CMS NEWS
FOR IMMEDIATE RELEASE
October 22, 2021
Contact: CMS Media Relations
CMS Media Inquiries
Biden-Harris Administration Issues Guidance to
States on Required Medicaid and CHIP Coverage for COVID-19-Related
Treatment
The Biden-Harris Administration is ensuring that144 million
people enrolled in Medicare, Medicaid and Children’s Health Insurance
Program (CHIP) have access to COVID-19 treatments. Today, the Centers
for Medicare & Medicaid Services (CMS) issued guidance to states about
the statutory requirement for states to cover COVID-19-related treatment
without cost-sharing in Medicaid and CHIP for many seniors, low-income adults,
pregnant women, children, and people with disabilities who receive health
coverage through these programs. This life-saving health care coverage,
supported through the American Rescue Plan (ARP), includes care for
conditions that could complicate the treatment of COVID-19 in patients who
are presumed positive for the virus or have been diagnosed with COVID-19.
This guidance furthers the Biden-Harris Administration’s
efforts to improve Medicaid and CHIP beneficiaries’ health outcomes and
reduce health disparities.
In addition to issuing today’s Medicaid and CHIP guidance, CMS
recognizes and applauds the efforts that many private issuers have taken to
waive cost sharing for COVID-19-related treatment in the commercial
market. Along with today’s guidance, CMS encourages private health
plans to continue to take steps to ensure consumers have coverage for
treatment for COVID-19, including for long COVID, without cost barriers.
“The American Rescue Plan expanded coverage for COVID-19 care.
The pandemic has exacerbated the inequities that underlie our health care
system, and we must continue to work on both the federal and state levels
to improve access to and quality of care for everyone,” said CMS
Administrator Chiquita Brooks-LaSure. “This guidance will guarantee COVID
treatment for people with Medicaid coverage, including those who have been
disproportionately harmed by COVID-19. Now that people with Medicaid and
CHIP coverage have the comfort in knowing that their COVID treatment is
covered, we encourage private health plans to take steps to ensure cost is
not a barrier for consumers’ access to treatment for COVID-19, including
for long COVID.”
Under the ARP, states are required to cover COVID-19 treatments
without cost-sharing, including preventive therapies and specialized
equipment, beginning March 11, 2021 and generally ending over a year after
the COVID-19 public health emergency ends. This coverage also includes
treatments for post-COVID conditions, which are often described as “long
COVID.” Long COVID includes a range of symptoms that can last weeks
or months after infection. Additionally, during the same time frame, states
are required to cover, without cost-sharing, treatments for conditions that
may seriously complicate the treatment of COVID-19 for individuals who have
or are presumed to have COVID-19, if otherwise covered under the state plan
(or waiver of such plan, including a section 1115 demonstration), during the
period when they are diagnosed with or presumed to have COVID-19.
In accordance with these
provisions of the ARP, states must cover drugs that have been approved, or
authorized by the U.S. Food & Drug Administration (FDA) to treat or
prevent COVID-19, consistent with the applicable authorizations.
CMS continues to work to expand coverage, increase benefits, and improve care for
beneficiaries across Medicaid, CHIP, Medicare, and the Marketplaces.
For more information on Medicaid and CHIP coverage of COVID-19-related
treatments, visit: : https://www.medicaid.gov/federal-policy-guidance/downloads/sho102221.pdf
For more information on Medicare and Marketplace coverage of
COVID-19-related treatments visit:
Medicare: https://www.medicare.gov/coverage?coverage_search=covid
Marketplace: https://www.healthcare.gov/coronavirus/
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