Skip to main content

Capitol to Capitol | Feb. 6, 2023

February 6, 2023

NCSL Staff Brief NCSL Standing Committee Members on Youth Trafficking

In honor of January being Human Trafficking Prevention Month, NCSL staff from the Criminal and Civil Justice; Children, Youth and Families; and State-Federal Relations programs briefed members of the Health and Human Services and Law, Criminal Justice, and Public Safety committees on youth trafficking. The briefing covered the legal differences between adult and child trafficking; anti-trafficking grant funding available for states; the intersections between youth trafficking and the criminal justice system; and trauma-informed, health and community-based approaches to combating and preventing child trafficking. If you missed it, the slides are available on the NCSL website and include links to helpful anti-trafficking resources and a list of grant opportunities for states.

End of Public Health Emergency Brings Big Changes to Health Coverage and SNAP Benefits

The Biden administration announced that the COVID-19 national emergency declaration and the public health emergency declaration, in effect since 2020, will expire on May 11, signaling the end of numerous COVID-era flexibilities in Medicaid, Medicare and CHIP programs as well as in private health insurance.

The timing of the announcement provides states with at least 60 days’ notice of the end of the emergency as promised by the Department of Health and Human Services. But it comes on the heels of the Consolidated Appropriations Act of 2023, which ends the Medicaid continuous coverage requirement enacted during the pandemic. The coverage mandate will end on March 31, 2023, and states will be in the midst of processing their Medicaid redeterminations for the first time in over three years, just as other as significant flexibilities, including those related to vaccines, boosters, tests and treatments, will be ending in May. Lots of complex moving parts lie ahead for states in the spring of 2023 and beyond.

Below is a list of some of the most significant changes that will occur as the emergency declarations expire:

COVID-19 Tests and Treatments

Access to free COVID-19 at-home tests and some treatments will no longer be federally required for Medicare beneficiaries or people with private insurance once the declarations expire in May, though Medicare and private insurance will continue to cover the cost of vaccines and of tests ordered by a doctor. Medicaid and CHIP recipients will continue to receive all federally recommended vaccines at no cost per the Inflation Reduction Act of 2022, but federally mandated coverage for at-home tests and COVID-19 testing and treatment will end 15 months after the end of the emergency. Federal funding of testing, treatments and vaccines for people without insurance ran out in April 2022.

Emergency Use Authorization for Medical Countermeasures

HHS has not yet announced when this declaration, which fast-tracked the use of vaccines, tests and treatments deemed safe but not formally approved by the Food and Drug Administration, will expire.

Liability Immunity

HHS issued a declaration in 2020 that provides liability immunity to pharmacists and other health care providers who vaccinate people in states outside of where the provider is licensed. The declaration is scheduled to expire on Oct. 1, 2024.

Medicaid Eligibility and Increased Federal Medical Assistance Percentage (FMAP)

As NCSL has previously reported, the continuous coverage mandate, and its corresponding 6.2% FMAP bump, will end on March 31, 2023. States may begin processing their renewals as early as Feb. 1 and disenrollments can begin April 1 provided certain requirements are met. States will have 12 months to initiate, and 14 months to complete, all redeterminations. The FMAP bump will decrease from 6.2% during the first quarter of calendar year 2023 to 5.0%, 2.5% and 1.5%, respectively, over the next three quarters. Click here for the most recent guidance from the Centers for Medicare & Medicaid Services.

Medicaid Disaster Relief

Emergency exceptions to state Medicaid programs approved by HHS  via a state plan amendment will end when the emergency declaration expires or an earlier date as determined by the state; exceptions granted pursuant to HHS’ authority under Section 1115 waivers will end 60 days after the emergency expires or earlier if approved by CMS; Section 1135 waivers will expire by the end of the declaration; and Section 1915(c) emergency waiver provisions will end no later than six months after the emergency declaration ends. Additional information may be found here.

Nursing Homes

While the blanket waiver of training and certification requirements for nurse aides has been lifted, states that face a backlog in their training and testing capacity can still apply for a waiver of the certification requirement. However, this flexibility will end when the emergency declaration ends in May, and nursing homes with numerous nursing aides who are not certified may be facing increased staffing shortages. In August 2022, it was reported that as many as 300,000 temporary nursing aides nationwide remained uncertified.

SNAP Benefits

The temporary increase in food stamp allocations in place since 2020 will officially end after February 2023 and benefit amounts will return to their normal levels. A number of states have already stopped providing the emergency allotments. SNAP beneficiaries, who also receive Social Security benefits, may see a decrease in their SNAP benefits because of COLA increases to Social Security that went into effect in January 2023. Other pandemic SNAP waivers will remain in effect until the end of the emergency.


Medicare beneficiaries may continue to access telehealth through Dec. 31, 2024, per the Consolidated Appropriations Act. These flexibilities otherwise would have expired 151 days after the end of the emergency. The availability of telehealth for Medicaid and CHIP beneficiaries is state specific with regard to whether the service was tied to federal versus state public health emergency declarations. Many states have made Medicaid telehealth a permanent option via their state plans.


The federal statute Title 42 expulsions will end with the public health declaration. Title 42 has been used to expel migrants who have unlawfully crossed into the United States since the outset of the pandemic. The statute grants the government the ability to take emergency action to stop the introduction of communicable diseases, including stopping border crossings during a public health emergency. The Department of Homeland Security has announced new border enforcement policies to tackle the transition away from Title 42.

EPA Announces Initiative to Accelerate Lead Pipe Replacement

The new “Lead Service Line Replacement Accelerators” initiative will help underserved communities access funding from the Infrastructure Investment and Jobs Act. Through the program, the Environmental Protection Agency will provide support to guide communities through the process of lead service line removals, including developing service line replacement plans, conducting inventories to identify lead pipes, and increasing community outreach and education efforts. The initiative is a partnership with the Department of Labor and four states—Connecticut, Pennsylvania, New Jersey and Wisconsin. Read More.

Administration Releases National Blueprint for Transportation Decarbonization

The blueprint outlines the administration’s strategy for eliminating all greenhouse gas emissions from the transportation sector by 2050. The blueprint follows a 2022 memorandum that called on the U.S. Departments of Transportation, Energy and Housing and Urban Development and the Environmental Protection Agency to release a comprehensive strategy for transportation decarbonization that would guide future policymaking, as well as development and deployment of new technologies. The blueprint is not guidance but does outline potential steps toward the administration’s decarbonization goals. Read more.

DOI Issues Draft Guidance on State Grants to Address Oil and Gas Wells

The Department of the Interior released draft guidance on both how states may apply for the formula grants to address orphaned oil and gas wells and permissible uses of the funds. The draft, which remains open for public comment until Feb. 24, also provides guidance on how applicants can ensure that activities funded under the program are creating new jobs. Uses of grant funding include measuring and tracking methane emissions; plugging, remediating and reclaiming orphaned oil and gas wells; and remediating water and soil. States may apply for grants up to their eligible amount. Read more.

  • Contact NCSL

  • For more information on this topic, use this form to reach NCSL staff.