5 things to watch in Snohomish County as COVID public emergency ends

EVERETT — After more than three years, the federal COVID public health emergency will end May 11.

The decision will trigger the end of a wide range of temporary waivers and flexibilities in health insurance and health care.

Providence Regional Medical Center in Everett treated the first known COVID patient in the United States. Since then, more than 15,000 Washington residents have died from COVID, including 1,420 in Snohomish County, according to the state Department of Health.

The end of the public health emergency marks a transition to managing COVID as endemic, or a disease that will be consistently present with some predictability.

The Daily Herald asked community leaders to share their key concerns about what this means for Snohomish County residents. As with much of health care, it’s complicated and depends on people’s health insurance or lack thereof.

1. COVID vaccines, testing and treatments could hit patients’ pocketbooks

The county health department flagged this as a particular concern for uninsured or underinsured people.

“We will continue to work toward improving access to vaccines and other healthcare for all residents of Snohomish County, and it will be important to work with impacted communities and healthcare partners on this,” said director Dennis Worsham and health officer Dr. James Lewis in a joint statement.

The health department will continue to update its website with how residents can get vaccine information and shots: snohd.org/covidvaccine

Private insurance will cover vaccines, but they won’t be required to do so when given by out-of-network providers. This is a big change.

And free at-home COVID tests will no longer be guaranteed through insurers or governments, except for Apple Health enrollees.

The Community Health Plan of Washington cautioned that as they work out coverage details for tests, vaccines and treatments, patients should “pay close attention to what kind of insurance they have and what it is now covering,” wrote spokesperson Meg Olberding.

People should call the phone number on the back of their health insurance card for questions about coverage or new processes as May 11 draws closer.

Leaders at Sea Mar Community Health Centers are concerned about the high prices folks could pay for a course of Paxlovid to treat COVID. The federal government has paid over $500 per five-day course of drugs, when buying in bulk. While Apple Health patients won’t pay anything until some time in 2024 at the earliest, folks with private insurance or no insurance might not be able to afford copays or coinsurance.

2. Apple Health, or Medicaid, access

During the federal public health emergency, Apple Health enrollees were guaranteed “continuous enrollment.” The state received extra federal dollars to cover higher enrollment.

Even though the federal government had already announced that states would have to restart Medicaid renewals on April 1, multiple health care leaders raised this as a top concern. As the Herald reported in January, up to 40,000 Snohomish residents might lose Apple Health — some because they are no longer eligible, some because they didn’t fill out paperwork on time.

Leaders from Community Health Plan of Washington and Community Health Center of Snohomish County urged folks with Apple Health or any state health plan, to make sure their insurance plan and the state have their current contact information. And open all mail from insurers, the state and health care providers.

Even so, spokesperson for Sea Mar Community Health Centers Rahab Mugwanja wrote: “Many immigrant and low-income populations have difficulty navigating the recertification and enrollment process for becoming eligible for Medicaid.”

Compass Health provides behavioral health care primarily for Medicaid patients. They expect to help their patients find new health insurance, or re-enroll if they lost Apple Health coverage because of paperwork mistakes or delays.

Tom Sebastian, president and CEO of Compass, wrote, “We will also work to identify grants and alternative funding sources that will enable clients to continue to receive care from their Compass Health team, even if they no longer qualify for Medicaid.”

3. Telehealth

Telehealth is the delivery of services to patients by phone, email or video. Early in the pandemic, the federal government made changes to expand telehealth for Medicare, and states did the same with Medicaid.

Dr. James Cook, chief medical officer at Providence’s Everett hospital, wrote: “We are grateful the Washington Congressional delegation, including Rep. Rick Larsen, extended those telehealth flexibilities.”

Medicare changes will continue through Dec. 31, 2024. Some of the telehealth provisions that apply to providers expire with the end of the public health emergency. This affects patients with private insurance.

Telehealth is one of those complex issues that varies based on public and private insurance plans, as well as provider.

4. Long-term care

Pete Wolkin is the director of operations for Nightingale Healthcare, a company that operates seven skilled nursing and assisted living facilities, two of them in Snohomish County. He flagged decreased funding for community health care providers generally. The operational costs of COVID will continue — such as extra personal protective equipment and precautions — while some government support for it will end.

During the federal public health emergency, the Centers for Medicare and Medicaid Services waived the requirement that patients be admitted to an acute care facility for at least three days before transitioning to a skilled nursing facility. Wolkin said this eased the burden on hospitals and streamlined care delivery for those in need of skilled nursing.

5. The end of the emergency doesn’t mean the end of COVID-19

The health department expects the county will continue to see surges of high transmission or severe illness. At those times, the department will work with the community to call for more prevention measures, such as vaccinations, masking, improved indoor ventilation and staying home when sick. In short, they wrote, “The end of the public health emergency doesn’t mean the end of COVID-19.”

Wolkin, from Nightingale Healthcare, shared the concern: “The public perception that the danger of the pandemic has subsided does not align with the reality of the continued threat that respiratory viruses pose to long-term care settings. Visitors may have less understanding of the continued need to protect staff and residents from infection.”

We will continue to report on access to health care in 2023. If you have faced barriers to accessing timely, convenient or affordable care in Snohomish County, please fill out this short form: forms.gle/DcgfccCvwqVTh6Sk7

Joy Borkholder: 425-339-3430; joy.borkholder@heraldnet.com; Twitter: @jlbinvestigates.