COVID-19: State Health Actions

7/6/2020

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The COVID-19 pandemic continues to challenge the U.S. health care and public health systems. State legislators, however, are rising to the challenge and pursuing various policy options to effectively respond to COVID-19. This webpage includes key health policy information relating to the pandemic, including legislative trends and state actions, federal action and additional resources.

NCSL is monitoring the evolving status of the COVID-19 pandemic and will continue to update this page as new resources and information become available.

State Action

This section highlights state responses to COVID-19 related to access and coverage, health workforce, public health and health-related appropriations. For a complete list of all COVID-19 legislation, visit NCSL’s State Action on Coronavirus (COVID-19) page.  

NCSL also developed several policy snapshots—which include state policy options, state examples, federal action and key resources—on priority health topics related to the COVID-19 pandemic. These include:

Health Workforce

Scope of Practice and Licensing

Out of concern that an increase in COVID-19 cases may overwhelm the health care system, state officials from both the executive and legislative branches are temporarily waiving certain requirements to mitigate health care workforce barriers. Many states are evaluating scope of practice (SOP) laws, which dictate the practice authority for different health care professionals, to enhance the role of certain providers responding to COVID-19—such as nurse practitioners, physician assistants and pharmacists. For example, Kentucky SB 150 authorizes the Kentucky Board of Medical Licensure, the Kentucky Board of Emergency Medical Services and the Kentucky Board of Nursing to waive SOP requirements allowing providers to practice in all health care settings. The legislation also allows medical students to conduct triage, diagnose and treat patients under the supervision of a licensed health care professional.

Additionally, more than 40 states are temporarily modifying licensing requirements and establishing expedited approval processes to recruit more health care workers during COVID-19. Vermont HB 742 allows the office of professional regulation to relax various licensing requirements for retired and out-of-state health care professionals, including mental health providers. NCSL is tracking the many changes to health care workforce licensing requirements here.

Liability Protections

Federal and state officials are pursing policy options to limit liability exposure for health care professionals and/or facilities providing COVID-19-related services. The Coronavirus Aid, Relief, and Economic Security Act provides immunity for volunteer health care providers during the COVID-19 emergency declaration, if a volunteer acts in good faith and within the scope of their medical license.

At least 25 states, the District of Columbia and Puerto Rico have provided some level of immunity for health care workers and/or facilities during the pandemic through executive or legislative action. Ten states, Puerto Rico and the District of Columbia enacted legislation providing liability protections specifically in response to COVID-19. For example, Oklahoma SB 300 provides immunity from civil liability for health care providers and facilities for any loss or harm delivered to a patient believed or confirmed to have COVID-19. Other states already had existing laws providing immunity during a public health emergency. Virginia maintained certain liability protections for health care workers and first responders in cases of emergency, and the governor signed an executive order clarifying the existing statutes extended to health care workers responding to the COVID-19 crisis.

Access and Coverage

Telehealth

All 50 states and the District of Columbia have made some revision to their telehealth policies during the pandemic to increase access to health care services and minimize potential exposure to the coronavirus. To enhance the effectiveness and reach of telehealth, state policymakers are bolstering Medicaid and private insurance coverage, expanding access to different telehealth modalities, and enhancing the number of services delivered via telehealth. Additionally, states are evaluating certain requirements relating to provider licensure, patient/provider relationship standards and originating site criteria. Most of these state actions are temporary for the duration of the pandemic.

Vermont HB 742 encompasses several of these policy strategies by reducing licensing requirements for out-of-state providers, extending private insurance coverage to include teledentistry, requiring coverage for store-and-forward modalities, and requiring private insurance plans to provide the same reimbursement for telehealth as the insurer would for in-person services. Alaska SB 241 permits a provider to deliver certain services to a patient through telehealth without first having to conduct an in-person visit. Minnesota SF 4334 requires coverage for telemedicine services delivered directly to a patient in their own home by expanding the definition of “originating site” to include a patient’s residence.

Private Insurance Coverage

To ensure that the costs of COVID-19 related services do not deter patients from seeking necessary care, federal and state policymakers have looked to limit out-of-pocket expenses for COVID-19 prevention, testing and/or treatment. Federal law requires private health insurance plans to cover COVID-19 testing and federally recommended preventative care, including a vaccine, free of cost-sharing. Some states have established coverage requirements that exceed this federal standard. Additionally, states have established other requirements or recommendations relating to private insurance coverage during the COVID-19 pandemic, such as requiring coverage for COVID-19 treatment without cost-sharing, establishing special enrollment periods in states operating their own individual insurance marketplace, or requiring coverage for early prescription drug refills.

While most of these actions have come from the executive branch and departments of insurance, many states have enacted or introduced legislation relating to private insurance and COVID-19. For example, New Jersey SB 2344 requires Medicaid and private health insurance carriers to cover early prescription drug refills for up to a 30-day supply so enrollees can maintain an adequate supply during the pandemic. Louisiana SB 426 requires health insurance carriers to cover COVID-19 diagnostic tests, antibody tests and antiviral drugs for prevention and treatment free of cost-sharing.

Medicaid

With Medicaid covering 1 in 5 Americans—and some studies estimating tens of millions will be newly-eligible for Medicaid coverage after losing their employer-sponsored insurance during the pandemic—policymakers are leveraging the federal-state program within the context of both a public health and economic crisis. The Families First Coronavirus Response Act (Families First Act) provides a temporary 6.2% increase to regular Federal Medical Assistance Percentage rates, which is the portion of federal funding provided to each state for Medicaid expenditures. In order to receive this increased federal funding, states must agree to certain terms and conditions—such as providing continuous coverage for all enrollees, maintaining current eligibility requirements and waiving cost-sharing for COVID-19 testing and treatment. The Families First Act also allows states to cover COVID-19 testing for uninsured individuals through Medicaid, with the federal government covering 100% of the costs for testing. As of late June, at least 17 states have received federal approval to implement this option.

Policymakers are also turning to various waiver opportunities to ease certain Medicaid requirements and expand access to vital services. All 50 states and the District of Columbia have received federal approval for emergency Section 1135 Waivers to waive requirements in general areas like prior authorizations for services and provider credentialing. Forty-nine states have received approval for changes to their home and community-based services (HCBS) waivers—or Section 1915(c) Waivers—to ease requirements relating to long-term care for older adults and people with disabilities, populations particularly vulnerable during the pandemic.

Additionally, state legislators and other officials are increasingly focusing on appropriations, financing and provider rate payments for their Medicaid programs in light of COVID-19. For example, Washington HB 2965 authorizes the department of social and health services to determine adequate Medicaid payment rates for nursing facilities responding to COVID-19. Facing budget shortfalls, states are pursuing cost containment strategies to lower Medicaid costs. For instance, Colorado’s FY 2020-2021 budget reduces certain optional benefits (unless the COVID-19 emergency period extends beyond December) and decreases community provider rate payments by 1% for some health care workers treating Medicaid enrollees to help make up for the state’s $3 billion budget deficit.

Public Health

Emergency Declarations

Every state and territory has declared a state or public health emergency due to the COVID-19 pandemic, allowing additional powers and resources to maximize their response. Emergency declarations provide state officials a wider scope of authority to activate emergency response plans, expend funds, deploy personnel and supplies, and may suspend certain rules and regulations. These actions generally occur through state executive offices; however, state legislatures also have a role to play. Legislatures can extend or limit the exercise of emergency powers and some states may require legislative approval for an emergency declaration made by state executive officers after a specified period of time. Read more about executive and legislative emergency powers here

Several states have introduced or enacted legislation to extend a public health disaster or emergency declaration. For example, Kansas HCR 5025 ratifies and provides the continuation of a disaster emergency declaration and Alaska SB 241 extends the governor’s declaration of a public health disaster emergency. Other measures seek to terminate an emergency declaration, such as Pennsylvania HR 836, or adjust provisions around the process of declaring or extending an emergency. For instance, Delaware HB 340 (pending) amends the state constitution to require the governor to inform the General Assembly in advance of a state of emergency order extension and South Carolina HB 5485 (pending) transfers the authority to issue a proclamation of emergency from the governor to the General Assembly.

Data Collection and Reporting

Since the first reported case of community spread in the U.S., states have collected large amounts of data regarding the number of cases and deaths among their constituents. The data has informed and guided government response to the pandemic at all levels. Additionally, accessibility to data, through the media and internet, has increased public knowledge and awareness.

Many bills relating to the collection and reporting of data often expand the scope of the data collected to include additional populations and ensure data is made available to the public. New Jersey SB 2357 requires the state department of health to include data about the age, ethnicity, gender and race of persons who have tested positive for or died from COVID-19 and update this information on its website daily. California SB 932 (pending) requires the sexual orientation and gender identity of individuals diagnosed with COVID-19 also be included in reported data.

Massachusetts HB 4672 similarly requires the state department of health to include demographic information in its COVID-19 data reports. The bill also requires that infected people in long-term care facilities as well as state and county correctional facilities be included in reported data. North Carolina HB 1023 funds the state office of state budget and management to build data exchanges to enable the use of near real-time data and allow the state to better understand the impact of the virus and quickly identify hotspots. Louisiana SR 74 urges the state department of health to include demographic data and study differential health impacts of COVID-19 on racial and ethnic minority populations in the state.

Testing

As states work to address the impact of COVID-19 in their communities, many have found widespread testing critical to targeting public health responses and measuring the spread of the virus. National guidelines and many state reopening plans rely on adequate testing to identify hotspots and direct interventions going forward. Legislators are taking an active role in this process, focusing on measures to help expand and carry out COVID-19 testing.

Many states have appropriated funding for testing services and supplies or implemented a protocol, task force or commission for testing support. Minnesota SF 4334 appropriates funds for the establishment and operation of temporary sites to provide testing services, and for the development and implementation of screening and testing procedures. Utah SB 3004 creates the Public Health and Economic Emergency Commission to make recommendations on the state’s response to COVID-19, including for a plan to promote widespread testing.

Other states are requiring or considering legislation to emphasize testing for certain populations. New York AB 10512 (pending) requires all nursing home staff and residents to receive coronavirus testing twice per week and New Jersey SB 2359 (pending) requires first responders and health care workers to be tested and the results expedited. South Carolina HB 3411 requires the statewide testing plan to focus testing in rural communities and areas with risk factors for COVID-19.

For more information on insurance coverage for testing, please see the section on Access and Coverage.

Contact Tracing

Contact tracing, the process of identifying and warning individuals who have come in contact with an infectious disease, is another public health measure that has been identified as a key component for a state’s ability to manage COVID-19 cases alongside plans to reopen. A report by the Association of State and Territorial Health Officials and the National Governors Association recommends states pursue a few actions to bolster contact tracing and ensure an adequate workforce, including identifying new sources of potential workers and removing barriers to hiring and training these workers.

States are managing contact tracing plans through a variety of approaches. Massachusetts, for example, launched a large-scale hiring effort through a partnership with local boards of health. Texas developed an online system for users to report COVID-19 exposure. Utah launched a beta app, which helps public health workers track where a person may have spread the virus if they test positive.

Many state legislatures are considering or have enacted legislation to coordinate or fund contact tracing or implement related privacy protections. Illinois SB 264 includes $200 million for costs and administrative expenses associated with contact tracing and testing. New York SB 8362 requires contact tracers to be representative of the cultural and linguistic diversity of the communities in which they serve, and South Carolina HB 4311 requires tracers to be hired through community partnerships. With concern over the privacy and security of individuals, some bills concern privacy protections around data collected through contact tracing, such as Kansas HB 2016 and New Jersey AB 4170 (pending).

Health-related Appropriations

Amid state challenges to address budgetary and economic threats spurred by the pandemic, several legislatures have appropriated funds to prepare for and respond to COVID-19. Health-related appropriations include those for Medicaid, health facility and workforce capacity, and disease preparedness and response activities.

For more information, see NCSL’s State Fiscal Responses to Coronavirus (COVID-19) and Coronavirus (COVID-19): Revised State Revenue Projections pages.

Federal Action

For the latest updates on the federal response to COVID-19, please see NCSL’s Daily Announcements from Federal Agencies.

Additional federal resources can be found on the NCSL Coronavirus (COVID-19) Resources for States page.  


Additional Resources

NCSL Resources

National Resources