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.
Resources for States on Unwinding the Medicaid Continuous Coverage Requirement
State Health and Value Strategies (SHVS) developed this resource page to serve as an accessible one-stop source of information for states in “unwinding” when the Medicaid continuous coverage requirement ends. The Families First Coronavirus Response Act (FFCRA) Medicaid “continuous coverage” requirement has allowed people to retain Medicaid coverage and get needed care during the pandemic. When continuous enrollment is discontinued, states will restart eligibility redeterminations for Medicaid enrollees. While most people will continue to be eligible for Medicaid or Marketplace coverage, the potential for loss of coverage for millions of Americans due to “administrative” reasons is significant, and Black, Latino(a) and other people of color will be most at risk. This resource is designed to support states planning for this major coverage event, including developing processes that prioritize coverage retention following the conclusion of the continuous coverage requirement.
SHVS will update this page frequently with new resources as they become available.
|SHVS Resources and Tools
SHVS technical assistance resources on the unwinding of the public health emergency
Please click on the links below to access topic-specific resources.
|Data/IT||Eligibility and Enrollment Policy/Operations||Consumer Communications and Outreach|
|Oversight and Monitoring||Medicaid and Marketplace Integration||Federal Resources|