Over the month of April, the COVID-19 emergency continued to dominate Americans’ lives – and lawmakers’ agendas. Here are some of the month’s developments.

  • A fourth COVID relief bill was signed into law on April 24th. R. 266 replenishes the Paycheck Protection Program (established in the March CARES Act but quickly depleted) with an additional $321 billion in federal funding. The latest legislation also provides loans and grants for economic disaster assistance, hospitals, and COVID testing.

Most observers expect that Congress will need to provide still more relief in the coming weeks and months. Patient groups, including HFA, are asking for additional COVID relief in form of: COBRA premium support, additional federal funding for Medicaid, incentivization of Medicaid expansion for remaining states, and more. Advocates are also urging the federal government to reopen enrollment in the 38 federally-facilitated ACA Marketplaces. (All of the state-based Marketplaces except for Idaho created generally available special enrollment periods in response to COVID-19; some of those SEPs remain open into May or June). Reopening Marketplace enrollment to all would cut through red tape that makes it hard for people affected by the COVID emergency to buy insurance, e.g., providing documentation of their job loss and consequent loss of health insurance. To date, the U.S. Centers for Medicare and Medicaid Services (CMS) has refused to reopen the federal Marketplaces; however, CMS did take some steps to ease the application process for people who have lost job-based insurance by virtue of the COVID emergency.

  • The hurried roll-out of the CARES Act raised a number of questions about how CARES Act payments might impact recipients’ continued eligibility for a range of health and safety net programs. HFA researched and wrote about one such issue: will enhanced unemployment benefits count against eligibility for Medicaid on the part of people who receive Supplemental Security Income disability benefits? HFA ascertained that SSI recipients will not lose Medicaid coverage due to their receipt of CARES Act unemployment compensation, at least during the COVID19 emergency. (CARES Act unemployment benefits, by contrast, do count as income when determining eligibility for premium subsidies in the Marketplaces.)
  • Guidance issued by the U.S. Department of Health and Human Services (HHS) in response to the federal CARES Act appears to ban surprise billing for out-of-network services during the COVID-19 emergency.
  • The Trump Administration expanded the window available to laid-off workers to exercise their COBRA rights (i.e., extend coverage under an employer-sponsored group health plan after losing or leaving their job). People eligible for COBRA may now sign up for such coverage at any time up to 60 days after the end of the national emergency (ongoing since March 1, with no endpoint yet identified).
  • State governments, too, continued to take action in response to the COVID-19 emergency. Kentucky and North Carolina moved to provide limited Medicaid coverage to uninsured individuals on a temporary basis. Louisiana’s insurance commissioner issued emergency regulations banning state-regulated health plans from applying step therapy protocols until at least May 12. Connecticut’s governor issued an executive orderrestricting balance billing for out-of-network emergency care during the COVID19 emergency.

Quick hits:

  • HFA and NHF released an Executive Summary report discussing findings of the jointly-convened January 2020 Safety Summit held in Washington, D.C. The Executive Summary is now open for public comment; any individual or organization that would like to comment on the document can do so via the Patient Voice inbox through May 29. HFA and NHF plan to create and distribute a final report before the end of the year, and will share initial findings at meetings throughout the coming months.
  • The U.S. Supreme Court decided in an 8-1 ruling that the federal government must pay insurers $12 billion in promised but unpaid ACA risk corridor payments. The ACA’s risk corridors were created to shield insurers from some of the risk they took on during the earliest years of the ACA Marketplaces (i.e., at a time before insurers could know who would sign up for Marketplace plans, and how expensive their care would be). Under the risk corridor program, the federal government committed to bear some of insurers’ costs if it turned out that the health plans lost money due to high health claims – but beginning in 2014, Congress refused to appropriate funds to pay those amounts. The Supreme Court agreed with the insurance companies that the federal government was obliged to make the risk corridor payments. It is unclear if this decision will have any impact on Marketplace plan premiums for 2021.
  • On April 2nd, the U.S. Food and Drug Administration announced policy changes related to blood and plasma donation eligibility. HFA along with other members of the American Plasma Users Coalition (APLUS) expressed support for the adoption of revised eligibility criteria policies that can increase the potential pool of donors, so long as the overall risk to end users is not increased.
  • HFA together with NHF and the Oklahoma Hemophilia Foundation filed comments opposing Oklahoma’s request for a federal waiver to convert its Medicaid program to block grants.  The state’s requested waiver would expand Medicaid but limit benefits and impose new barriers to care (including higher premiums and work reporting requirements).  Meanwhile, Oklahoma’s governor moved up the state’s ballot referendum on expanding Medicaid under the ACA to the June 30 primary (instead of the general election in November).
  • South Dakota’s governor signed legislation restricting the use of step therapy protocols by state-regulated health plans.  Florida’s governor signed legislation removing lifetime cap on benefits under the state Children’s Health Insurance Program (CHIP).




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