Implementation of the American Rescue Plan Kicks off Quickly and the Federal Government Announces its Health Priorities for Discretionary Spending

The past month brought the fifth renewal[1] of the U.S. COVID-19 Public Health Emergency (PHE), as well as the start of the American Rescue Plan Act of 2021 (ARP)’s implementation. The administration moved quickly to implement the ARP, which was signed into law on March 11, 2021 and seeks to broadly address the pandemic and its impacts. Below, we provide an update on its key health policy provisions. We also highlight the Biden administration’s health priorities for discretionary spending, which Department of Health and Human Services (HHS) Secretary Xavier Becerra announced on April 9th.

COVID-19 Health Policy Updates

As the Centers for Medicare and Medicaid Services (CMS) announced shortly after passage of the ARP, the law’s enhanced Premium Tax Credits (PTCs) became available on Federally-facilitated Marketplaces (FFMs) on April 1, 2021. Additionally, federal agencies released ARP-related guidance over the last month. The Internal Revenue Service (IRS) issued guidance on April 9, 2021 regarding the suspension of Advance Premium Tax Credit (APTC) reconciliation for 2020. It confirms that taxpayers who received an APTC in excess of the amount for which they were eligible in 2020 (because their income was higher than expected) do not need to file Form 8962. Those who filed their taxes prior to the passage of the ARP do not need to file an amended return; the IRS will automatically reduce the individual’s APTC reconciliation repayment amount to zero. The IRS will also automatically reimburse any taxpayers who already repaid excess APTC amounts—with further guidance about the reimbursement process forthcoming. Finally, the guidance confirms that those who are claiming a net PTC (either because their income was lower than expected, making them eligible for a larger PTC than they received in APTC payments during the year, or because they did not claim any APTCs during the year) must file a Form 8962 to claim that amount.

CMS also recently updated guidance for both issuers and consumers on the extended 2021 Special Enrollment Period for the PHE.

Additionally, the Department of Labor (DOL) issued guidance regarding the COBRA subsidies available under the ARP, which took effect on April 1, 2021. The guidance outlines who is eligible for these subsidies, the plans for which they can be used, the duration of the assistance, and how to claim the subsidies. DOL also confirmed that the subsidies will be paid directly to the employer, plan administrator or insurance carrier. The guidance also addresses notice requirements for plans and issuers, as well as options for individuals to newly enroll in COBRA or change plans. The guidance provides contacts for assistance and more information, including a link to a new DOL webpage featuring additional guidance, model notices and other information.

In April, the administration announced information about ARP funding for health care providers. The Department of Health and Human Services (HHS) released details about funding for community-based healthcare providers. The $150 million of funding will assist providers of primary care services to underserved and vulnerable populations in their COVID-19 response, including vaccine administration. Applications for the funding are due on May 14, 2021, and more information is available online. Just this week, HHS awarded more than $32 million to organizations that provide training, technical assistance and health information technology support related to COVID-19 to health centers.

CMS also granted three PHE-related waivers this month. The Section 1135 Waivers, issued to Tennessee, Maine and Colorado, mirror authorities previously granted in other states.

Discretionary Funding Request Priorities

Also this month, HHS Secretary Becerra announced the health priorities included in the President’s request to Congress for discretionary funding. This includes investments in:

  • Public Health and readiness for the next public health crisis
  • Health equity and addressing racial disparities
  • Reducing maternal mortality
  • Biomedical research
  • Addressing the Opioid Crisis

The full discretionary funding request is available on the White House website.


[1] The renewal was effective April 21, 2021.

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