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Covid Testing, Vaccinations for Uninsured at Risk as Funds End

March 23, 2022, 9:00 AM

Every phase of the Covid-19 pandemic has thrown Laura Owens a curveball. Now, as a result of congressional inaction, she isn’t sure how she’ll hit the latest one.

Owens is chief executive officer for Carolina Family Health Centers, a group of health centers that serve eastern North Carolina and the seasonal farm workers who migrate there starting each spring. Many of the workers are entering the area in need of Covid vaccine boosters and tests, but lack insurance coverage.

With a stalemate on Capitol Hill over approving more funds to deal with the pandemic, health centers such as the one Owens runs may have to scale back Covid testing and vaccination programs if the virus again surges in the community. The federal program created to reimburse these health centers for serving the uninsured is set to stop accepting claims Wednesday.

“Our options at this point are: do we try to absorb the cost of continuing our operations, or do we limit or stop our Covid testing and eventually Covid vaccination efforts,” Owens said.

The lack of additional federal Covid funds could threaten the ability of health clinics to provide vaccinations
Credit: Getty Stock image

Owen’s quandary illustrates how the standoff in Washington over more pandemic funds could impact providers and patients in the months ahead, as public health experts warn that a new Covid variant may increase transmission of the virus.

Democrats Pull Covid Money to Quell Revolt on Spending Bill

Health centers and clinics across the country that serve a population that’s largely without insurance coverage say the end of the federal program paying for Covid testing, vaccination, and treatment for the uninsured will force them to make hard choices.

How long Carolina Family can float the cost depends on the next surge, Owens said. As Covid cases skyrocketed in January and February the center performed almost 3,000 tests, compared to 5,000 total tests in the previous six months. Another major surge would be costly, she said.

Shutting Down Programs

The White House announced last week it has to shut down the program that pays health-care providers for Covid tests, treatment, and vaccines for the uninsured due to a lack of funding.

Lawmakers were set to give $15.6 billion in Covid aid to the Biden administration as part of the omnibus government spending package (Public Law 117-103), but the funds were jettisonedafter House Democrats balked at offsetting that money with state and local funds. However, even that Covid aid proposal didn’t include funding for the uninsured program.

Republicans in the Senate have questioned the need for additional funds to keep Covid response programs running. Sen. Richard Shelby (R-Ala.), the ranking Republican on the Appropriations Committee, told reporters last week that based on information given to him by the White House, there’s billions of dollars in unallocated Covid funds going untouched.

“I don’t know if they need the money,” he said.

Transparency, Not Warnings, Needed for More Covid Aid, GOP Says

An official with the Health Resources and Services Administration said the $180 billion pool of money earmarked to aid health-care providers has all been allocated. But some of that money hasn’t yet gone to the hospitals or providers it was promised to. The federal agency is still processing and paying claims from the uninsured fund, and to providers who applied for relief funds, said the official, who spoke on condition of anonymity to discuss budgetary matters.

Budget documents sent to lawmakers and obtained by Bloomberg Government show that as of Feb. 15, there was $3.3 billion in relief funds and $2.6 billion for testing the uninsured that was tapped to go out to providers but hadn’t yet been paid out.

Costly Treatment

Providers can submit claims for Covid testing and treatment claims until Wednesday. Covid vaccination claims will be accepted until April 5, according to the Health Resources and Services Administration website.

Ending the program means the uninsured who get Covid tests, vaccines, or treatments may have to pick up all or part of the tab for the services. Emergency care can be costly, with some labs charging hundreds of dollars for Covid tests due in part to quirks in insurance coverage requirements.

Since May 2020, HRSA paid thousands of health-care providers, clinics laboratories, and hospitals nearly $11.4 billion for Covid testing, $1.6 billion for administering Covid vaccines, and $5.8 billion for Covid treatments to people without insurance, according to public data analyzed by Bloomberg Government.

Laboratory companies and large health systems received a significant share of those funds. Curative Labs Inc., which runs 13,000 testing sites across 18 states, was the largest single recipient of testing reimbursement at $587 million. Harris Health System of Texas, a collection of public clinics and two hospitals in Houston, was the largest recipient of treatment funds at $196 million, according to the data, last updated March 3.

The end of the HRSA program means Curative will stop testing people who don’t have insurance in states like Florida and Texas where the demand is high. In states with fewer uninsured people, the company is exploring allowing them to access low-cost lab-based tests. “We are deeply concerned about this new development and the impact it will have on uninsured patients,” said Pasquale Gianni, the company spokesman.

‘Angst and Fear’

Many community health centers have relied heavily on this program to offer free Covid tests and vaccines to the uninsured, said Colleen Meiman, who advises state community health center associations on federal policy. Large hospital systems and lab companies have the option to turn away the uninsured or charge them for testing and treatment, she said, but health centers and clinics have a mission to serve this population.

“This situation has created a fire drill and nobody is entirely sure how real or how bad the fire is going to be,” she said. “What I’m hearing is a lot of angst and fear.”

In Texas, many hospitals and local health agencies have scaled back their Covid testing and vaccination programs, leaving health centers as the main provider of these services, said Jana Eubank, executive director of the Texas Association of Community Health Centers. Almost a fifth of Texans lacked insurance coverage in 2019, according to the latest Census data.

The ending of the HRSA program means health centers will have to use other public funds to pay for these programs, and likely focus on vaccinating and testing those who come in for regular primary care services rather than on the general public, Eubank said. Health centers can charge for their services based on income, but the process requires proof of income, she said.

Eubank said it’ll be harder to hold large, public vaccination events or drive-through testing. “Each center is going to have to figure out: based on our current budget what can we do, and how can we fit these in,” she said.

Questions on ‘Test to Treat’

Cutting back on programs like vision or dental services to the uninsured may be necessary to keep Covid programs running, said Vicki Soule, CEO of Treasure Coast Community Health in Florida.

“There’s very effective treatments we can offer but we’ll have to bear the cost of it,” she said. “That could mean something else goes by the wayside.”

The end of the uninsured program also has implications for the Biden administration’s “test-to-treat” initiative, which aims to get Americans tested for Covid and, if positive, treated with antiviral in one location.

In California, 29 health centers have signed up for HRSA’s therapeutics program, which distributed certain oral antivirals, according to DeeAnne McCallin, director of health information technology at the California Primary Care Association.

Many health centers signed up with the assurance they would be reimbursed for testing and treating uninsured people, she said.

For Owens, the end of the program means her staff may not be able to take their mobile Covid testing system to migrant farm camps as often this year, and force people to make difficult choices if they become ill.

“When you offer a service such as testing or vaccination, it allows individuals to not have to consider whether or not I’m paying my utility bill or rent or a field trip for my child—versus my health care costs,” Owens said. “It narrows the disparities in access to care.”

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bgov.com

To contact the editors responsible for this story: Bennett Roth at broth@bgov.com; Anna Yukhananov at ayukhananov@bloombergindustry.com