Tentative deal to provide pandemic funding won’t replenish the COVID-19 Uninsured Program

• A bipartisan Senate bill would pay for additional COVID-19 vaccines and therapeutics but wouldn’t restore funding to the COVID-19 Uninsured Program.
• Providers won’t have recourse to bill self-pay patients for COVID-19 vaccine administration costs but can choose to bill for testing- and treatment-related services.
• Providers can’t count on being paid for claims submitted to the program before the announced deadlines, HHS Secretary Xavier Becerra indicated.

The fate of the COVID-19 Uninsured Program appears to be sealed now that a bipartisan agreement is in place to fund pandemic-related supplies but not anything related to provider payments.

Senate Republicans and Democrats agreed March 31 on the contours of a bill that would provide $10 billion for therapeutics and vaccines but would not fund the COVID-19 Uninsured Program. The bill still must gain the support of at least 60 senators and then pass the House.

Barring last-minute changes to the bill, providers will be on the hook for the costs of administering vaccines to patients who have no insurance coverage — although vaccines will continue to be made available through the federal government at no cost. The terms and conditions of the federal vaccination program prohibit billing individuals for vaccine-related services.

At the provider’s discretion, uninsured patients can be billed for COVID-19 tests and treatments such as antivirals and monoclonal antibodies now that the federally funded program is out of money.

In some states, uninsured patients automatically become eligible for Medicaid coverage when receiving COVID-19-related testing. The Families First Coronavirus Response Act allowed states to implement that option starting in 2020 and receive federal funding to cover the additional costs.

According to the Kaiser Family Foundation’s tracker, 15 states had incorporated that option as of last 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 the U.S. Department of Health and Human Services (HHS).

A last-ditch request is only partially met

The Biden administration had requested $22.5 billion to maintain its efforts against COVID-19. That sum would have been enough to continue operating the Uninsured Program, but the allocation in the new agreement falls short in that respect and also does not sustain current levels of U.S. support for international efforts to combat the virus.

The Health Resources and Services Administration (HRSA) announced on March 14 that without additional funding, the Uninsured Program would stop accepting claims for COVID-19-related testing and treatment services March 22 and do the same for vaccination services April 5. A related program, the Coverage Assistance Fund, has offered reimbursement to providers that administer the vaccine to patients whose insurance doesn’t fully cover vaccinations; that program likewise will stop accepting claims April 5.

Even claims sent in before those deadlines may not be paid due to high demand for limited funds, HHS Secretary Xavier Becerra said.

In the week or so leading up to the final day to submit testing and treatment claims, “We got about $2.3 billion worth of estimated claims in the door,” Becerra said March 31 during a forum hosted by POLITICO in Washington, D.C.

“And we already were in the process of trying to get through another tranche of claims that probably added up to close to that as well. And we’re lucky if we’ve got half of that.”

While claims for vaccination services can be submitted for another few days, Becerra said, “If we get [around] the number of claims again as we saw with the announcement back on March 22, chances are it’s going to be tough to meet those as well.”

Insolvency marks the end of an ‘experiment’

Larry Levitt, executive vice president for health policy with the Kaiser Family Foundation, described the Uninsured Program as a mechanism for providing universal coverage — albeit in a narrow context — of the sort envisioned by “Medicare for All” advocates. The goal was to ensure that regardless of insurance status, all Americans would have access to free COVID-19-related care.

“That’s all now coming to an end,” Levitt said during the POLITICO forum. “But this was quite an experiment, and it certainly did improve access.”

During a budget hearing March 31 on Capitol Hill, Rep. Rose DeLauro (D-Conn.), chair of the House Appropriations Committee, said the lack of funding likely will have consequences in the effort against the novel coronavirus.

“I worry about the uninsured and what will happen to them if there isn’t funding there, and then therefore we will see less people getting the tests and vaccinated, etc., which is harmful,” she said.

Most COVID-19-related funding winds down

The COVID-19 Uninsured Program is a component of the $186 billion Provider Relief Fund (PRF), which is expected to be depleted of funds once HRSA completes the ongoing Phase 4 general distribution.

Despite pleas from hospital advocates, the overall PRF likewise did not receive additional funding during negotiations in March on an FY22 appropriations bill. Congress also did not offer relief on restoration of the Medicare payment sequester, which will reduce payments on all claims by 1% starting April 1 and then rise to 2% on July 1.

“How much do you want us to help doctors, hospitals, labs, pharmacies, nursing homes, long-term care centers? If you want us to be able to provide reimbursement to all of them — if they’re doing the testing, treating, vaccination — then [the required funding is] going to be pretty big because we pretty much consumed $186 billion that Congress has given us over the last two years for that,” Becerra said.

Speaking at the POLITICO forum, Rep. Michael Burgess (R-Texas) said the Congressional Budget Office has pegged the amount of money remaining from previous pandemic-related allocations at $440 billion. Some of those funds surely could be repurposed, he added.

“If you need another $22 billion to complete the job, let’s come in, let’s rationalize the expenditure, but you actually have the dollars in the till to go ahead and pay for that,” Burgess said. “You don’t need another $22 billion that is going to add to the inflationary pressure that we’ve already put on the American people.”

Becerra pushed back on criticism that the Biden administration should give a better accounting of how previous funds have been spent before new funding is authorized.

“I can give you the binder,” he said. “It has about 400 pages where we’ve outlined essentially what we’ve done with all the COVID money in all the different areas on numerous occasions for a number of members — Senate and House. And it’s public information.”