Biden-Harris Administration Issues Guidance to States on Required Medicaid and CHIP Coverage for COVID-19-Related Treatment

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The Biden-Harris Administration is ensuring that 144 million people enrolled in Medicare, Medicaid and Children’s Health Insurance Program (CHIP) have access to COVID-19 treatments.  Today, the Centers for Medicare & Medicaid Services (CMS) issued guidance to states about the statutory requirement for states to cover COVID-19-related treatment without cost-sharing in Medicaid and CHIP for many seniors, low-income adults, pregnant women, children, and people with disabilities who receive health coverage through these programs. This life-saving health care coverage, supported through the American Rescue Plan (ARP), includes care for conditions that could complicate the treatment of COVID-19 in patients who are presumed positive for the virus or have been diagnosed with COVID-19.

This guidance furthers the Biden-Harris Administration’s efforts to improve Medicaid and CHIP beneficiaries’ health outcomes and reduce health disparities.  

In addition to issuing today’s Medicaid and CHIP guidance, CMS recognizes and applauds the efforts that many private issuers have taken to waive cost sharing for COVID-19-related treatment in the commercial market. Along with today’s guidance, CMS encourages private health plans to continue to take steps to ensure consumers have coverage for treatment for COVID-19, including for long COVID, without cost barriers.

“The American Rescue Plan expanded coverage for COVID-19 care. The pandemic has exacerbated the inequities that underlie our health care system, and we must continue to work on both the federal and state levels to improve access to and quality of care for everyone,” said CMS Administrator Chiquita Brooks-LaSure. “This guidance will guarantee COVID treatment for people with Medicaid coverage, including those who have been disproportionately harmed by COVID-19. Now that people with Medicaid and CHIP coverage have the comfort in knowing that their COVID treatment is covered, we encourage private health plans to take steps to ensure cost is not a barrier for consumers’ access to treatment for COVID-19, including for long COVID.”

Under the ARP, states are required to cover COVID-19 treatments without cost-sharing, including preventive therapies and specialized equipment, beginning March 11, 2021 and generally ending over a year after the COVID-19 public health emergency ends. This coverage also includes treatments for post-COVID conditions, which are often described as “long COVID.”  Long COVID includes a range of symptoms that can last weeks or months after infection. Additionally, during the same time frame, states are required to cover, without cost-sharing, treatments for conditions that may seriously complicate the treatment of COVID-19 for individuals who have or are presumed to have COVID-19, if otherwise covered under the state plan (or waiver of such plan, including a section 1115 demonstration), during the period when they are diagnosed with or presumed to have COVID-19. 

In accordance with these provisions of the ARP, states must cover drugs that have been approved, or authorized by the U.S. Food & Drug Administration (FDA) to treat or prevent COVID-19, consistent with the applicable authorizations.

CMS continues to work to expand coverage, increase benefits, and improve care for beneficiaries across Medicaid, CHIP, Medicare, and the Marketplaces.

For more information on Medicaid and CHIP coverage of COVID-19-related treatments, visit: : https://www.medicaid.gov/federal-policy-guidance/downloads/sho102221.pdf

For more information on Medicare and Marketplace coverage of COVID-19-related treatments visit:

Medicare:  https://www.medicare.gov/coverage?coverage_search=covid

Marketplace:  https://www.healthcare.gov/coronavirus/

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