What does ending the emergency status of the COVID-19 pandemic in the US mean in practice? 4 questions answered

The COVID-19 pandemic’s public health emergency status in the U.S. expires on May 11, 2023^[1]. And on May 5, the World Health Organization declared an end to the COVID-19 public health emergency of international concern^[2], or PHEIC, designation that had been in place since Jan. 30, 2020.

Still, both the WHO and the White House have made clear that while the emergency phase of the pandemic has ended, the virus is here to stay and could continue to wreak havoc^[3].

WHO Director General Tedros Adhanom Ghebreyesus noted that, over that time, the virus has taken the lives of more than 1 million people in the U.S.^[4] and about 7 million people globally^[5] based on reported cases, though he said the true toll is likely closer to 20 million people worldwide^[6]. While the global emergency status has ended, COVID-19 is still an “established and ongoing health issue^[7],” he said.

The Conversation asked public health experts Marian Moser Jones^[8] and Amy Lauren Fairchild^[9] to put these changes into context and to explain their ramifications for the next stage of the pandemic.

1. What does ending the national emergency phase of the pandemic mean?

Ending the federal emergency reflects both a scientific and political judgment that the acute phase of the COVID-19 pandemic crisis has ended and that special federal resources are no longer needed to prevent disease transmission across borders.

In practical terms, it means that two declarations – the federal Public Health Emergency^[10], first declared on Jan. 31, 2020, and the COVID-19 national emergency^[11] that former President Donald Trump announced on March 13, 2020, are expiring.

Declaring those emergencies enabled the federal government to cut through mountains of red tape to respond to the pandemic more efficiently. For instance, the declarations allowed funds to be made available^[12] so that federal agencies could direct personnel, equipment, supplies and services to state and local governments wherever they were needed. In addition, the declarations made funding and other resources available to launch investigations into the “cause, treatment or prevention^[13]” of COVID-19 and to enter into contracts with other organizations to meet needs stemming from the emergency.

The emergency status also allowed the federal government to make health care more widely available by suspending many requirements^[14] for accessing Medicare, Medicaid and the Children’s Health Program, or CHIP. And they made it possible for people to receive free COVID-19 testing, treatment and vaccines and enabled Medicaid^[15] and Medicare to more easily cover telehealth services^[16].

Finally, the Trump administration used the national emergency to invoke Title 42^[17], a section of the Public Health Service Act that allows the federal government to stop people at the nation’s borders^[18] to prevent introduction of communicable diseases. Asylum seekers and others who normally undergo processing when they enter the U.S. have been turned away under this rule.

2. What domestic policies are changing?

An estimated 15 million people are likely to lose Medicaid or CHIP coverage, according to the federal government^[19]. Another analysis projected^[20] that as many as 24 million people will be kicked off the Medicaid rolls.

Before the pandemic, states required people to prove every year that they met income and other eligibility requirements. This resulted in “churning”^[21] – a process whereby people who did not complete renewal paperwork were being periodically disenrolled from state Medicaid programs before they could reapply and prove eligibility.

In March 2020, Congress enacted a continuous enrollment provision in Medicaid that prevented states from removing anyone from their rolls during the pandemic. From February 2020 to March 31, 2023, enrollment in Medicaid and CHIP grew by nearly 23.5%^[22] to a total of more than 93 million. In a December 2022 appropriations bill, Congress passed a provision that ended continuous enrollment on March 31, 2023.

The Biden administration defended this time frame as sufficient^[23] to ensure that patients did not “lose access to care unpredictably” and that state Medicaid budgets – which received emergency funds beginning in 2020 – didn’t “face a radical cliff.”

But many people who have Medicaid or who enrolled their children in CHIP during this period may be unaware of these changes until they actually lose their benefits over the next several months.

At least five states already began disenrolling Medicaid members in April^[24]. Other states are sending out termination letters^[25] and renewal notices^[26] and will disenroll members starting in May, June and July^[27].

Only Oregon has set up a comprehensive program to minimize disenrollments. That state is running a five-year federal demonstration program^[28] that allows it to temporarily let people stay on Medicaid if their income is up to 200% of the federal poverty level and lets eligible children stay on Medicaid through age 6. Many other states are trying more limited strategies^[29] to improve the renewal process and decrease churning.

The array of telehealth services that Medicare began covering during the pandemic^[30] will continue to be covered through December 2024. Medicare is also making coverage for behavioral and mental telehealth services a permanent benefit^[31].

The end of the emergency also means that the federal government is no longer covering the costs of COVID-19 vaccines and treatments for everyone. However, in April, the Biden administration announced a new $1.1 billion public-private “bridge access program^[32]” that will provide COVID-19 vaccines and treatments free of charge for uninsured people through state and local health departments and pharmacies. Insured individuals may have out-of-pocket costs depending on their coverage.

The end of the emergency lifts the pandemic restriction on border crossing. Large numbers of migrants have gathered at the Mexico-U.S. border^[33] and are expected to enter the country in the coming weeks, further straining already overwhelmed staff and facilities.

3. What does this mean for the status of the pandemic?

A pandemic declaration^[34] represents an assessment that human transmission of a disease, whether well known or novel, is “extraordinary,” that it constitutes a public health risk to two or more U.S. states and that controlling it requires an international response. But declaring an end to the emergency doesn’t mean a return to business as usual.

New global guidelines for long-term disease management^[35] of COVID-19, released on May 3, 2023, urged countries “to maintain sufficient capacity, operational readiness and flexibility to scale up during surges of COVID-19, while maintaining other essential health services and preparing for the emergence of new variants with increased severity or capacity.”

Former White House COVID-19 response coordinator Deborah Birx recently warned^[36] that the omicron COVID-19 variant continues to mutate and may become resistant to existing treatments. She called for more federally funded research into therapeutics and durable vaccines that protect against many variants.

Birx’s warnings come as remaining states have ended their COVID-19 press briefings^[37] and shut down their exposure notification systems^[38], and the federal government has ended its free COVID-19 at-home test program^[39].

With the end of the emergency, the CDC is also changing the way it presents its COVID-19 data to a “sustainable national COVID-19 surveillance” model^[40]. This shift in COVID-19 monitoring and communication strategies accompanying the end of the emergency means that the virus is disappearing from the headlines, even though it has not disappeared from our lives and communities.

4. How will state and local pandemic measures be affected?

The end of the federal emergency does not affect state-level or local-level emergency declarations. These declarations have allowed states to allocate resources to meet pandemic needs and have included provisions^[41] allowing them to respond to surges in COVID-19 cases by allowing out-of-state physicians and other health care providers to practice in person and through telehealth.

Most U.S. states, however, have ended their own public health emergency declarations. Six states – Delaware, Illinois, Massachusetts, New York, Rhode Island and Texas – still had emergency declarations in effect as of May 3, 2023, that will expire by the end of the month. So far, Massachusetts Gov. Maura Healey^[42] stands alone in having indicated that she will “extend key flexibilities provided by the public health emergency” related to health care staffing and emergency medical services.

While some states may choose to make permanent some COVID-era emergency standards, such as looser restrictions on telemedicine or out-of-state health providers, we believe it could be a long time before either politicians or members of the public regain an appetite for any emergency orders directly related to COVID-19.

This is an updated version of an article that was originally published^[43] on Feb. 3, 2023.

References

1. ^{^} expires on May 11, 2023 (www.npr.org)
2. ^{^} the COVID-19 public health emergency of international concern (www.statnews.com)
3. ^{^} could continue to wreak havoc (www.washingtonpost.com)
4. ^{^} more than 1 million people in the U.S. (www.washingtonpost.com)
5. ^{^} about 7 million people globally (doi.org)
6. ^{^} closer to 20 million people worldwide (www.npr.org)
7. ^{^} established and ongoing health issue (www.who.int)
8. ^{^} Marian Moser Jones (cph.osu.edu)
9. ^{^} Amy Lauren Fairchild (cph.osu.edu)
10. ^{^} federal Public Health Emergency (www.phe.gov)
11. ^{^} COVID-19 national emergency (www.whitehouse.gov)
12. ^{^} funds to be made available (aspr.hhs.gov)
13. ^{^} cause, treatment or prevention (aspr.hhs.gov)
14. ^{^} suspending many requirements (aspr.hhs.gov)
15. ^{^} enabled Medicaid (www.medicaid.gov)
16. ^{^} more easily cover telehealth services (telehealth.hhs.gov)
17. ^{^} Title 42 (www.dhs.gov)
18. ^{^} stop people at the nation’s borders (theconversation.com)
19. ^{^} according to the federal government (aspe.hhs.gov)
20. ^{^} Another analysis projected (www.kff.org)
21. ^{^} resulted in “churning” (www.kff.org)
22. ^{^} enrollment in Medicaid and CHIP grew by nearly 23.5% (www.kff.org)
23. ^{^} defended this time frame as sufficient (www.whitehouse.gov)
24. ^{^} began disenrolling Medicaid members in April (ccf.georgetown.edu)
25. ^{^} sending out termination letters (medicaid.ohio.gov)
26. ^{^} renewal notices (www.hhs.texas.gov)
27. ^{^} disenroll members starting in May, June and July (ccf.georgetown.edu)
28. ^{^} five-year federal demonstration program (www.oregon.gov)
29. ^{^} trying more limited strategies (www.medicaid.gov)
30. ^{^} covering during the pandemic (telehealth.hhs.gov)
31. ^{^} behavioral and mental telehealth services a permanent benefit (telehealth.hhs.gov)
32. ^{^} public-private “bridge access program (www.hhs.gov)
33. ^{^} have gathered at the Mexico-U.S. border (www.cnn.com)
34. ^{^} A pandemic declaration (www.ncbi.nlm.nih.gov)
35. ^{^} New global guidelines for long-term disease management (www.who.int)
36. ^{^} Deborah Birx recently warned (fortune.com)
37. ^{^} remaining states have ended their COVID-19 press briefings (www.krem.com)
38. ^{^} shut down their exposure notification systems (www.cdph.ca.gov)
39. ^{^} federal government has ended its free COVID-19 at-home test program (apnews.com)
40. ^{^} sustainable national COVID-19 surveillance” model (www.cdc.gov)
41. ^{^} included provisions (telehealth.hhs.gov)
42. ^{^} Massachusetts Gov. Maura Healey (nashp.org)
43. ^{^} originally published (theconversation.com)