The COVID-19 Public Health Emergency (PHE), which has been in effect since early 2020, is ending on May 11, 2023. The PHE allowed state and federal governments to implement several emergency waivers to provide flexibility and improve access to services during the pandemic. The PHE unwinding is separate from the Medicaid continuous eligibility unwinding, which began in April. While several Medicare and Medicaid flexibilities have been temporarily extended beyond the PHE, others are set to expire including:

1. Medicare coverage for at-home COVID-19 tests. Medicare enrollees could get up to eight over-the-counter at-home COVID-19 tests per month for free, but will now have to pay out-of-pocket for those tests. People enrolled in Medicare Advantage should check with their plan about continued coverage of at-home tests. See this Fact Sheet from CMS on Coverage for COVID-19 Tests through Medicare, Medicaid, and private insurance. 
2. Waiver of 3-day inpatient hospitalization prior to Medicare coverage for skilled nursing facilities. Individuals in Original Medicare will again require a 3-day inpatient stay before receiving Medicare coverage for nursing facility care.
3. Medicaid Home and Community-Based Services (HCBS) Appendix K Flexibilities. The Appendix K allowed states to provide additional flexibilities to their 1915(c) waiver programs. Appendix K will not expire until 6 months after the PHE ends on May 11th.

Additional Resources for Advocates

• Centers for Medicare and Medicaid Services (CMS): Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency
• Kaiser Family Foundation: Implications for Ending the COVID-19 Public Health Emergency (PHE)
• Advancing States, National Association of Medicaid Directors (NAMD), National Association of State Directors of Developmental Disabilities (NASDDDS): The End of Pandemic-Era Flexibilities in Medicaid Home- and Community- Based Services
• Justice in Aging’s COVID-19 and Public Health Emergency (PHE) Unwinding Resources
•  NCLER 4 Things to Know as Medicaid Redeterminations Resume