Announcement does not change testing protocol but serves to allay fears that cost could be a factor in who seeks help

Credit: CDC Public Health Image Library (PHIL) via Wikimedia

Most New Jerseyans — including uninsured residents — will not have to pay out-of-pocket for medical services related to coronavirus testing thanks to public and private actions designed to reduce barriers to screening and calm peoples’ fears.

Gov. Phil Murphy announced Tuesday — just hours after New Jersey recorded its first death related to COVID-19, the first fatality in the Northeast — that state agencies had taken steps to immediately waive testing-related copays and other cost sharing for Medicaid members, public employees, individuals insured under state-regulated plans and those without any health care coverage.

The move followed Murphy’s declaration of a public-health emergency on Monday, and was one of a series of actions government officials have taken to control the spread of the disease.

These waivers apply to charges for the medical screening process, the blood test and related services — not for costs associated with treating COVID-19 (coronavirus disease), if detected. The governor’s announcement does not change the protocol for who should be tested and public health experts insist that most people who develop symptoms are likely more likely to have a cold or the flu.

NJTV News report on New Jersey’s first coronavirus death

The changes should also make it easier for some patients to obtain long-term supplies of certain maintenance medications and use telemedicine services, state officials said.

Private companies also stepping up

Many private health insurance companies have also stepped up to ease access to screening services, suspending copays for screening services and encouraging patients to use telehealth options when possible. State Department of Banking and Insurance Commissioner Marlene Caride advised other companies to take action, if they haven’t yet.

In addition, Vice President Mike Pence also suggested these changes could be made on a national basis following a meeting he had Tuesday with insurance executives.

State of emergency triggers rules to curb price gouging

On Friday, Horizon Blue Cross Blue Shield — New Jersey’s largest health insurance provider, with 3.4 million members — waived prior authorization and cost-sharing requirements for coronavirus diagnostic procedures and is allowing patients to get early prescription refills without paying the usual fee.

“As we continue to strengthen our efforts to mitigate the spread of COVID-19, we must ensure that our residents are focused on their health and not on the cost of medically necessary testing,” Murphy said. “These actions bolster our state’s coordinated response and preparedness efforts by eliminating affordability concerns for New Jerseyans.”

While the state lab — which doesn’t charge patients — has handled nearly all of the testing so far, individuals were likely to be billed by the doctor or hospital doing the screening and taking a swab if testing is considered appropriate. Private labs, which began testing Monday, could also charge patients or their insurance for the testing process itself — a situation the governor’s order hopes to limit.

Where things stand

As of Tuesday afternoon, 15 of the 59 New Jerseyans tested had contracted the novel virus, which can cause mild respiratory and flu-like symptoms in most people, but has been fatal to older or immune-compromised patients. There is not currently a vaccine or a cure for COVID-19, which has infected more than 118,000 worldwide, with 800-plus located in the United States, and contributed to over 4,000 deaths, including 28 in this country, according to a global tracking system compiled by Johns Hopkins University.

Garden State leaders are increasingly focused on developing mitigation strategies — like school closings and restrictions on large gatherings — in addition to their efforts to contain the virus by screening people and isolating those at risk. But as of now, it is up to local officials and business leaders to shutter schools or workplaces; individuals are urged to evaluate their personal exposure risks and options when deciding whether to take mass transit or attend a social event.

“We do not see, particularly in New Jersey right now, what we call community spread, which is person-to-person transmission without a known COVID-19 exposure,” state Department of Health Commissioner Judy Persichilli said Tuesday during the administration’s daily coronavirus briefing. “When we start seeing community spread there is no doubt we will be exercising more vigilance in our recommendations for closure, travel, mass transit. But in New Jersey we’re not there yet.”

Lt. Gov. Sheila Oliver underscored that administration officials are meeting to review their responses each day.

“As you can see, information and circumstances are changing on a dime,” Oliver said. “So our approach is … as we do the data collections and we get reports from the field, we will make those kinds of decisions on a daily basis.”

Test results pending on more cases

Regardless of the current trends, Persichilli and others agree more COVID-19 diagnoses are coming. Another 20 tests were being processed Tuesday and 31 additional people were being screened for coronavirus factors and may also be tested.

“I don’t expect community spread to occur. I hope with containment and mitigation it doesn’t,” Pershichilli said. “What I do expect is more cases. You may have more cases, but it might not necessarily be qualified as community spread,” she said, if the infection is traced back to another person with the disease or a location in which it is active.

DOH officials have been distributing guidance to health care providers — including nursing homes and other facilities caring for vulnerable individuals — businesses and schools for weeks, a process that continues. As head of the state’s inter-agency coronavirus task force, Persichilli also meets daily with other Cabinet officials to develop more aggressive responses in case community transmission becomes an issue.

For the state’s Motor Vehicle Commission, this could mean changes at licensing facilities, Persichilli noted. The Department of Corrections is considering restricting visits to prisoners. Frontline caseworkers in the Department of Human Services and the Department of Children and Families are looking at ways to reduce the risks they face making multiple home visits as part of their job.

DOH has already drafted waivers to allow hospitals to expand bed capacity, which they can distribute if needed, Persichilli said. “That’s just an example, but every department is going to be looking at (similar ways to create flexibility),” she said.

Assurances for those on Medicaid, too

In his actions Tuesday, Murphy ordered DHS, which oversees the state’s Medicaid, or FamilyCare, system, to ensure its nearly 1.7 million members are not charged for visits to a clinician to discuss coronavirus testing or for costs associated with the test itself. Medicaid must also cover three-month supplies of maintenance medications, expand access to telemedicine and deploy care managers to make sure high-risk patients have the services and support needed.

“The health and safety of our Medicaid members, especially older residents and those with complex medical conditions, are our top priority,” said DHS Commissioner Carole Johnson.

In addition, Murphy called for the Department of Banking and Insurance to advise commercial insurance carriers who cover individuals through the state’s large-employer, small-business and individual markets to waive cost-sharing requirements for all medically necessary screening and testing associated with coronavirus. This includes plans sold on the Affordable Care Act marketplace, or exchange.

Companies must also keep those they insure well-informed of these and other changes related to the outbreak, under the order. The governor’s office said this would apply to roughly 1.3 million people in New Jersey. Another 3.2 million are covered by commercial insurance plans regulated by the federal government and could benefit from the reforms mentioned by Pence.

The Division of Pensions and Benefits was ordered by Murphy to advise public workers and school employees — nearly 800,000 in total — that copays were waived for coronavirus screening and testing. The division is also working to ease restrictions on prescription refills and make telemedicine more available to these workers.

The DOH also ordered hospitals not to charge any fees to uninsured patients who come to their facilities for any visit that leads to coronavirus testing. While it is not clear exactly who would be eligible, estimates suggest there are more than 650,000 people without coverage; while some of their medical costs are covered through the state’s charity care program, they may also pay a portion out-of-pocket.