Low-income and uninsured San Antonians will be most affected by the Biden administration’s decision to end the national COVID-19 emergency declarations on May 11.
The end of the national and public health emergencies means the end of federal support for COVID-19 resources, such as free vaccines and at-home tests. Many low-income residents will also be at risk of losing their Medicaid health insurance and food benefits.
That’s because the public health emergency included a “continuous coverage” provision that prevented removing people from Medicaid and Supplemental Nutrition Assistance Program, or SNAP, during the pandemic. When the declarations are lifted, that provision goes away.
In Bexar County, where almost 19% of residents under 65 are uninsured, Medicaid recipients haven’t had to re-apply for the past three years, said Joe Ibarra, director of enrollment at Enroll SA, a community coalition that works to increase the health insurance enrollment rate in San Antonio.
Recipients will all have to re-apply or will be dropped from the rolls, Ibarra said. The Centers for Medicare & Medicaid Services will determine who remains eligible.
Because access to no-cost COVID-19 tests and vaccines are also ending, the message from San Antonio’s Metropolitan Health District to residents is to get shots or boosters before the emergency declarations end.
“I’m hoping that people will realize that this is their last opportunity to get the vaccine completely for free so easily,” said Junda Woo, medical director and local health authority for Metro Health. “Run out before May 11 and go get it…”
Right now, Bexar County’s COVID-19 risk level is medium and improving. Case rates and hospitalizations are low, while new admissions are medium.
Compared to a year ago, Woo said the general population has higher immunity to the virus through vaccinations and previous infections and so are less likely to be hospitalized if they do get COVID-19. The elderly, infants under six months and those with a weakened immune system remain at the highest risk of death from the disease, she said.
Vaccines, tests and treatments
COVID-19 vaccines and tests will remain free for those with private health insurance, which have been required to cover up to eight free COVID-19 tests per month as part of the public health emergency declaration.
People who are uninsured will not have access to free tests or vaccines, she said; those on Medicare or Medicaid may have a co-pay, Woo said.
Woo said Metro Health is waiting for more information from the federal government to determine whether or not it and University Health can continue to provide low-cost access to COVID-19 vaccines to low-income residents, and how that might be funded.
Bexar County’s latest data reveals 74% of residents have received a booster dose of the vaccine and almost 14% have received either the bivalent booster or two booster doses.
“If you don’t have health insurance, and you have not gotten your updated booster, you might want to do it before May 11,” Woo said. “You won’t have as many options.”
Metro Health is a Texas Vaccines for Children and Adults provider, meaning through that federally funded program, it offers vaccines to uninsured populations at a low cost, Woo said she believes COVID-19 vaccines would be folded into the program, but hasn’t yet received confirmation.
For uninsured people, Woo said free COVID-19 tests will be a thing of the past, while San Antonians on Medicaid will have access to free testing, treatment and vaccines through 2024. Those on Medicare may have co-pays.
SNAP, Medicaid changes
Ibarra said the looming end of the public health emergency has pushed Enroll SA into action, raising awareness about the upcoming need to re-apply for Medicaid. The nonprofit is targeting areas with the highest uninsured rates.
“If we don’t come together as a coalition and make sure that we’re addressing this with our community, we could really see increased uninsured numbers,” said Ibarra — and means “we have families who no longer have access to proper health care.”
He noted that not everyone will find another affordable insurance option if dropped from Medicaid and encouraged those enrolled now to make sure their contact information is up to date, so they will be contacted about re-enrolling ahead of May 11.
Woo said some households eligible for SNAP will see their benefits decrease by about a third, about $80 a month. Others may be dropped altogether, as the three-month time limit on food assistance resumes.
Woo described the changes wrought by the public health emergencies a “national experiment” that allowed anyone to get COVID-19 prevention, treatment and testing, regardless of their health insurance status.
“We have a dysfunctional health care system. And for a little while, it was somewhat less,” Woo said. “One big picture takeaway, if we take a step back, is that as a society, we can offer some health care to all people just by tinkering with our existing structures, and the world does not end.”
For the foreseeable future, the health department will continue to offer the COVID-19 vaccine at its immunization clinic at 210 N. Mel Waiters Way, Woo said, and host outreach events while it works to understand the landscape come May 12.
An earlier version of this story misstated the basis for the requirement that private insurance companies provide free COVID-19 tests.