Termination of the Federal COVID-19 Public Health Emergency: Likely Impact on Rural Health

April 14, 2022

The Administration has extended the COVID-19 Public Health Emergency (PHE) for 90 days until July 16, 2022. The PHE was due to terminate on April 16 without that extension:


This PHE extension will permit continuation of a number of key waivers and special permissions. See a good summary of PHE dependent considerations at this link:


Multiple flexibilities are permitted for the period of the PHE. These include:

  • Coverage, costs, and payment for COVID-19 testing, treatments, and vaccines,
  • Medicaid coverage and federal match rates,
  • Telehealth expansion and reimbursement,
  • Other Medicaid and CHIP flexibilities,
  • Other Medicare payment and coverage flexibilities,
  • Other private insurance coverage flexibilities,
  • Access to medical countermeasures (vaccines, tests, and treatments) through FDA emergency use authorization (EUA), and
  • Liability immunity to administer medical countermeasures.

Note that funds for some of the special initiatives authorized for the PHE have run out. This includes subsidies for some COVID-19 testing and treatment. The Administration continues to seek additional appropriations for these efforts. States and the Federal government have voiced their intentions to seek continuation of some PHE policies, particularly around telehealth policies. In many instances this will require legislative or congressional action.

A major flexibility of the PHE has been the permission given to states to grant automatic extension of Medicaid eligibility. Medicaid programs have been allowed to extend enrollment to eligible Medicaid participants without routine review of income changes. This has permitted extended Medicaid coverage for individuals and families who might otherwise have lost coverage as their income increased.

It has been estimated that between 10-15 million people could lose coverage when this Medicaid provision of the PHE ends. Many states have begun planning for this loss of coverage, conducting outreach to current enrollees and providing counseling about subsidized private coverage available on health insurance exchanges. SORHs would be a natural partner in planning for this transition in rural communities.

Note that DHHS has promised state Medicaid programs that they would be given 60 days’ notice of the proposed end of the PHE. This means that, at the earliest, if notice is given before May 16, this current extension will be the last. If notice is given after that date, an additional extension of the current July 16 termination will be needed.

DHHS has announced that state Medicaid programs will have 12 months after the end of the PHE to complete final reviews and redeterminations for Medicaid enrollees. This means that extended Medicaid coverage need not end on the same date as the PHE termination. Some interviews with state Medicaid directors have indicated that most states will be conducting redeterminations 4-6 months after the end of the PHE.


Date: April 14, 2022

Tags: COVID-19, Medicaid, Telehealth, Public Health Emergency