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Here's What Happens When the COVID Public Health Emergency Ends

The emergency declaration has just been extended for the 12th time.

HHS Secretary Xavier Becerra
HHS Secretary Xavier Becerra renews the COVID public health emergency on Jan. 11, 2023.
Bloomberg/Getty Images
For the most up-to-date news and information about the coronavirus pandemic, visit the WHO and CDC websites.

The federal government has extended the COVID-19 public health emergency for another 90 days, the US Department of Health and Human Services said Wednesday.

This marks the 12th time the order has been renewed since January 2020 and keeps the public health emergency in effect through mid-April. The order provides continued federal funding for free vaccines, testing and treatment and maintains relaxed requirements for Medicaid and Medicare coverage. 

Here's what to know about the public health emergency, including what it does, when it could end and what happens when it does.

For more on COVID-19, find out what we know about the latest variantshow to order more free test kits and how to differentiate coronavirus from the flu.

What is a public health emergency?

Under the Public Health Service Act of 1944, the secretary of the US Department of Health and Human Services can determine that a disease outbreak or bioterror attack poses a public health crisis for a period of 90 days at a time. After that, the declaration must be extended.

That public health emergency determination allows the HHS, the Centers for Disease Control and Prevention and other government agencies to access funding and increase staffing "to prevent, prepare for, or respond to an infectious disease emergency."

It also waives certain requirements for Medicare, Medicaid and the Children's Health Insurance Program (CHIP) and relaxes restrictions on telemedicine.

Some 20 million people have enrolled in Medicaid since the start of the pandemic, according to the Kaiser Family Foundation, an increase of 30% over typical numbers. 

When is the COVID-19 public health emergency set to expire?

A public health emergency was first declared on Jan. 31, 2020, and has been extended 12 times since then. The current order is scheduled to end on April 11, 2023, HHS confirmed to CNET.

The department has said it would give 60 days' notice before allowing the order to expire. 

Several Biden administration officials cited the possibility of a COVID surge this winter and the need for more time to transition into private health insurance coverage as reasons for the order's renewal, Reuters reported on Jan. 11.

Politico reported on Jan. 10 that this most extension will be the last, although HHS denied that any decision has been made. 

What happens when the public health emergency ends?

Paxlovid pills

To date, the cost of Paxlovid has been covered by the federal government. That will end when the public health emergency expires.

Joe Raedle/Getty Images

When the declaration lapses, payment for COVID-19 vaccines, testing and treatment will likely become the responsibility of individuals and their health insurance companies.

The retail price of Pfizer's two-dose COVID vaccine is expected to quadruple from the current government rate, from $30 per shot to between $110 and $130. 

Paxlovid, which has been shown to be nearly 90% effective in reducing the risk of a severe COVID disease, will also no longer be free. A course of the drug currently costs the US government $530, according to Kaiser Health News, but that's at a bulk discount. Pfizer, which manufactures Paxlovid, has not said what the retail price would be.

Right now, special waivers for Medicaid and Medicare requirements that have been in place throughout the pandemic will also come to an end when the public health emergency expires. Without government action, that would cause more than 5 million people to lose health care coverage by 2024, according to management consulting firm OliverWyman.

The debate over renewing the public health emergency

In a November 2022 open letter to Congress, the National Association of Medicaid Directors said the "uncertainty" about the order is "no longer tenable." 

The organization asked lawmakers to provide concrete information on when normal Medicaid coverage would resume, with at least 120 days' notice. 

"The most critical thing Congress can do to ensure a successful unwinding from the PHE is to provide clear dates and funding levels in statute for state Medicaid agencies to reliably plan around," it said. PHE is short for public health emergency.

That same month, Mark Parkinson, president of the American Health Care Association and the National Center for Assisted Living, asked HHS Secretary Xavier Becerra to renew the public health emergency past the Jan. 11 cutoff.

"Coming out of the holiday season, we need to ensure our health care infrastructure can quickly adapt," Parkinson wrote. "Extending the PHE is critical to ensure states and health care providers, including long-term care providers, have the flexibilities and resources necessary to respond to this ever-evolving pandemic."

In December, 25 Republican governors asked President Joe Biden to end the public health emergency declaration, claiming it's a financial burden costing states "hundreds of millions of dollars." 

"While the virus will be with us for some time, the emergency phase of the pandemic is behind us," they wrote.

Many people have returned to employer-sponsored health coverage, the governors added, but "states still must still account and pay for their Medicaid enrollment in our non-federal share." 

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.