With COVID-19 cases in every state, the severity of its impact and responses by the states vary. Putting politics aside, let’s take a look at what actions have been taken, why, and what may be working for other states to follow. We have broken down state actions into three buckets:
- Access to health care coverage
- Social distancing measures
- Testing
Access to Health Care Coverage
Ensuring easy and affordable access to health care is vitally important during a public health crisis such as this. With actions taken by insurers to alleviate the costs of testing and follow up action by Congress, all group health plans and individual health insurance coverage will cover testing and visits related to COVID-19.
To make sure people have coverage, states are taking action to expand access during this pandemic.
COVID-19 Care Coverage
Many states are using their authority and new federal flexibility to take action to bolster their health insurance systems and provide coverage specifically related to COVID-19. For example:
- Two states (Massachusetts and New Mexico) and the District of Columbia, have waived any patient cost sharing for COVID-19 treatment.
- Six states (Kentucky, Louisiana, Maine, New Hampshire, Pennsylvania, and Rhode Island) have waived prior authorization requirement for COVID-19 testing.
- And looking to the future, nine states (Kentucky, Louisiana, Maine, Maryland, Massachusetts, Nebraska, New York, Oregon, and Rhode Island) and the District of Columbia have taken action to provide free access to a COVID-19 vaccine when it becomes available.
Health Insurance Coverage
When it comes to coverage through Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP), states are taking action. Thirteen states (Alabama, Arizona, California, Florida, Illinois, Louisiana, Mississippi, New Hampshire, New Jersey, New Mexico, North Carolina, Virginia, and Washington) have now received rapid approval from CMS on federal Section 1135 waivers. These waivers provide states with additional flexibility to make sure patients are enrolled in coverage, and health care facilities are able to provide necessary care during a national emergency.
Additionally, ten states are taking action to expand access to insurance coverage by opening Special Enrollment Periods (SEPs) specific to COVID-19. This will allow residents of those states to enroll in health insurance coverage through state-based health insurance marketplaces for any reason.
Further, as unemployment increases, individuals can enroll in coverage in any state due to either the loss of employment or their existing insurance – even if the state or federal exchange is not offering a special enrollment period.
| State Exchange | Enrollment Period Ends |
| Colorado | April 3 |
| Connecticut | April 2 |
| Maryland | April 15 |
| Massachusetts | April 25 |
| Minnesota | April 21 |
| Nevada | April 15 |
| New York | April 15 |
| Rhode Island | April 15 |
| Washington | April 8 |
| Vermont | April 17 |
*Note: California and the District of Columbia are allowing resident to enroll now for reasons not initially related to the pandemic.
States are also looking to increase bandwidth in, and therefore access to, their health care systems through regulatory flexibility, including Texas’s recent actions to bring more nurses into the system and Idaho’s removal of 125 regulations to allow for out of state and retired medical professionals to be brought to bear during crisis. Bottom line, during this crisis, there are options for coverage.
Social Distancing Measures
States have taken action to limit the movement and spread of COVID-19 within their communities. These efforts, known as “social distancing” vary in extent, severity, and enforcement mechanisms from state to state.
Typically, these restrictions start with the closure of schools and reduction in the size of public gatherings and progress to statewide orders to close non-essential businesses, and finally orders for residents to stay at home except for certain essential activities:
- Closing schools: Forty-six states, American Samoa, the District of Columbia, Guam, Northern Mariana Islands, Puerto Rico, and the Virgin Islands have closed schools while they remain open in four states.
- Closing “non-essential” businesses: Eleven (California, Connecticut, Delaware, Illinois, Indiana, Maryland, Massachusetts, Michigan, New York, Ohio, and Pennsylvania) states have closed all “non-essential” businesses.
- “Stay at home” orders: Twelve states (California, Connecticut, Delaware, Illinois, Indiana, Louisiana, Michigan, New Jersey, New York, Ohio, and West Virginia) have issued “stay home” orders, which means all non-essential trips to and from home are barred for a certain period of time. That length of time differs from state to state. Further, Massachusetts and Maryland have made their stay at home guidance voluntary. To put this in the broader national context, over 126 million people (39%) of the population is being officially told to stay home.
Testing
With public health care professionals advising that widespread COVID-19 testing will be an important weapon in fighting the epidemic, the federal government has loosened requirements and allowed states to develop and implement their own testing programs. This has quickly led to a number of states jumping into action.
There are currently 22 public health laboratories testing results of COVID-19 tests, which feeds into the California Department of Public Health for daily reports. This stemmed the initial number of cases as universities, labs, and commercial companies were able to help, beginning in early March, and drastically ramp up the amount of tests conducted per day.
New York has ramped up their testing program quickly and is now testing nearly five times the share of its population compared to the United States, as a whole.
Washington has taken a diverse set of resources to ramp up testing that includes: the State Public Health Lab, University of Washington Virology Lab, and commercial labs (Labcorp and Quest). All of these labs and results feed into the Washington Disease Reporting System (WDRS) to analyze data across the state.
It is still too early to measure the impact of health care coverage, social distancing, and/or increased testing. With the actions states have taken, one thing is certain: In the coming days, states who have not yet taken action will learn from those who have. Addressing COVID-19 is not a partisan issue – states like Ohio, Massachusetts, and Maryland have taken measures similar to Illinois, Pennsylvania, and Connecticut. As the states begin to learn best practices, the spread of COVID-19 will be slowed, and Americans will have access to the care they need.
Disclaimer: With all of this information changing rapidly, please check back to our blog for updates. The data and information included here is up to date as of Tuesday, March 24th at 9am EST.