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The End of COVID-19 PHE: Impact on Residential Care Facilities

By Tangram Insurance Services
March 28, 2023
The End of COVID-19 PHE: Impact on Residential Care Facilities

After three long years, the COVID-19 public health emergency (PHE) is finally coming to an end. Although this does not mean the virus has been eradicated, it does mean certain temporary policies put in place during the pandemic will be sunsetting. Some of the changes brought about by the end of the COVID-19 PHE will have a noticeable impact on residential care facilities.

When Is the COVID PHE Set to End?

HHS currently expects the COVID-19 PHE to expire at the end of the day on May 11, 2023.

It’s likely COVID will never be completely eradicated. Plus, new variants may continue to emerge and cause outbreaks. According to the HHS fact sheet, COVID remains a public health priority but the country can transition away from the emergency phase. Compared to January 2022 – when Omicron cases peaked – daily COVID-19 reported cases are down by 92%, new COVID hospitalizations are down nearly 80%, and COVID deaths are down more than 80%.

The end of the PHE period will bring about many changes, but CMS says some of the changes implemented during the pandemic are permanent or have been extended through Congressional action.

Medicaid Enrollment

HHS says states received increased federal funding as long as they agreed to certain conditions, which included maintaining continuous Medicaid enrollment for beneficiaries. As a result, people on Medicaid or CHIP have not had to submit additional information to show they are still eligible for coverage.

The continuous enrollment provision was originally going to end when the PHE did, but HHS says the Consolidated Appropriations Act of 2023 includes a provision to end the condition as of March 31, 2023. Therefore, the end of the PHE will not technically impact Medicaid continuous enrollment, but only because it’s set to expire earlier.

When this happens, millions of people could lose coverage, either because they no longer qualify or because they fail to submit the necessary evidence to show they still qualify. The latter may be a particular problem because people have become used to not submitting documentation. They may take continuous enrollment for granted.

KFF estimates that up to 14 million people could lose Medicaid coverage after continuous enrollment ends. For facilities with residents who depend on Medicaid, this could be a major issue.

Medicare and Medicaid Waivers

During the PHE, CMS gave healthcare providers increased flexibility through the use of emergency authorization waivers. Some of these waivers and flexibilities will end when the public health emergency expires, but others will remain in effect.

According to CMS, the blanket waivers that generally apply to all entities in a provider category will end with the PHE. These waivers can include things like allowing acute care patients to be housed in other facilities or waiving the three-day prior inpatient hospitalization requirement for Medicare coverage of skilled nursing care.

HHS says some Medicaid waivers will end either when the PHE ends or six months later, but states may have the option to extend certain waivers.

Vaccine, Test, and Treatment Coverage

Many people will still have access to the COVID vaccine with no out-of-pocket costs once the emergency ends. HHS says most private insurance plans fully cover vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). Furthermore, Medicaid will continue to cover all COVID-19 vaccines without a co-pay through September 30, 2024, and will cover ACIP-recommended vaccines after that. CMS says Medicare will also continue to cover COVID vaccines without cost sharing.

Free over-the-counter tests may no longer be available. Plus, Medicaid and private health insurance plans may stop offering tests with no out-of-pocket costs. However, people enrolled in traditional Medicare will still have access to tests with no out-of-pocket costs when a healthcare provider orders the tests and a laboratory performs them. Coverage and costs for COVID treatments will vary depending on the plan.

Telehealth Access

Many people have used telehealth to access care during the pandemic. This likely won’t be affected. HHS says the end of the PHE will not impact Medicaid or Medicare telehealth flexibilities. Medicare telehealth flexibilities have been extended through December 2024 and may be extended again. Private health insurers will likely continue offering telehealth benefits, as this has been a popular option.

Navigating the End of the PHE and Other Emerging Exposures

As we reach the end of the COVID-19 PHE, residential care facility operators need to be aware of the possible consequences for their facilities and residents and take necessary steps to comply with new rules.

If COVID-19 taught us anything, it’s that preparedness and risk management are essential core competencies. It’s easier to manage risk with an insurance partner who understands your business.

Tangram provides insurance for adult residential care facilities through the Personal Care & Assisted Living Insurance Center (PCALIC). Learn more.


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