​What the End of the COVID-19 Public Health Emergency Act Means

Posted by Reeve Staff in Daily Dose on October 10, 2022 # COVID-19

COVID-19In January 2020, Alex Azar, the Secretary of the U.S. Department of Health and Human Services (HHS), approved the first Public Health Emergency (PHE) declaration. The PHE was set to expire 90 days after it was signed. However, since the first signing, the HHS's Secretary of HHS or its Acting Secretary of the HHS has extended the PHE every 90 days. As a result, the PHE is set to expire on October 13, 2022, unless President Biden approves another extension.

Public Health Emergency

A public health threat becomes an emergency because it poses a significant threat. These outbreaks are considered momentous outbreaks of infectious disease (or bioterrorism). The PHE lasts for the duration or 90 days after the Public Health Emergency is declared. Congress must be informed within 48 hours of the declaration, and the Department of Homeland Security, the Federal Bureau of Investigation, and the Department of Justice must be updated.

While there are several acts the Acting or Secretary of the HHS can take during a PHE, some of the acts include:

  • Adjusting Medicare reimbursement of specific Part B medications. During non-emergency times, the reimbursement of prescriptions is based on the manufacturer's average sale price (ASP). However, during a PHE, a documented inability to access medication can increase the cost of drugs. If this occurs, the HHS Secretary may use the wholesale or acquisition price of the drug.
  • Modify the practice of telemedicine or telehealth.
  • Modify or waive specific Medicare, Medicaid, Children's Health Insurance Program (CHIP), and Health Insurance Portability and Accountability Act (HIPAA).

The HHS Secretary may also ensure that certain healthcare services and items are available to meet the needs of people during a PHE declaration under the Social Security Act (SSA).

Families First Coronavirus Response Act

Former President Trump signed the Families First Coronavirus Response Act in March 2020. The Act outlined conditions for states receiving additional federally funded Medicaid funding. One clause in the Act said states might not deny Medicaid services to those enrolled in the Medicaid program on or after March 18, 2020. The exceptions are if a person moves out of state, dies, or asks to be removed from Medicaid. People's continued enrollment is guaranteed until the end of the federal government's COVID-19 PHE. President Biden has continued to renew the PHE. The President's Administration has said they will give the states at least 60-day notice if the Administration doesn't renew the PHE.

The Social Effects of the Public Health Emergency Declaration

The beginning of the COVID-19 public health response highlighted the inequities in access to health care. The PHE created awareness of the issues that exist in access to affordable, quality health care for those in underserved populations. Previous to COVID-19's PHE declaration, underserved populations such as those living with disabilities weren't receiving or were experiencing obstacles in accessing the needed care.

The Centers for Disease Control and Prevention (CDC) released a study examining the risk of those in the disability community contracting COVID-19. The CDC warned that those with disabilities, especially those with limited mobility, for example, people with a spinal cord injury (SCI), are at an increased risk because of underlying health issues, living environment, or socio-economic or health disparities.

The implementation of the PHE did help healthcare workers better serve those in underserved populations. The way Americans received healthcare services during the COVID-19 pandemic improved access to necessary healthcare services because of the PHE. With the PHE in effect, those in underserved communities were given increased access to medical and other healthcare services.

COVID-19, Public Health Emergency Declaration, and Spinal Cord Injuries

Despite the protections and increased access to health care services provided through the PHE, there were some exceptions. For example, researchers investigated the impact of COVID-19 on people with a spinal cord injury. The researchers found the participants in their study reported medical discrimination, rationing, and supplies concerns. In addition, participants expressed concerns over the pandemic's impact on care services and their general and mental health.

The study concluded that those with SCI found the COVID-19 pandemic adversely affected their mental health and increased worries regarding social isolation and access to medical supplies.

Another study found people with an SCI were at an increased risk of mental health issues if they lacked financial security, had food insecurity, or could not access personal assistance services.

While the PHE did work to decrease the gap between services and healthcare equity in underserved communities, areas remain to be addressed. Service providers, organizations, and support systems can access more information to help them understand and meet the needs of those in the SCI community at the Christopher & Dana Reeve Foundation’s website.

What Happens if the Public Health Emergency Act Isn't Renewed

People enrolled in Medicaid, CHIP, or Medicare will face changes if the PHE is not extended past October 13, 2022. The federal matching grants increase the states receive if they allow qualified individuals to retain their Medicaid during COVID-19 will end if the PHE is not extended.

The expiration of the PHE means states will no longer receive enhanced funding from the federal government and will be in charge of renewals for Medicaid eligibility. There are approximately 80 million people enrolled in Medicaid programs across the United States. The loss of the PHE puts about 14.4 million people at risk of losing their Medicaid or CHIP eligibility.

People who lose their Medicaid or CHIP eligibility may experience a gap in coverage as they search for and enroll in a different health insurance plan. Gaps in coverage may exist when:

  • Those without a permanent home address don't receive the information for renewal
  • People experience an increase in income due to a rise in the economy
  • Administrative or legislative issues in various states affect vulnerable populations

The rate of Medicaid enrollment post-PHE through the rest of 2022 and the rate of enrollment in states remains uncertain.

The 60-day Stipulation

The Department of Health and Human Services is committed to providing a 60-day notice to states if they decide to terminate or let the PHE expire. This would mean the HHS would notify the states in August 2022. However, HHS has remained quiet and hasn't told groups such as the Association of State and Territorial Health Officials, the Federation of American Hospitals, or the American Public Health Association to end the PHE. Therefore, Larry Levitt, the Executive Vice President for the Kaiser Family Foundation, believes silence from the Administration means the PHE could extend into January 2023.

The Fate of the Public Health Emergency Declaration

The federal government will decrease its role in purchasing COVID-19 tests, vaccines, and treatments for the states this fall. As a result, the states will become responsible for buying and providing COVID-19 healthcare services.

The fate of those on Medicaid and CHIP programs remains uncertain once the states regain control of Medicaid enrollment. However, the Centers for Medicare and Medicaid Services (CMS) is taking a proactive stance regarding the end of the PHE. The agency monitors data across the healthcare system to identify strengths and weaknesses in the services provided during the pandemic. As CMS keeps track of the impact of programs, the agency is also working with states to help them transition back to enrolling people in Medicaid.

The CMS launched the CME National Quality Strategy. The CMS National Quality Strategy's objective is to ensure everyone receives equitable health care. After the PHE expires, the CMS plans on maintaining some of the waivers and flexibilities from the PHE to advance innovation, improve health equity, maintain or increase healthcare quality, and broaden access to healthcare services.

Federal Government Protection

The federal COVID-19 vaccination and treatment effort is coming to an end. President Biden's efforts to buy and distribute vaccines to people for free will run out as early as January 2023. Without federal funding, those in underserved populations are at increased risk during the height of a winter wave of COVID-19.

However, the Biden administration has begun talking with Moderna and Pfizer executives. Both companies have stated they plan to sell their vaccine to the private sector. The Assistant Secretary for Preparedness and Response, Dawn O'Connell, noted the agency always knew there would be a transition from federal funding to having the vaccines available on the commercial market. Talks between agencies, corporations, organizations, and federal health officials remain focused on two issues: the way COVID-19 vaccinations will be distributed and paid for. Doctors, insurance plans, pharmacies, and distributors will need to agree with Moderna and Pfizer on the price of the products and administering them. People who rely on Medicaid for access to COVID-19 tests, vaccines, and treatment, for example, monoclonal antibody treatment, will be unable to afford them. Especially if the PHE ends and the states once again control Medicaid enrollment.

President Biden's 2023 Proposed Budget

The Biden Administration's 2023 proposed budget earmarks funds to assist people who live in states that refused to expand Medicaid coverage. However, because Congress is the branch of government tasked with approving the budget, the budget's fate remains unknown.

Once Congress approves, the Medicaid Saves Lives Act would expand coverage to 2.2 to 4.4 million people. Similarly, the Inflation Reduction Act extends enhanced subsidies for people receiving health insurance from the Affordable Care Act (ACA) providers.

Medicaid Coverage

You can learn more about your state's Medicaid coverage by visiting Medicaid.gov.

Christina Sisti, DPS, MPH, MS is a bioethicist and health care policy advocate. She works to create awareness and improve health care policy for those with long-term health issues.

This publication was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $160,000 with 100% funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, ACL/HHS or the U.S. government.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.