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. |
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).)
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.
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.
This expert perspective provides a survey of actions that state and local governments have taken to intentionally incorporate equity into their recovery and reopening policies.
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 Los Angeles’ reopening plan incorporates testing rates by poverty levels and race/ethnicity into its Effectiveness Indicators, which guide future decisions about loosening or tightening social distancing restrictions.
The city of Chicago’s reopening plan monitors cases over time by zip code, age, sex, race, and ethnicity to determine movement into different phases.
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.
Rhode Island’s recovery plan.
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.