The Biden administration has informed Congress it will end the COVID-19 national and public health emergencies May 11 — signaling an end to the pandemic's crisis era and an unwinding of federal flexibilities that reshaped the nation's healthcare system.
"At present, the administration's plan is to extend the emergency declarations to May 11, and then end both emergencies on that date," the Office of Management and Budget said in a Jan. 30 statement. "This wind-down would align with the administration's previous commitments to give at least 60 days' notice prior to termination of the PHE."
Over the last three years, the PHE has played a significant role in its influence of national healthcare policy — it reformed telehealth and expanded who can use it, fast-tracked approvals of COVID-19 vaccines and treatments, and preserved healthcare coverage for millions of Medicaid beneficiaries nationwide. HHS has renewed the PHE every 90 days since January 2020, with the most recent renewal declared on Jan. 11.
Though states could not disenroll people from Medicaid during the PHE, Congress passed a $1.7 trillion omnibus spending bill in December that detached the federal policy from Medicaid redeterminations. Starting April 1, states will begin redetermining who is and is not eligible for Medicaid, a process that could leave up to 18 million people without health coverage over the span of about a year.
The spending bill also extends Medicare telehealth flexibilities through 2024, which previously would have ended 151 days after the PHE expired. Acute hospital care at home waivers and flexibilities were also extended for two years through 2024. Similar to telehealth, the deadline for hospital at home waivers was tied to the status of the PHE. More than 250 hospitals have been approved by CMS to participate in the acute hospital care at home program.
COVID-19 tests and vaccines were covered for most Americans at no cost during the PHE, but the federal government has planned to shift much of these costs to the commercial market in 2023. Once the PHE ends, Medicare enrollees will generally face out-of-pocket costs for at-home tests and treatments, but vaccines would largely remain free for those with Medicare, Medicaid and commercial insurance. Medicaid programs will still cover physician-ordered tests, but treatments will incur a fee — commercially insured individuals can receive free treatments until federal supplies run out.
Commercialization would also leave the over 26 million uninsured individuals in the U.S. with a major disadvantage in accessing free vaccines and treatments. Moderna and Pfizer have floated commercial vaccine prices of up to $130 per dose.
The PHE's termination will also mean states will no longer be required to report COVID-19 data to the CDC. A senior official with the Biden administration told ABC News that the CDC will be reaching out over the next few months to urge them to continue sharing data voluntarily.
News of the declaration's tentative end comes as the flu, COVID-19 and respiratory syncytial virus — which have strained hospitals for months — appear to have peaked. In September, President Joe Biden declared the pandemic "over" amid a decline in case totals and deaths.
"It's been a heavy flu season and a significant time for other illnesses," Chip Kahn, president and CEO of the Federation of American Hospitals, told Becker's Jan. 11. "I do think we're fast approaching a point where there will be heightened [COVID-19] surges, but this will be part of the routine — it's becoming integrated with hospital activity, especially with the drugs and treatment knowledge at this point."
On Jan. 30, the World Health Organization determined COVID-19 remains a public health emergency while also acknowledging the pandemic is "probably at a transition point." The WHO's emergency committee recommended the agency work with stakeholders on a proposal for how to maintain focus on COVID-19 once its emergency declaration is terminated.