Coronavirus Update: Federal and State Responses

April 24, 2020

By Garrett Hall

In late 2019, a strain of Coronavirus emerged and began to cause respiratory illness in humans, known as COVID-19, and has since rapidly spread across the globe. On March 11, 2020, the World Health Organization (WHO) officially characterized COVID-19 as a pandemic. COVID-19 is revealing major challenges and gaps within the United States and California’s systems of disease prevention and care that particularly affect individuals who are uninsured, underinsured, and those that rely on the safety net. In response, federal and state actions have proceeded to support both individuals and health care systems. In this rapidly changing environment, this blog outlines some of the actions taken by Congress and California.

Congressional Actions

Phase 1: Coronavirus Preparedness and Response Supplemental Appropriations Act– An $8.3 billion aid package enacted on March 6, 2020, to provide additional funding to federal entities, including the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and National Institutes of Health (NIH), among other public health entities. Kaiser Family Foundation’s (KFF) analysis of the bill can be found here.

Phase 2: Families First Coronavirus Response Act– A $104 billion aid package enacted on March 18, 2020, to support individuals impacted through COVID-19 that includes testing coverage without cost-sharing, nutrition assistance, expanded paid sick and family leave, and extended unemployment insurance. KFF’s analysis of the bill can be found here.

Phase 3: Coronavirus Aid, Relief, and Economic Security “CARES” Act– A $2 trillion economic stimulus and aid package enacted on March 27, 2020, that provides support to the health care system, state and local governments, and workers including stimulus checks. KFF’s analysis of the bill can be found here.

While these bills are notable for their expenditures and expansiveness, groups focused on workers, immigrants, and persons with disabilities claim more support is needed for those most impacted by COVID-19.

California Actions

Legislative–On March 17, 2020, Governor Newsom signed Senate Bill 89, which amends the Budget Act of 2019 to appropriate $500 million General Fund to any item related to the COVID- 19 state of emergency, which can be increased to at most $1 billion. On April 16 and April 20, 2020, the California State Senate and Assembly Budget Committees, respectively, held subcommittee hearings on the state’s COVID-19 response.

Executive– Since the COVID-19 crisis began, Governor Newsom was the first governor nationwide to issue a Stay-at-Home Executive Order. Governor Newsom has issued over 18 public health-related executive orders, announced the launch of several public health campaigns, secured additional state and federal resources, and directed funding to support the state’s emergency response, health care infrastructure, and people experiencing homelessness, among other efforts. More information on the governor’s actions can be found here.

Regulatory– California’s departments and agencies have also taken swift action to respond to COVID-19. Their actions include:

 March 5, 2020—The Department of Managed Health Care (DMHC) required all full service commercial and Medi-Cal health plans to provide COVID-19 testing and screening at zero share-of-cost.

 March 16, 2020– The Department of Health Care Services (DHCS) instructed counties to delay the processing of Medi-Cal annual redeterminations and to delay discontinuances, and negative actions for 90 days.

 March 18, 2020–DMHC instructed health plans to allow patients to obtain health care through telehealth and issued requirements related to telehealth cost-sharing and provider reimbursement.

 March 20, 2020– Covered California (the state’s ACA marketplace) extended open enrollment through June 30, 2020.

 March 23, 2020– The Centers for Medicare and Medicaid Services (CMS) approved a Section 1135 waiver request from DHCS to bolster, streamline, and financially support California’s health care programs. DHCS sent CMS a letter on March 16, 2020 requesting additional flexibilities that are retroactive to January 27, 2020 to coincide with the Public Health Emergency start date.

 March 30, 2020– DHCS, the California Department of Public Health (CDPH), and DMHC released guidance reminding providers and insurers that rationing care based on disability status is impermissible and unlawful. This action reflected similar guidance released by the Department of Health and Human Services (HHS) on March 28, 2020.

 April 8, 2020– DHCS deemed all COVID-19 testing and treatment, including services performed outside an emergency department, to be emergency services, and created a presumptive eligibility aid code for persons seeking COVID-19 testing, screening, and treatment who are uninsured or underinsured.

 April 15, 2020– DHCS postponed the California Advancing and Innovating Medi-Cal (CalAIM) implementation timelines to allow the state to effectively address COVID-19.

Since CalAIM proposals were designed to replace and go beyond the state’s existing federal waivers, DHCS plans to discuss Section 1115 and 1915(b) waiver extensions with the federal government and will seek CalAIM proposal approvals at a later time.

 California Community Foundation: Our Collective Impact

 California Health Care Foundation: Resources for Consumers, Serious Illness and End-of-

    Life Care, Telehealth

 The California Endowment: $5 Million COVID-19 Response Plan, COVID-19 and Race

 The California Wellness Foundation: $4 Million to Combat the COVID-19 Pandemic