The COVID-19 public health emergency ends in May. Here’s what it means for healthcare providers.

After much uncertainty and speculation, healthcare providers now know the end date for the federal government’s COVID-19 public health emergency.

President Joe Biden said the COVID-19 emergency will expire on May 11. The Biden administration had promised to provide at least 60 days' notice before ending the emergency declaration, and ended up giving healthcare operators more time to prepare.

“The main takeaway is we’re glad that there’s more than 60 days notice, which is something we have asked for,” said Claire Ernst, director of government affairs for the Medical Group Management Association. She said she hopes the White House will continue to work with the MGMA and other healthcare advocates.

House Republicans are telling Biden he shouldn’t wait until the spring and have crafted legislation designed to end the emergency right away. However, the White House said Americans and hospitals need time before pulling the plug on the public health emergency.

“An abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans,” the White House said in a statement.

The Biden administration and Congress previously agreed to extend waivers for telehealth programs beyond the public health emergency. Stacey Hughes, executive vice president of government relations and public policy for the American Hospital Association, said hospitals are hoping to see permanent reforms relating to telehealth and hospital-at-home programs.

She also stressed that hospitals will continue to face enormous challenges, even with the end of the emergency declaration. Hospitals endured their worst financial year of the COVID-19 pandemic in 2022, according to Kaufman Hall, a healthcare consulting firm.

“While the country may be entering a new phase of the fight against COVID-19, hospitals and their caregivers continue to navigate a host of weighty challenges including workforce shortages and financial pressures, cost increases for equipment and drugs, disrupted supply chains and sicker patients,” Hughes said in a statement. “These issues will require continued attention and investment from the federal government.

“The decision to sunset the PHE is a testament to the progress we have made, but that progress should not end with the PHE,” Hughes said. “We should preserve many of the best care innovations that served us well during the pandemic, like expanded use of telehealth and the development of hospital at home programs. We will work with the administration to build on the lessons learned from the COVID-19 pandemic, beginning with our strong urging that many of the COVID-19 PHE flexibilities be made permanent.”

During the public health emergency, hospitals have received a higher reimbursement from Medicare for treating COVID-19 patients, KFF reports. Medicare has offered a 20% bump in its payment rate for COVID-19 admissions, but that ends with the expiration of the public health emergency.

• Read more: Hospitals should brace for difficult 2023, but ‘there’s light at the end of the tunnel’

Aiming to avoid ‘chaos’

The White House is resisting calls to immediately end the public health emergency to avoid “confusion and chaos.”

“Due to this uncertainty, tens of millions of Americans could be at risk of abruptly losing their health insurance, and states could be at risk of losing billions of dollars in funding,” the White House said in its policy statement. “Additionally, hospitals and nursing homes that have relied on flexibilities enabled by the emergency declarations will be plunged into chaos without adequate time to retrain staff and establish new billing processes, likely leading to disruptions in care and payment delays, and many facilities around the country will experience revenue losses.”

Hospitals and healthcare providers would be facing more uncertainty, but the White House and lawmakers agreed to extend some flexibilities in the $1.7 trillion federal spending package in December.

The package included a provision to extend telehealth waivers for healthcare providers through 2024. And the spending package also included a two-year extension for hospital-at-home programs through 2024.

“Congress had addressed a lot of the critical Medicare telehealth waivers in the omnibus,” Ernst said. “Because Congress acted last month, most of our concerns with telehealth access were addressed.”

• Read more: Where telehealth can help patients, and providers, avoid in-person care

Telehealth advocates had warned one waiver that is tied to the public health emergency allows for the remote prescription of some medications for substance use disorder. That waiver is slated to end after the emergency designation is phased out.

Kyle Zebley, the American Telemedicine Association’s senior vice president of public policy, said that needs to be addressed.

“The ATA and ATA Action implore our government leaders to provide a sense of certainty to a huge cohort of individuals requiring access to important medications for substance use disorders and other necessary drugs via telehealth after May 11,” Zebley said in a statement.

“Unfortunately, flexibilities allowing for remote prescribing of controlled substances, as part of the Ryan Haight Act, currently expire with the PHE. Without a plan in place, these vulnerable populations will be left out in the cold, and we are quite sure this is not the intent of our government leaders.”

Scores of healthcare advocates have written to the administration asking them to provide a remedy for remote prescriptions. “There is now an extreme sense of urgency with the public health emergency ending in only a few months," Zebley said.

Impact on patients

States received additional funding for Medicaid coverage in the pandemic, but that too is changing. The federal omnibus package allowed states to begin making new determinations for Medicaid eligibility beginning in April, so some states are expected to stop coverage for some recipients.

Healthcare analysts have said millions could be losing coverage from Medicaid.

Health systems and hospitals could also see additional headaches if millions lose Medicaid coverage, advocates say.

The number of Americans deferring healthcare needs due to financial concerns reached a two-decade high, according to a recent Gallup poll. It’s certainly plausible more people will postpone seeking treatment until they are seriously ill, and they could end up needing hospital admissions and lengthy stays that could be avoided with earlier treatment.

Patients will be paying more for COVID-19 tests when the emergency ends. Americans have been able to get up to eight free tests per month, but they will have to start paying out-of-pocket for those.

COVID-19 vaccines will be covered for those with private insurance, Medicare, and Medicaid, but Americans can expect to pay for treatments, such as Paxlovid, The New York Times reports.

The end of the emergency also means changes to Medicare Advantage coverage. In the emergency, Medicare Advantage charged participants the rates at in-network facilities, even if they received care by a provider outside their network, CNN reports. That will phase out when the public health emergency ends in May.

The Food and Drug Administration said the end of the emergency declaration will not affect the agency’s ability to authorize treatments, devices or vaccines for emergency use.

In a statement Tuesday, the FDA said, “Existing emergency use authorizations (EUAs) for products will remain in effect and the agency may continue to issue new EUAs going forward when criteria for issuance are met.”