Updates on the State-Level Responses to COVID-19

As the U.S. continues battling the COVID-19 pandemic, individual states have enacted policy mandates and taken action to ensure patients have access to medication, healthcare, and COVID-19 testing and treatment—while minimizing barriers to these resources and/or the pre-approval needed to access them.

With social distancing and the stay-at-home order still in effect, a nationwide focus on the use of telehealth for routine medical care continues. Because telehealth offers an alternative to in-office or facility visits, many states[1] have released guidance or standards that expand the use and availability of this service. For more information on the topic of telehealth, we suggest you read this month’s article related to federal responses to COVID-19.

In addition to federal response updates, we’ve compiled an overview of the latest state-level responses to the pandemic this month. Read them below.

State-Mandated Requirements Related to COVID 19 Testing and/or Treatment

In order to ensure timely access to testing and/or treatment and reduce administrative burden during this time of crisis, many states now require health issuers to remove prior authorization (PA) requirements for COVID-19 testing and/or treatment.

Four states (Massachusetts, Oklahoma, Washington, Delaware) and the District of Columbia have mandated PA waivers for both testing and treatment to ensure that those in need of both services can access them without a waiting period related to utilization review or approvals. A number of other states have mandated PA waivers solely for testing purposes. Massachusetts expanded the waiver requirement to both commercial entities and entities participating in Mass Health. urging flexibility with PA and referral requirements, as well out out-of-network requirements for access to urgent testing and treatment.

In an April 9th bulletin, the Massachusetts Division of Insurance also addressed concerns of unexpected medical bills related to accessing urgent or emergency out-of-network services . This expansion of the emergency order that we wrote about last month requires that:

  • necessary outpatient services be delivered without the imposition of cost-sharing;
  • any services rendered in the emergency department by in or out of network providers be covered with no cost sharing; and
  • acute care services be provided without any PA requirements that may delay treatment.

Balance billing is a concern that has been front and center in health policy for some time, as without state action, many consumers are subject to surprise medical or balance billing. COVID-19 brings increased urgency to the issue: without assurance that they will be protected from surprise medical bills, those with symptoms may try to “wait out” their illness, deterred by concerns about the cost of treatment and testing. Avoidance of care by COVID-19-positive individuals would inevitably lead to more severe health conditions and inhibition of efforts to stop the spread.

To help prevent this outcome, some large health insurers have publicly announced they will provide treatment with no cost sharing. However, this is only a partial solution, as it does not deter out-of-network providers who are providing care at in-network facilities from potential balance billing for services rendered.

Extension of Premium Payment Grace Period

Another popular COVID-19-related, state-level policy approach is extending traditional 90-day premium payment grace periods to ensure that individuals with insurance stay enrolled.  Some states, like New York, Connecticut and West Virginia, have limited this grace period to COVID-19 diagnosis cases, while eleven other states have applied the grace period to all policies.

For example, Oregon’s grace period will run through the entirety of its state of emergency (declared on March 8, 2020)  as announced in the March 25th Department of Consumer and Businesses Services guidance for all issuers operating in the state. The District of Columbia extended the grace period to small employers enrolled on DC Health Link, outlining in guidance issued on April 10th that throughout the state of emergency, small employers will not have their coverage terminated or receive late notices. Additionally, small businesses can defer premium payments and take advantage of a new 60-day grace period that will begin when the District’s public health emergency declaration ends.

Marketplace Special Enrollment Period

Finally, a number of state exchanges have created a special enrollment period to ensure consumer access to marketplace coverage. As we covered last month, Massachusetts was one of the first states to offer this; as of early April, twelve states had enacted a Special Enrollment Period (SEP) for enrollees affected by COVID-19.

While the Massachusetts Health Connector originally announced a 45-day extension of the enrollment period, this deadline was recently extended another thirty days to allow enrollment though May 25th.

On March 20th, Covered California announced a COVID-19-related SEP, and between that date and April 10th , 58,400 Californians signed up for coverage. With the SEP offered through June 20th, it will be interesting to see if this surge in enrollment continues.

All these state-level efforts indicate a commitment to maintaining low numbers of uninsured individuals, offering additional time to check eligibility for private individual insurance subsidies, and protecting consumers financially when they seek out testing and treatment. The swiftness in enacting these consumer protections will hopefully ensure a healthier, insured population that can aid in stopping the spread of COVID-19.


[1] For reference, the Center for Connected Health Policy released a full list of all state actions relative to COVID-19, including telehealth: https://www.cchpca.org/resources/covid-19-related-state-actions


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