With enactment of the Families First Coronavirus Response Act on March 18, 2020, the federal government took action to ensure access to COVID-19 testing. The legislation requires Medicare, Medicaid, all group health plans, and individual health insurance policies to cover testing and associated visits related to the diagnosis of COVID-19 during the federally-declared emergency period. In addition, the new law gives states the option to provide Medicaid coverage of COVID-19 testing for uninsured residents with 100% federal financing.
Many states have also implemented policies to increase access to COVID-19 testing and treatment, as well as continued management of other health conditions. Some states have already indicated that they are requiring insurers to cover a COVID-19 vaccination with no cost-sharing if and when one becomes available, while others are requiring state-certified insurance carriers to waive patient cost-sharing for COVID-19 treatment, as well as treatment for other related conditions, including pneumonia and the flu.
States have also announced other actions, including extending special enrollment periods in state-based health insurance marketplaces, facilitating early prescription drug refills, and relaxing prior authorization and utilization review processes.
In addition, states are requesting approval for Section 1135 waivers that permit them to waive or modify certain Medicare, Medicaid, CHIP, and HIPAA requirements during a national emergency.
Finally, while the new federal law creates a federal emergency paid sick leave program through December 2020, a number of states have enacted mandatory sick leave policies that will fill in gaps in the new federal emergency leave, while others are proposing to adopt these policies in the wake of the coronavirus outbreak.
This
list of
resources
prepared by the Kaiser Family Foundation as of March 26 (most recently updated as of March 31) indicates state health policy mandates in these six areas:
- Waive Cost Sharing for COVID 19 Treatment
- Free Cost Vaccine When Available
- State Requires Waiver of Prior Authorization Requirements
- Early Prescription Refills
- Marketplace Special Enrollment Period (SEP)
- Section 1135 Waiver
- Paid Sick Leave
Florida has mandated early prescription refills and applied for a Section 1135 waiver.
Eleven states (CA, CO, CT, MA, MD, MN, NV, NY, RI, VT, and WA) and the District of Columbia have authorized a special enrollment period to permit enrollment in an Affordable Care Act plan outside of open enrollment for individuals who otherwise don't meet eligibility to apply for special enrollment because of the COVID emergency. All these jurisdictions have their own Exchanges and do not participate in the Federal Facilitated Marketplace (healthcare.gov). As of March 31 Idaho is the only state with a state Exchange that has not as yet authorized such a special enrollment period.
Although there is speculation that this may occur, the Federal Facilitated Marketplace [which provides On-Exchange ACA coverage in the 38 states not mentioned in the above paragraph (including Florida)]
has not yet announced a special election period for individuals who did not enroll during open enrollment and because of the COVID emergency now wish to enroll.
If such a special election period is announced, we'll issue an appropriate notification.
NOTE, however, that many individuals have lost group coverage as a result of the COVID emergency. Individuals who have lost group coverage have a 60 day window to elect coverage through healthcare.gov, and in most cases these individuals will find it advantageous to elect an ACA plan rather than COBRA.
In addition, many people with ACA plans are receiving less income because of reduced hours. This is a "life event" that can be reported to healthcare.gov. Reporting lower income will increase tax subsidies if these people are eligible for a subsidy and can also result in a special enrollment period (determined through the healthcare.gov software) that will permit them to choose a different plan or change their level of cost share reduction if applicable.
If you or anyone you know is affected in accordance with either of the above two paragraphs, please have them contact us at 877-734-3884 or 561-734-3884 for assistance
.
This
link
prepared by America's Health Insurance Plans (AHIP) contains information about the actions most health insurance carriers are taking in response to the healthcare emergency. Some short-term health insurance carriers, such as National General, have also announced they'll cover COVID-19 testing and certain other services.
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