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.
Medicaid at a Crossroads: What’s at Stake for the Nation’s Largest Health Insurer
Deborah Bachrach, Patricia Boozang, and Arielle Traub, Manatt Health
Since its inception 50 years ago, Medicaid has evolved from a small welfare program into an integral part of the nation’s health insurance system, now covering more than one in five low-income children and adults. As Medicaid coverage has expanded and stabilized, states are making strides to improve the cost and quality of the care provided to Medicaid enrollees. Because Medicaid is the single largest payer in every state, governors are using Medicaid to drive multi-payer reforms, including adoption of value-based payment methodologies and advancement of population health models. Proposals being considered by Congress and the new administration to repeal the Affordable Care Act’s (ACA) Medicaid expansion and implement limits on federal Medicaid funding through block grants and per capita caps could have a significant impact on these advances. This issue brief, developed by Manatt Health, considers how much states have accomplished to drive value in and through their Medicaid programs over the last 50 years, and most especially over the last five years, and what states stand to lose in terms of progress and innovation in their Medicaid programs and health care delivery systems if federal support for Medicaid is reduced.