Revised March 19, 2020 to reflect final Senate-passed package on March 18, 2020
On March 14, the House passed H.R. 6201, the Families First Coronavirus Response Act of 2020. Monday night, the House passed a “technical corrections” bill that slightly changed some provisions. On Wednesday evening, the Senate passed the final package, 90-8. This finalizes “phase 2” of legislative action and both houses are focused on developing a third package focused on economic stimulus.
The Families First bill is a positive first step in addressing a public health pandemic that has the nation gripped with fear and uncertainty. Governors are working to tamp down the spread of the virus and “flatten the curve” of growth in numbers of cases. States and localities are closing schools for varying numbers of weeks, shutting down restaurants, halting all visits to nursing homes and banning gatherings larger than designated size limits, while instructing all households to take the pandemic seriously and practice social distancing. A number of governors are increasingly vocal, building a collective narrative about the importance of social distancing and quarantine. States are responding swiftly – their quick and concrete directives are vital to protecting the nation’s health.
Below is a quick overview of what is in the bill in terms of health care coverage and delivery.
What are the Health Care Provisions?
The legislative package begins to address the coronavirus pandemic by advancing provisions related to a number of key domains of concern: paid leave and employment; nutrition and food support; and health care access. As health care advocates, we are focused most on how Medicaid is supplemented and other funds are made available to states to ramp up a response to local concerns and fiscal needs. This is just a first step – let us be clear – but an important one.
No cost sharing for testing and related services
First and foremost, the bill eliminates cost-sharing for testing and related services associated with treatment for most. This is tremendously important for consumers but has its limitations. While “associated treatment” is listed in the bill text, the interpretation and implementation of the provision could vary. For example, if a consumer is tested for other illnesses prior to a COVID-19 series – and are COVID-19 negative – they will still be responsible for non-COVID-19 related tests and associated costs. While this is a positive step that encourages care seeking, it is not a guaranteed protection and we must be clear in our messaging about it.
In this vein, sections 6002-6004 are devoted to no cost-sharing and associated treatment for Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). Section 6004 also gives states flexibility to extend Medicaid eligibility to the uninsured during the crisis for the purposes of COVID-19 testing and testing related services. This would be fully matched by the federal government at 100 percent, eliminating financial burden for states. Finally, section 6001 directs health insurance issuers offering group or individual health coverage (including grandfathered plans as defined in the ACA) to waive cost-sharing of COVID-19 testing and treatment as part of “urgent care center visits, and emergency room visits that result in an order for or administration” of a COVID-19 test “when they are an outcome of a regular provider visit.” The technical amendment clarifies that group health plans and issuers in the individual and group markets must cover COVID-19 services related to testing that are provided through a telehealth office visit with no cost-sharing.
Increased Federal Medical Assistance Percentage
The bill increases the federal medical assistance percentage (FMAP) for state Medicaid programs by 6.2 percentage points. Increasing Medicaid funding to states is a powerful tool that supports our health care system and can help counter the economic effects of the pandemic. Coupled with the funding available to states under the federal “State of Emergency” that was declared on Friday, the bill will enhance the ability of states to respond to the crisis.
The bill conditions the FMAP increase on the following (see section 6008):
- States cannot restrict eligibility for coverage or make it more difficult to apply for or retain coverage or increase premiums than those in effect on January 1, 2020. This is referred to as “maintenance of effort” or MOE.
- States cannot impose cost-sharing for coronavirus testing and treatment related to COVID-19 under the Medicaid program “including vaccines, specialized equipment, and therapies”
- The FMAP “bump” is extended to all states and territories (further outlined in section 6009)
This bill would override any requests from states to waive cost-sharing during the public health crisis – this legislation clears the path for increased access.
Other health provisions
There are other health provisions in the House bill that are worth mention. Notably, elements include: the loosening of rules for telehealth in Medicare; N95 respirators are categorized as a medical device; and Veterans and American Indians and Alaskan Natives who receive services through the TRICARE or the Indian Health Service (IHS) are not exposed to cost-sharing.
The package also includes other key provisions that begin to address the needs of people experiencing hardship as a result of the pandemic, either directly or because of an economic downturn. They include some paid leave provisions and efforts to protect families’ food security. Unfortunately, there are loopholes that still need to be addressed. One of the obvious ones is that the paid sick leave provisions simply do not go far enough. They were watered down as the price of Trump administration and House Republican support.
What is Next?
Leader McConnell is working to swiftly pass a third and larger stimulus package. Senator Schumer is floating a $750 billion package that includes a number of provisions related workforce safety and bolstering hospital capacity. It also includes economic relief for affected businesses in addition to measures to protect workers and families who are struggling. As health advocates, we are advocating for measures that are needed to further protect the health care workforce, the uninsured and the safety net – with an additional Medicaid FMAP boost at its core. We appreciate all the hard work to protect consumers and families at this difficult time and appreciate your virtual advocacy. Stay tuned for more!