Several changes that lowered barriers to health care and services during the pandemic are about to expire. One program supported free tests and vaccination for COVID-19, the other made it possible for people to stay on Medicaid without having to fill out paperwork frequently. Now, these programs are about to end, leaving patients and experts worried about the fallout.
George Mink Jr. took advantage of free Covid testing and vaccines. He lives in the suburbs of Philadelphia, and lost his health insurance since he left a job years ago. He has not had any serious health issues, but in 2020, a close family friend died from COVID-19. Mink and his family got tested, and found out they were positive.
This was back when the federal government paid for COVID-19 testing regardless of insurance status, which stopped in March 2022. Mink said he might not have gotten tested if he had to have health insurance or pay for it himself.
“Who knows what could have happened? … We still would have been … infecting other people.” he said. “It made a major difference.”
Mink is also up to date with his COVID-19 vaccinations, but worries about what will happen when the vaccines are no longer free. Last August, the federal government announced they do not have more funds from Congress to pay for COVID-19 vaccines that can be freely provided.
“What if in two months, we got a new variant … coming …and now I need a new booster, and now I can’t afford it?”
He is a community activist for Health Educated, a nonprofit in Delaware County that has hosted vaccine clinics, health fairs, and webinars. Founder Kristin Motley is a pharmacist who has worked on vaccine clinics before the pandemic. She said the fact that the COVID-19 vaccines were free made a big difference.
“It allowed us to go into the community, wherever people were, to provide the vaccines, to provide testing and to say, you don’t have to register, you don’t have to bring I.D., you don’t have to bring insurance. You just come,” she said. “That was really nice to be able to help people in that way with no red tape, no bureaucracy … it was so seamless.”
The health departments in Pennsylvania and Delaware say they plan to keep providing free tests and vaccines for the foreseeable future, and that the federal government has yet to say when the free vaccine supply will be cut off.
Another big concern is what will happen once people on Medicaid, the public health insurance program for people on low income, have to start filling out the paperwork to re-enroll again. Usually, they have to reapply every year to show that they still qualify based on their income.
The federal government recognized that a pandemic would be a bad time for people to lose access to medical care because they cannot pay, so the Families First Coronavirus Response Act required states to keep people on Medicaid as long as the country was in a public health emergency. That means people on Medicaid, and their medical providers, did not have to fill out the forms to re-apply for the past two years.
Robert (WHYY agreed not to use his last name to protect his privacy) has not been on Medicaid for a few years. But he recently signed up again because his daughter encouraged him to go for a checkup. He’s filled out the paperwork before, so it only took him about half an hour, with his daughter’s help.
He has ADHD, so having a second set of eyes on his application was good.
“If we miss one little detail, they would reject you,” he said. “I usually get two applications, so if I mess up on one. I can do the other one.”
If someone makes a mistake on their forms to get Medicaid, they could be denied coverage.
Jenn Lydic is the director of social services and community engagement at the Public Health Management Corporation, a nonprofit that runs six health centers in Philadelphia. She says the reprieve from renewal paperwork “allowed for a continuity that I think has really been lifesaving for a lot of folks.”
“I know so many patients who have now been able to really finally get ahead of a lot of their health conditions, to be living with a chronic and acute health condition and know that they are going to be able to consistently access medication.”
Research shows that disruptions in Medicaid coverage can lead to delayed care, less preventative care, and higher health care costs due to pent up demand.
The latest spending bill that President Biden signed at the end of 2022 included a section that allowed states to start the process of kicking people off Medicaid again this April – if they are no longer eligible, or didn’t reapply. That means people on Medicaid, or the medical staff helping them, will have to go back to renewing their paperwork every year, or run the risk of losing access to medicine or treatments that they need.
Lydic says that will mean going back to a “constant battle and … constant struggle to make sure that … our patients stay connected to health insurance.”
The US Department of Health and Human services estimates that the barrier of paperwork will mean more than six million people could lose their Medicaid coverage, despite still being eligible.
If a state finds someone to be no longer eligible for Medicaid, they won’t be cut off immediately, said Jennifer Tolbert, associate director for the program on Medicaid and the uninsured at the Kaiser Family Foundation. The states will take a few months to a year to go through the process. The Pennsylvania Department of Human Services said they will take a full year to do this, and are working across offices to prepare for the end of continuous enrollment to try and make sure no one experiences lapses in health coverage.
The federal government also increased Medicaid funding to the states when it required the states to keep people enrolled during the pandemic, and that increased funding won’t start phasing out until the end of next year.
Tolbert added that the move to keep people enrolled on Medicaid continuously is truly unprecedented, but there will be some lasting changes from the pandemic.
For instance, Oregon will allow children who qualify for Medicaid to enroll at birth, and stay enrolled until age 6, without having to reapply. Washington state, California, and New Mexico are considering similar policies as well.
Philadelphia Health Commissioner Cheryl Bettigole worked in city health centers for years. She said the continuous Medicaid enrollment and free access to COVID-19 tests and treatments have been a big advance, and would like to see some of that last.
“There was this moment with the pandemic in which we recognized that it was really important for everybody to have access to care. And we’ve somehow changed our minds about that,” she said. “If we were to have a newer, better vaccine that … lasts longer, we would want everyone to get that, and …treatments that prevent hospitalization.”
“ All of those things are things that we want everyone to have access to, frankly, in the same way that we want everybody to have access to treatment for heart disease or diabetes or … asthma. And we recognized it for a moment for a single condition, and now we’re kind of walking back from that … I do think that’s a pity.”