Questions and answers about the end of the national public-health emergency for Covid-19: There are many changes

By Kate Yandell
SciCheck, a service of FactCheck

May 11 marked the end of the federal public health emergency for Covid-19, bringing changes to health care and public benefits. These differences include changes in the cost of Covid-19 tests and treatments and the potential loss of access to free Covid-19 vaccines for people who are uninsured.

The biggest change originally tied to the emergency designation has already gone into effect. The public-health emergency allowed states to keep millions of people on Medicaid regardless of eligibility in exchange for extra federal aid. But this continuous enrollment requirement ended March 31, and states are asking Medicaid members to reconfirm their eligibility.

The emergency began in January 2020 and was renewed every 90 days after that by the secretary of the Department of Health and Human Services. Following pressure to end the emergency with the introduction of the Pandemic is Over Act in January, the Biden administration announced on Jan. 30 that it would let the emergency declaration expire May 11.

The end of the public-health emergency is not the definitive end of pandemic-related policies. Some, including some changes to telehealth coverage and expanded access to free vaccines, are still in effect.

A declaration allowing the Food and Drug Administration to grant and maintain emergency-use authorizations for measures to combat COVID-19 has no stated end date. This means that authorized treatments and vaccines, such as Paxlovid and the bivalent Moderna and Pfizer/BioNTech vaccines, can remain in use.

How will this affect Covid-19 testing?

Costs of Covid-19 testing for individuals will rise, which the Kaiser Family Foundation called the “widest ​​ranging impact” directly resulting from the end of the public health emergency.

People on Medicaid will still be able to get free at-home or health care provider-ordered tests through September 2024, before potentially facing costs. However, the requirement that insurers cover eight at-home Covid-19 tests per month ended for most other people on May 11. Private insurers and Medicare Advantage plans could decide to keep offering this coverage, while traditional Medicare will no longer offer free at-home tests.

Tests ordered by health care providers will also get more expensive for individuals. As of May 11, private insurers and Medicare Advantage plans will be able to charge patients for these tests and related visits, following the normal rules of their health care plan. People on traditional Medicare will still be able to get provider-ordered tests for free, but they may pay for visits associated with the tests.

Depending on funding and supplies, other government programs offering free tests will continue, including a Centers for Disease Control and Prevention program designed for uninsured and other disadvantaged people. AHHS says says that the mail-order at-home test program will continue through the end of May.

How will it impact Covid-19 vaccines and treatments?

The end of the public-health emergency will not immediately change the availability and costs of Covid-19 vaccines or oral antiviral treatments. This is because the emergency constituted just one of multiple layers of laws and policies that make vaccines and some treatments free.

Currently, Covid-19 vaccines and oral antiviral drugs, such as Paxlovid, are sourced from the federal government’s own supply. These doses must be offered at no cost regardless of whether there is a public-health emergency.

However, the government supply of vaccines is only expected to last through the summer or early fall, depending on demand. It is also possible that a new version of the Covid-19 vaccine will come out, and these will be provided commercially rather than through government purchases.

Even after the federal vaccine doses run out, most people with insurance will still get recommended Covid-19 vaccines for free. Some laws requiring free vaccines for Medicaid and Medicare recipients were enacted during the pandemic, while requirements for no-cost coverage of any recommended vaccines from in-network providers were already in place for people with private insurance.

“It’s really the uninsured who will be the most challenged because there’s no permanent guarantee,” said Jennifer Kates, senior vice president and director of global health and HIV policy at the KFF.

To fill this gap, the Biden administration has proposed a Vaccines for Adults program, similar to the Vaccines for Children program, which provides free vaccines to children whose families couldn’t otherwise afford them. Congress has not been willing to enact this program, however.

On April 18, the administration announced the Bridge Access Program, which will temporarily provide vaccines and treatments to the uninsured. This depends in part on the government purchasing vaccines and treatments, but also on pharmaceutical companies being willing to provide them for free. “It’s not permanent and it’s unclear how far it will go,” Kates said.

The federal supply of Paxlovid will be depleted by early fall, Kates said, and some people with private insurance or Medicare will face cost sharing, just like with other drugs. As with Covid-19 tests, people on Medicaid will continue to have access to free Covid-19 drugs through September 2024.

Vaccine mandates and other changes

The Biden administration has announced it will lift most federal vaccine mandates. These mandates are winding down around the same time as the public health emergency but were ended by a separate action.

Mandates for health-care workers at facilities that treat patients on Medicare and Medicaid will end soon, with more details to come. The administration also announced an end to vaccine requirements for Head Start and federal workers, although these mandates had already been blocked by courts.

Some other policies and changes allowed during the public-health emergency will remain. For instance, many telehealth-related changes for people on Medicaid and Medicare have been made permanent or extended through the end of 2024, Kates said. Changes to rules about limits on take-home doses of methadone and access to controlled substances via telehealth will also be extended, with the intention to eventually make some permanent.

Many changes will not be immediately obvious to the public, although they could have an indirect impact. Just to name a couple examples, hospitals will no longer receive extra money from Medicare for treating hospitalized COVID-19 patients and a number of waivers are ending, such as relaxed rules on what types of care different providers can give.