COVID-Related Health Insurance Changes and Implications for Provider Relief Funds

Abstract

To cover health care related expenses or lost revenues associated with the COVID-19 Public Health Emergency (PHE), Congress authorized a total of $178 billion dollars in Provider Relief Funds (PRF). To date, when allocating PRF resources, the Department of Health and Human Services (HHS) has not accounted for lost revenue that may result from changes in coverage in U.S. insurance markets. In 2020, the size of the Employer-Sponsor Insurance (ESI) market fell by nearly 4-percent, the Medicaid market increased by nearly 6-percent, the Medicare market grew 3-percent, and the individual private health insurance exchange market changed very little, with only a 0.4-percent reduction from 2019. These coverage changes will likely lead to changes in volume and subsequent shifting of revenue-mix for providers. Hospitals are likely to experience a net positive revenue change and nursing homes and home health agencies are likely to experience a net negative revenue change. Thus, nursing homes and home health agencies should receive priority for any remaining or new PRF resources.