Claims submitted to HRSA’s COVID-19 funds for uninsured and underinsured patients soon won’t be paid

In the absence of congressional action, funds used to reimburse providers for supplying COVID-19-related services to the uninsured and underinsured are set to expire.

The Health Resources and Services Administration (HRSA) says a lack of funding for the COVID-19 Uninsured Program and a related program mean both soon will stop accepting claims.

For services provided to uninsured patients, claims won’t be accepted after March 22 for testing and treatment and after April 5 for vaccinations, according to a posting. That will be the case “regardless of whether the system shows your claim as having been received,” HRSA states.

In addition, the Coverage Assistance Fund (CAF), which covers the cost of administering vaccines to underinsured patients — i.e., those whose insurance doesn’t cover the entire cost of vaccine administration — will stop accepting claims after April 5.

It sounds as though claims submitted before the deadlines aren’t guaranteed to be paid, either, with HRSA stating that such claims “will be adjudicated and paid subject to their eligibility and the availability of funds.”

Providers have been reimbursed at Medicare payment rates during the pandemic through both the CAF and the Uninsured Program.

Implications for reimbursement

The federal government’s vaccination program prohibits billing patients for any costs stemming from COVID-19 vaccine administration. That part of the terms and conditions remains in place since the government continues to supply the vaccines free of charge to states, municipalities, pharmacies and community health centers.

COVID-19 tests and treatments are not subject to the same restrictions. March 30 update: A source with the U.S. Department of Health and Human Services (HHS) confirmed that providers can choose to bill self-pay patients for testing and treatment services unless and until funding is restored to the Uninsured Program. 

In some states, uninsured patients automatically become eligible for Medicaid coverage when receiving COVID-19-related services. The Families First Coronavirus Response Act allowed states to implement this option and receive federal funding to cover the additional costs.

According to the Kaiser Family Foundation’s tracker, 15 states had incorporated this option as of July 1: California, Colorado, Connecticut, Illinois, Iowa, Louisiana, Maine, Minnesota, Nevada, New Hampshire, New Mexico, North Carolina, South Carolina, Utah and West Virginia. The option will cease to be available upon the expiration of the public health emergency, which currently is scheduled for April 16 but has been expected to be pushed back to July given the lack of notice to date from HHS.

Congressional deadlock

The funding issue arose when Congress couldn’t agree on how to pay for the Biden administration’s requested allocation. Republicans refused to support the allocation as part of the FY22 appropriations bill unless the administration accounted for how previous COVID-19 funding has been used.

The appropriations bill passed Congress earlier this month, minus the pandemic-related funding. House leaders say they will have a vote on a stand-alone bill, but the bill’s prospects of gaining the required 60 votes in the Senate are uncertain. March 30 update: Negotiations on a bill reportedly are underway between Majority Leader Charles Schumer (D-N.Y.) and Sen. Mitt Romney (R-Utah).

The White House says the lack of funding will have implications beyond the COVID-19 Uninsured Program and Coverage Assistance Fund over the next few months, including in efforts to ensure additional booster doses are available if needed on a large-scale basis.

Other aspects of the COVID-19 response that would be affected include oral antivirals, domestic testing, surveillance capacity and development of a next-generation vaccine that could offer long-term protection against all variants, according to a White House fact sheet that aims to put pressure on Congress.