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.
Overview of Final Medicaid Eligibility Regulation
Manatt Health Solutions
On March 16, 2012, the Department of Health and Human Services (HHS) issued final and interim final rules codifying Medicaid eligibility and enrollment provisions of the Patient Protection and Affordable Care Act (ACA). The rules address Medicaid eligibility categories, expansion of Medicaid eligibility for non-disabled adults, modernization of eligibility verification rules, streamlining Medicaid and Children’s Health Insurance Program (CHIP) applications and renewals, and coordinating eligibility across Medicaid and CHIP. This policy brief, prepared by Manatt Health Solutions, gives a high level overview of important highlights, focusing on key areas where HHS has changed or expanded upon the proposed Medicaid rules published on August 17, 2011. It then provides a section-by-section summary of the regulations.