Updated: Jun 3
Author: Belle Duguid, Special Populations Community & Partner Liaison, AmeriCorps VISTA at the Legal Council for Health Justice.
We are two years into the COVID-19 pandemic and there is still yet to be a clear end in sight as new variants evolve and cases in the US reach record highs (Coronavirus in the U.S.: Latest Map and Case Count, 2022). On January 31, 2020, Alex Azar, former Secretary of the U.S. Department of Health and Human Services (HHS), first declared COVID-19 a Public Health Emergency (“PHE”), and the federal government has extended it every ninety days since that date. On January 16, 2022, current HHS Secretary Xavier Becerra authorized the PHE’s most recent extension (Becerra, 2022). But what exactly does the declaration of a PHE mean? How does a PHE affect the over three million Medicaid recipients in Illinois (HFS, 2022)? And, how does the PHE impact Medical Legal Partnership (“MLP”) programs throughout the state? This article will provide answers to these questions and more as we delve into Public Health Emergency 101.
What is a PHE and what does the declaration mean?
Following the declaration of a PHE, the HHS Secretary is permitted to take certain actions to aid in resolving and addressing the crisis. A PHE can be caused by a range of occurrences, including, but not limited to: natural disasters such as tornadoes, drug-related issues such as the opioid epidemic, and outbreaks of contagious and life-threatening disease such as the COVID-19 pandemic. These events can create public health emergencies because they often result in widespread injury, sickness, and death leading to a strain on the healthcare system, and even threatening public order (World Health Organization, 2016). Strain on the healthcare system is exceedingly prevalent in Illinois as ICUs throughout the state are at roughly 90% capacity. Dr. Kalisha Hill, regional chief medical officer of AMITA Health St. Joseph Medical Center in Joliet and AMITA Health St. Mary’s Hospital in Kankakee, reported that, “some emergency room patients are [having to receive] care in the ER lobby instead of a room” due to lack of available beds (Armentrout & Avery, 2022).
The declaration of a PHE lasts for ninety days, or until the HHS Secretary determines the emergency no longer exists (Public Health Emergency Declaration Q&As, 2019). In the case of COVID-19, the Secretary has been renewing the PHE declaration every ninety days since the emergency was first declared on January 31, 2020.
The HHS Secretary can authorize a range of actions during a PHE, including, but not limited to: deploying the National Disaster Medical System (NDMS) teams and supporting other emergency operations; conducting research regarding treatment, cause, and prevention of the PHE; creating grants and utilizing the Public Health Emergency Fund; providing supplies and services where needed; expanding telehealth; and any other actions deemed appropriate by the Secretary (Public Health Emergency Declaration Q&As, 2019). The American Hospital Association (“AHA”) reinforced the importance of declaring COVID-19 a PHE because the “declarations have proven critical in equipping hospitals and health systems with the tools and resources necessary to manage the recent COVID-19 surges and ensure high-quality care in this unprecedented environment” (AHA, 2022). Thus, declaring a PHE allows local, state, and federal governments to take certain actions that address potential gaps in healthcare and that help to ensure the health and safety of the U.S. population.
How does the PHE impact Medicaid enrollment?
The PHE provides a safety net for millions of Medicaid recipients in danger of losing coverage. Since February 2020, more than 11 million people across the US have enrolled in Medicaid, largely due to the Families First Coronavirus Response Act (FFCRA) which was first signed into law on March 18, 2020 (McCausland, 2021). The HHS Secretary’s PHE declaration (in conjunction with an official Presidential declaration of emergency) allows HHS to modify or waive certain public benefits requirements. Currently, pursuant to the PHE, individuals enrolled in Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP) have “expanded access” to healthcare services throughout the emergency (Public Health Emergency Declaration Q&As, 2019) as these programs receive increased funding due to the FFCRA (Buettgens & Green, 2021). "Expanded access” means that any individual who was covered by Medicaid as of March 18, 2020 or later must still be covered through the end of the PHE (Brooks, 2021). As long as the PHE declaration is in effect, states are barred from terminating Medicaid coverage. In Illinois, this means that, per the FFCRA, the IL Department of Human Services (IDHS) will not conduct any Medicaid redeterminations or remove any beneficiaries from the state rolls until the PHE expires (Hou & Eagleson, 2020). IDHS can still, however, review eligibility for benefits other than Medicaid, such as AABD cash, SNAP, TANF, and the Medicare Savings Program. An individual receiving multiple benefits may still have to undergo the redetermination. However, if the individual fails to complete the redetermination process or is deemed no longer eligible for other benefits, the State cannot terminate Medicaid benefits while the PHE remains in effect.
When the PHE eventually expires, each state will have twelve months to review all Medicaid cases and redetermine each individual’s eligibility. If the current PHE expires on April 16, states can begin processing Medicaid renewals as early as May 1, 2022. As we know, since March 2020, Medicaid beneficiaries have had guaranteed benefits and have not had to take any affirmative steps to maintain benefits, such as updating their personal information or verifying household income (Buettgens & Green, 2021). When the PHE declaration officially expires, failing to take either of these steps could result in many individuals losing healthcare coverage.
The current PHE is set to expire on April 16, 2022. The Biden administration has stated that they will give states a minimum of 60 days' notice prior to the end of the PHE (Brooks, 2021). The U.S. Centers for Medicare and Medicaid Services (CMS) has expressed that their most pressing concern is to ensure that people are aware of the enrollment redeterminations and other healthcare options that will be available to them (McCausland, 2021). However, healthcare advocacy groups are concerned that 60 days will not be enough time to educate the public on necessary steps to maintain health coverage (Brooks, 2021).
How does the PHE impact the Medical Legal Partnerships (MLP’s) throughout Illinois?
The COVID-19 pandemic has highlighted many of the weak spots within our country’s healthcare, legal, and welfare systems. Illinois MLPs seek to address these weak spots by spreading awareness of coverage changes and assisting individuals facing legal and administrative barriers to public assistance.
The PHE allows easier access to life-sustaining treatment by eliminating paperwork requirements for the Medicaid Spend-Down Program
Legal Council for Health Justice, an MLP IL legal partner, recently represented John, a 73-year-old client who receives $1,200 in monthly Social Security benefits. John was diagnosed with cancer in 2019. He has Medicare as his primary insurance but needs Medicaid as secondary coverage to help with the medical costs associated with chemotherapy treatment. Before the PHE, IDHS required John to submit medical bills each month in order to qualify for the Medicaid Spend-Down Program. John often waited months for IDHS to process his paperwork so that he could receive Medicaid benefits. When he would get medical care, he never knew if Medicaid would pick up the costs. Because of the PHE, if an individual meets his spend down at least once since March of 2020, IDHS will automatically extend Medicaid until the PHE expires. This client now has peace of mind, and does not have to worry about completing onerous monthly paperwork to keep his healthcare coverage.
The PHE eliminates long wait times for receiving and utilizing life-sustaining Medicaid benefits
Legal Council for Health Justice assisted Sam, a 39-year-old client who recently lost his job and his employer health insurance. He applied for Medicaid and submitted proof of his last earnings. Under normal circumstances, Sam would have to endure a long wait for Medicaid benefits. While the PHE is in place, the Illinois Department of Healthcare and Family Services (HFS) requires only one pay stub to determine eligibility, and if the proof of income submitted is close to the Medicaid limit, individuals receive a presumptive eligibility notice and a Medicaid ID number that can be used right away for medical care. Due to the PHE, Sam was able to receive healthcare benefits and fill his prescriptions within just two weeks of application.
(Names and ages of clients have been changed for confidentiality purposes)
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