of the COVID-19 pandemic. Specifically, states can utilize this template to conduct both a primary analysis as they determine which flexibilities to unwind or maintain and a secondary analysis to plan for operational and implementation implications. The workbook has been updated to reflect the renewal of the Public Health Emergency as of July 23, 2020.
To help states respond to the ongoing coronavirus (COVID-19) pandemic, the White House, the U.S. Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid Services (CMS) have invoked their emergency powers to authorize temporary flexibilities in Medicaid and the Children’s Health Insurance Program (CHIP). Congress has passed legislation that provides additional federal support for state Medicaid programs, subject to certain conditions. The table summarizes the timeframes for these emergency measures, including the effective dates and expiration timelines dictated by law or agency guidance. The chart also includes current end dates, which are subject to change as federal and state officials take actions to renew or terminate particular authorities. This SHVS product has been updated to reflect HHS’s July 23 declaration renewing the federal Public Health Emergency, as well as CMS’s June 30 Key Dates for Termination of COVID-19 Flexibilities Table.
HHS announced and issued notices of awards to to 64 jurisdictions for $200 million in CARES Act funding for vaccine preparedness, issued through the existing CDC Vaccines for Children cooperative agreement. A list of jurisdictions that received awards is available in the document linked in column J (see the column titled “COVID-19 Vaccine Preparedness Complete”). The press release indicates that the funds are intended to “plan for and implement COVID-19 vaccine services”; CDC has not yet made additional guidance about the funding–including its specific eligible uses–publicly available.
HHS’ Office of the Assistant Secretary for Health (OASH) issued guidance under its authority under the Public Readiness and Emergency Preparedness Act (PREP Act) intended to expand access to safe and effective COVID-19 vaccines when they are made available. This guidance authorizes state-licensed pharmacists to order and administer COVID-19 vaccinations; state-licensed or registered pharmacy interns acting under the supervision of the qualified pharmacist may also administer COVID-19 vaccinations. Among other requirements outlined in the guidance, state-licensed pharmacists and pharmacy interns must ensure the following conditions are met:
– The vaccine must be FDA-authorized or FDA-licensed.
– The vaccination must be ordered and administered according to the Advisory Committee on Immunization Practices’ (ACIP) COVID-19 vaccine recommendation.
– The licensed pharmacist and/or intern must complete a practical training program that is approved by the Accreditation Council for Pharmacy Education (ACPE).
– The pharmacist/pharmacy intern must comply with any applicable requirements set forth in the CDC’s COVID-19 vaccination provider agreement and any other federal requirements that apply to the administration of COVID-19 vaccine(s).
(Previously on August 19, HHS issued the third amendment to the Declaration under the PREP Act to authorize state-licensed pharmacists to order and administer any vaccine that the Advisory Committee on Immunization Practices (ACIP) recommends to individuals ages three to 18 years according to ACIP’s standard immunization schedule. This amendment was intended to mitigate decreasing rates of routine childhood immunizations due to COVID-19, The order does not affect federal requirements regarding screening and enrollment of Medicare and Medicaid providers (42 CFR Part 455, subpart E).)
CMS released preliminary Medicaid and CHIP data highlighting that rates of vaccinations, well visits, and dental services among children enrolled in Medicaid/CHIP have dropped substantially, and issued an “urgent call to action.” The data set examines vaccinations, primary, and preventive services among children in Medicaid and CHIP for March-May 2020 compared to March-May 2019 and shows:- 22 percent fewer (1.7 million) vaccinations received by beneficiaries up to age 2- 44 percent fewer (3.2 million) child screening services that assess physical and cognitive development and can provide early detection of autism and developmental delay, among other conditions, even after accounting for the increased use of telehealth- 69 percent fewer (7.6 million) dental servicesThe preliminary data shows that beneficiaries age 18 and under enrolled in Medicaid and CHIP had relatively low treatment rates due to COVID-19. Although more than 250,000 children enrolled in Medicaid and CHIP were tested for COVID-19 through June 2020, only about 32,000 received treatment for COVID-19 and fewer than 1,000 were hospitalized for COVID-19 through the end of May.
In response to decreasing rates of routine childhood immunizations due to COVID-19, HHS issued a third amendment to the Declaration under the Public Readiness and Emergency Preparedness Act (PREP Act) to authorize State-licensed pharmacists to order and administer any vaccine that the Advisory Committee on Immunization Practices (ACIP) recommends to individuals ages three to 18 years according to ACIP’s standard immunization schedule. The order does not affect federal requirements regarding screening and enrollment of Medicare and Medicaid providers
CDC issued a press release and updated guidance clarifying the intent of updates first made to its isolation guidance on August 3. The guidance indicated that people can continue to test positive for up to 3 months after diagnosis and may not be infectious to others. In its clarification, CMS indicated that its August 3 guidance does not imply that a person is immune to re-infection with COVID-19 in the 3 months following infection and, at this time, it is not known whether someone can be re-infected with COVID-19. Rather, the latest data suggests that retesting someone in the three months following initial infection is not necessary unless that person is exhibiting symptoms of COVID-19 and the symptoms cannot be associated with another illness. Individuals who test positive for COVID-19 should be isolated for at least 10 days after symptom onset and until 24 hours after their fever subsides without use of fever-reducing medications
HHS released a fact sheet explaining Operation Warp Speed’s (OWS) goals, timeline, and major accomplishments. OWS is a public-private partnership led by HHS with the goal of delivering 300 million doses of a safe, effective vaccine for COVID-19 by January 2021. The fact sheet included a summary of OWS’ actions to support vaccine development, manufacturing and distribution, as well as plans for making COVID-19 vaccines affordable to Americans.
The DOE, HHS, and VA jointly announced the formation of the COVID-19 Insights Partnership, an initiative to coordinate and share health data to support research and analysis on COVID-19. Specific focus areas of the initiative include the evaluation of vaccine and therapeutics candidates for COVID-19, outcomes data, and virology. HHS and VA will provide additional updates and information on research projects as they become available.
The U.S. Department of Health and Human Services and the Department of Defense (DoD) announced an agreement with U.S.-based Pfizer Inc. for large-scale production and nationwide delivery of 100 million doses of a COVID-19 vaccine in the United States following the vaccine’s successful manufacture and approval. The agreement also allows the U.S. government to acquire an additional 500 million doses.
HHS issued a Request for Information (RFI) soliciting public input on the development of a federal interagency Council on Economic Mobility (Council) tasked with promoting economic recovery and resilience in response to the COVID-19 pandemic. The Council is composed of the heads of various federal agencies and chaired by HHS. Through this RFI, HHS requested input from state/local government agencies and other stakeholders to inform the Council’s priorities, working group activities, stakeholder engagement, and federal programs. The RFI was published on the Federal Register on July 16 and public comments will be accepted until October 2.
The COVID-19 pandemic is a public health crisis that has triggered an economic crisis. While the federal government acted to provide financial relief, states have faced significant growth in expenditures in response to the pandemic, as well as simultaneous and severe drops in revenue. This expert perspective provides a snapshot of how states are navigating the known and unknown fiscal challenges of the COVID-19 pandemic, given declining revenues and rising spending demands in the context of balanced budget requirements. The strategies that states employ to address the fiscal fallout of COVID-19, will have significant and long-lasting implications for critical health care and safety net programs.
HHS and DoD jointly announced: – A $1.6 billion agreement with Novavax to demonstrate commercial-scale manufacturing of the company’s COVID-19 investigational vaccine, NVX-CoV2373. The agreement expands upon a June agreement for Novavax to provide 10 million doses for use in Phase 2/3 clinical trials. The July 7 agreement is expected to provide the federal government with 100 million doses of the investigational vaccine.- A $450 million agreement with Regeneron to demonstrate commercial-scale manufacturing of the company’s investigational therapeutic treatment, REGN-COV2. The agreement is expected to produce between 70,000 and 300,000 treatment doses expected by fall. Clinical trials for the investigational therapeutic are currently underway.
OSHA issued FAQs for employers and employees about topics such as best practices to prevent the spread of COVID-19, workers’ rights to express concern about workplace conditions, COVID-19 testing, and worker training. The FAQs are supplementary to guidance issued in May and June, respectively: Guidance on Preparing Workplaces for COVID-19 and Guidance on Returning to Work.
CMS issued guidance regarding hospital visitation policies for patients during Phase II of reopening, reiterating previous guidance that unrestricted visitation is not advised until Phase III of reopening. The guidance also outlines discretionary exceptions that hospitals may want to consider in certain instances, such as during end-of-life care and labor and delivery. In scenarios where visitation is allowed, CMS indicated that visitation should be limited to one visitor at a time and all in-person visitors should be screened for symptoms and wear cloth face coverings. CMS also indicated that virtual or outdoor visitation should be encouraged to the extent possible and that facilities should consider the prevalence of COVID-19 in the community, staffing levels, and PPE supplies before making exceptions to non-visitation policies.
The Pennsylvania Department of Health and Pennsylvania Emergency Management Agency (PEMA) are partnering with CVS Health to offer COVID-19 testing services to skilled nursing facilities statewide, free of charge.
The Governor of California released tools, technology, and data that will allow scientists, researchers, technologists, and all Californians to better understand the impact of COVID-19.
OSHA issued guidance to assist employers and workers in safely returning to work and reopening businesses deemed by local authorities as “non-essential” during the COVID-19 pandemic. The guidance is intended to supplement HHS, White House, and CDC guidance issued to date.
EEOC updated their technical assistance questions and answers, prohibiting employers from requiring COVID-19 antibody testing before allowing employees to return to the workplace. Under the Americans with Disabilities Act (ADA), antibody testing constitutes a medical examination; citing the CDC guidance that antibody testing “should not be used to make decisions about returning persons to the workplace,” the EEOC explains antibody testing does not meet the ADA’s “job related and consistent with business necessity” standard for medical examinations or inquiries for current employees. Viral tests, however, are permissible under the ADA.
HHS issued a fact sheet reiterating the composition and objectives of Operation Warp Speed (OWS), a private-public partnership between CDC, FDA, NIH, BARDA, DoD, and private firms to deliver 300 million doses of a COVID-19 vaccine by January 2021. The fact sheet also provides updates on OWS activities and investments to develop the manufacturing and distribution capacity necessary for accomplishing its objectives. The CARES Act appropriated $10 billion for OWS, including over $6.5 billion for vaccine development through BARDA and $3 billion for NIH research.
The National Academy for State Health Policy (NASHP) created an interactive map highlighting how every state and Washington, DC, is innovating and expanding its contact tracing capacity to contain the infection and reopen its economy.
The state’s Task Force on Business and Jobs Recovery issued an open letter urging business and civic leaders in California to explicitly address racial disparities and focus their recovery policies on equitable and sustainable solutions.
Pennsylvania launched a dashboard that enhances data on demographic, testing, and re-opening metrics.
CMS issued guidance for providers in states and regions in Phase II of the White House’s “Opening Up America Again” guidelines that have no evidence of a COVID-19 rebound. The guidance encourages providers in these regions to return to offering non-emergent, non-COVID care in-person when such care cannot be offered virtually, for patients that are not at higher risk for severe COVID-19 illness (as defined by CDC).
Governor Janet Mills announced that the Maine Department of Health and Human Services (DHHS) is significantly expanding contact tracing by increasing the number of skilled staff and volunteers, harnessing innovative technology, and securing social services to help people with COVID-19 maintain self-isolation.
The state of New York announced a contact tracing program that will be done in coordination with the downstate region as well as New Jersey and Connecticut.
Governor DeWine announced that Ohio is expanding testing and encouraged those who want a COVID-19 test, including those who are low-risk or asymptomatic, to talk with their health care provider or contact a testing location to arrange a test.
The state of Rhode Island has partnered with SalesForce, a global software company, to make a database that will allow the state and the National Guard to implement contact tracing processes effectively.
Governor Gavin Newsom launched California Connected, the state’s comprehensive contact tracing program and public awareness campaign in which the state plans to launch 10,000 contact tracers statewide.
Washington’s Phased Reopening plan, which moves the state through phased reopening on a county-by-county basis, will provide counties the flexibility to demonstrate they can safely allow additional economic activity based on targeted metrics.
Targeted testing and contact tracing represent a more ethical approach to lifting pandemic restrictions and opening up the economy given limited test supplies.
On May 18, Governor Phil Murphy unveiled a multi-stage approach to execute the responsible and strategic economic restart to put New Jersey on the road back to recovery from COVID-19.
To help states respond to the ongoing coronavirus (COVID-19) pandemic, the White House, the U.S. Department of Health and Human Services, and the Centers for Medicare and Medicaid Services have invoked various emergency authorities that allow for temporary flexibilities in the Medicaid and the Children’s Health Insurance Program programs. Congress also has passed legislation that provides additional federal support for state Medicaid programs, subject to certain conditions. The table describes the effective dates of these various provisions as well as the expiration timeline dictated by law or agency guidance; the table also includes current end dates, which are subject to change as federal and state officials take actions to renew or terminate particular authorities.
The New Jersey COVID-19 Information Hub addresses privacy concerns around contact tracing, including around public charge, in their FAQ page.
In an effort to address health disparities, the Governor of North Carolina signed an executive order directing resources to historically underutilized businesses, ensuring equitable distribution of pandemic relief funds, and supporting mass testing of migrant farm workers and food processing plant workers.
The city of New York hired over 1,700 contact tracers to join their Test & Trace Corp, with 700 of the new hires being from the neighborhoods that have been the hardest hit by COVID-19.
In a letter to the state’s Patient Protection Commission, the Governor of Nevada requested that the Commission develop long-term policy recommendations that address COVID-19 and broader health equity concerns.
In addition to helping New Yorkers safely separate, the city will also support those who are separating at home by designating Resource Navigators, who work with community-based organizations across the city, to help New Yorkers overcome logistical issues such as accessing medicine or clean laundry.
The state of Rhode Island submitted a waiver to CMS to use Medicaid funds to provide food, housing, and mobile phone minutes for people who are housing insecure.
West Virginia is increasing COVID-19 testing access for marginalized populations and those in medically underserved counties, making testing free and available to all residents in the targeted localities.
The state of Virginia is partnering with the City of Richmond to expand access to personal protective equipment in underserved communities.
The Virginia Department of Health and the Health Equity Task Force partnered with a local media outlet to provide information about the next phases of the recovery process and its implications for health equity.
To contain the spread of COVID-19, states are rapidly ramping up their contact tracing efforts.
Ohio’s Minority Health Strike Force recommended the hiring of public health workers who reflect the makeup of their own community to expand exposure notification capacity.
The state of New York is expanding access to testing for communities of color and low-income neighborhoods by establishing an initial 24 testing sites at churches in predominantly minority communities in downstate New York.
This report outlines three guiding principles for state policymakers in their equity efforts.
The Washington State Department of Health’s reopening plan relies on distinct data-driven categories to determine the state’s readiness for safely reopening.
The Michigan Safe Start Plan, which utilizes public health metrics such as impacts on at-risk populations as criteria to trigger movement into consequent phases of reopening.
The state of Virginia has formed a Health Equity Work Group that is intentionally embedded into the state’s Uniform Command center addressing COVID-19. Both the Work Group and the Taskforce meet on a regular basis and work to apply a health equity lens to each phase of the state’s response, ranging from preparedness to mitigation to recovery.
In April, the state of Ohio formed the Minority Health Strike Force, which is tasked with responding to the disproportionate impact of the Coronavirus on African Americans. The state is now focused on implementing recommendations from the Strike Force.