The Biden Administration this week launched a website and toll-free phone line allowing people to request four COVID-19 tests per household. These tests would be provided by the federal government as part of an effort to expand access to at-home tests, which have been in limited supply.

Directly mailing an equal number of free tests to households through the U.S. Postal Service (USPS) will increase availability and allow for faster implementation. Moreover, mailing free tests may increase access for people who are not able to pay upfront costs to purchase tests from retailers and/or who do not have health insurance to reimburse test costs. The White House also has indicated that the first 20% of each day’s orders will go to areas that experienced high rates of cases and deaths, which will help ensure that disproportionately affected areas are among those first to receive them.

However, providing an equal number of tests to every household without accounting for size of the household or the risk of household members will result in inequitable access to the tests. Other countries are distributing free tests at the individual level—the United Kingdom, for example, allows individuals to order up to seven tests per day through a website or phone line, which are mailed to their home or available for pick up from a local pharmacy or checkpoint.

Hispanic, Asian, and Black people are more likely than White people to live in households with more than four people, where not everyone will receive a free COVID-19 test from the federal government. Hispanic, Asian, and Black people also are more likely than White people to live in multi-unit structures, like apartments. Early reports suggested that some people living in multi-unit buildings were not able to order COVID-19 tests because an order was already marked to their address. However, the USPS told news outlets that the problem affected a “small percentage of orders,” and White House officials said the government is working to address website bugs. Analysis further shows that Hispanic and Black people are less likely to have internet access at home, making it more challenging for them to order tests without a phone option. At the same time, people of color likely have increased need for tests because they often are employed in jobs that cannot be done remotely.

This inequity in access to free tests is yet another example of the consistent theme of inequities over the course of the pandemic. Compared to their White counterparts, people of color have faced increased risk of exposure to the virus, suffered more illness and death, and faced more barriers to accessing protective equipment, testing, care, and treatment, as well as vaccines. These disparities in COVID-19 mirror and are driven by underlying inequities in health and health care that are rooted in racism and discrimination. Policies that do not recognize or account for underlying differences and inequities will perpetuate and further widen disparities going forward.

Less than a week after a new federal mandate to cover such products took effect, about half of the nation’s largest private insurers allow enrollees to directly obtain rapid at-home COVID-19 tests from specific sources without having to pay anything upfront, a new KFF analysis finds.

The new coverage requirement took effect Jan. 15, just five days after the Biden administration released detailed guidance about implementing the new requirements originally announced on Dec. 2..

The analysis examines how the 13 private insurers with at least a million enrollees are currently implementing the requirement, including how enrollees can obtain tests, submit claims and get reimbursed. These insurers collectively cover more than half of all people covered in the fully insured commercial market.

Key findings include:

• Seven of the insurers – Anthem, Blue Cross Blue Shield of Michigan, Blue Shield of California, Care First, Cigna, CVS Group/Aetna, and Kaiser Permanente – currently require enrollees to pay for their tests upfront and seek reimbursement. Their reimbursement policies vary, with some requiring mail-in forms, some allowing online submissions. Three require claims to include the product’s barcode.
• Six of the insurers- Blue Cross Blue Shield of North Carolina, Centene/Ambetter, Guidewell (Florida Blue), Health Care Service Corporation, Humana, and United Health Group– allow enrollees to obtain rapid tests directly from an in-network or preferred pharmacy without having to pay anything up front. A seventh – Kaiser Permanente – indicates that they plan to offer such an option in the future. These insurers generally limit reimbursements for tests purchased elsewhere to $12 per test.

A separate brief examines how states are implementing Medicaid’s requirements to cover rapid at-home tests at no cost to enrollees, as required by the American Rescue Plan of 2021.

As COVID cases have surged across the United States due to the new Omicron variant, the Biden Administration has stepped up efforts to expand testing capacity including by making at-home COVID tests more available.  Recent efforts include a new program that started January 18^th to allow every household to order 4 free at-⁠home COVID-⁠19 tests from COVIDtests.gov; increasing the number of COVID tests available to schools and community health centers; standing up new federal free-testing centers; and requiring private health insurers to cover the costs of at-home COVID tests.  While there has been a lot of attention paid to coverage and reimbursement requirements for at-home tests for people with private insurance, there seems to be confusion about how Medicaid enrollees can access at-home COVID tests.

What are the rules for Medicaid coverage of at-home tests?

Recent press releases and FAQs note that in accordance with the American Rescue Plan Act (ARPA), State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. In August 2021, the Centers for Medicare and Medicaid Services (CMS) issued guidance about coverage and reimbursement of COVID-19 testing under the ARPA for Medicaid and CHIP.  The guidance says that “all types of FDA-authorized COVID-19 tests must be covered under CMS’s interpretation of the ARP COVID-19 testing coverage requirements, including, for example, “point of care” or “home” tests that have been provided to a Medicaid or CHIP beneficiary by a qualified Medicaid or CHIP provider of COVID-19 tests.”  It further indicates states have discretion to condition coverage of a home test on a prescription as part of their utilization management or apply medical necessity criteria. The guidance also says that “as states establish utilization management techniques, including possible prescription conditions, they are encouraged to do so in ways that do not establish arbitrary barriers to accessing COVID-19 testing coverage, but that do facilitate linking the reimbursement of a covered test to an eligible Medicaid or CHIP beneficiary.”

Given that Medicaid covers low-income individuals, Medicaid rules would allow individuals to access at-home COVID-19 tests without having to pay out of pocket and then seek reimbursement.  Under the new federal rules, private insurance must reimburse for up to 8 tests per member per month, however, in many cases this may require individuals paying out of pocket and then filing for reimbursement from insurance.  There is no mechanism in Medicaid to provide similar direct reimbursement to enrollees, so even if enrollees could afford to pay out of pocket, they could not recoup costs in the same way.

How are states implementing these rules?

As with most rules for Medicaid, states have some discretion and flexibility in how they provide coverage and reimbursement for at-home tests so there may be variation across states in how easily enrollees can access at home tests.  While state policy and bulletins are evolving, a number of states are using a standing order to allow Medicaid enrollees to obtain at-home tests from a retail pharmacy with no cost sharing.  For example:

• A bulletin in North Carolina says that “effective Jan. 10, 2022, NC Medicaid-enrolled pharmacies may bill for FDA approved over-the-counter (OTC) COVID-19 tests dispensed for use by NC Medicaid beneficiaries in a home setting, with or without a prescription issued by a NC Medicaid-enrolled provider…NC Medicaid will cover one kit per claim per date of service, with a maximum of four test kits every 30 days.” The bulletin specifies which tests will be covered, how the pharmacy can claim Medicaid reimbursement and that there is no copayment.
• A Massachusetts bulletin states that effective January 14, 2022, at-home antigen self-test kits are covered through the MassHealth pharmacy benefit without prior authorization with a limit of eight test kits per member per month (additional tests can be covered with prior authorization on a case-by-case basis). The Department of Public Health issued a statewide standing order that allows licensed pharmacists to dispense self-test kits to any individual, and to treat that standing order as a prescription for any such test kit. Accordingly, an individual prescription is not required for any such test kit. Additional guidance directs Medicaid Managed Care Organizations (MCOs) and the Program of All-inclusive Care for the Elderly (PACE) to provide coverage for at-home tests as well.
• In December, Maine and Vermont also issued guidance that pharmacies may now bill for select at-home tests for Medicaid and specified that the a pharmacists can be the prescribing provider through the use of a standing order.

Under the rules, states can require a prescription for the at-home tests.  For example, New York issued guidance in December 2021 confirming Medicaid coverage of FDA-approved at-home tests ordered by a Medicaid-enrolled practitioner.  The bulletin requires a fiscal order (similar to a prescription) for each at-home test kit and limits coverage to one test kit per week.  The bulletin specifies that while the coverage policy applies to all types of plans, the COVID-19 testing billing and reimbursement may vary across MCOs.  It is not clear how many states are imposing prescriptions or other utilization management techniques.

What are key issues to watch for Medicaid enrollees?

As states continue to update and adopt policies about coverage for at-home tests, it will be important to provide outreach and education to facilitate access.  If enrollees are not aware of a policy that may enable them to access at-home tests from a pharmacy without cost-sharing, they may not seek out at-home tests at all due to the cost.  State Medicaid agencies, pharmacies, and managed care plans could help inform enrollees about coverage policies.

Variation in Medicaid policies about coverage and access to at-home tests will make national education efforts challenging.  It will be important to see how quickly and effectively new efforts to increase general supply of at-home tests work to address current shortages.  Many Medicaid enrollees work in jobs where they are at risk of contracting COVID-19 (such as health care, retail or food service) with top occupations among Medicaid workers include cashiers, drivers, janitors, and cooks.  Given these types of jobs, Medicaid enrollees may require even greater access to at-home testing to ensure they can follow isolation protocols if they test positive.

Staff and residents at long-term care facilities were hit hard by the pandemic, reporting over 195,000 deaths as of the end of 2021¹ , or about 23% of all COVID-19 deaths in the U.S. After a dramatic surge, cases and deaths in long-term care facilities (including nursing homes, assisted living facilities, ICF/IIDs, and other settings) dropped following the vaccine rollout in the Winter of 2020-2021, according to a KFF analysis. Since then, nursing home cases and deaths have mostly risen and fallen in tandem with national cases and deaths, although they are once again on the rise as Omicron has taken hold in the U.S.

This data note analyzes federal nursing home data as of January 2^nd, 2022 to determine the impact of the pandemic on COVID-19 cases and deaths among staff and residents, amid the recent surge of national cases due to the Omicron variant. The data on overall U.S. and nursing home cases and deaths in this analysis reflects data reported over the holiday season, which may include delayed, disrupted, or otherwise anomalous reporting. Additionally, since increases in deaths lag increases in cases, it is not yet clear the extent to which the surge in Omicron will affect mortality. See methods box for more details.

What are the recent trends in COVID-19 cases and deaths in nursing homes?

Cases and deaths in nursing homes are rising, generally mirroring current trends in the overall U.S., though rates have recently started to rise faster in nursing homes (Figure 1 and Appendix Table 1). In the week ending January 2^nd, 2022, nursing homes reported 18.75 resident cases per 1,000 residents, a 225% increase from the week prior, and 0.54 resident deaths per 1,000 residents, a 48% increase from the week prior.

Cases among nursing home staff have increased at an even steeper rate, with staff cases per 1,000 staff increasing by 277%. These patterns look mostly similar to the current rise in cases and deaths across the U.S., aligning with the general pattern observed over the course of the pandemic.

In the week ending January 2^nd, nursing home residents and staff reported higher case rates (per 1,000) than the overall U.S. population, and higher death rates (per 1,000) among nursing home residents (Figure 1 and Appendix Table 1). According to the most recent data available, the case rate was higher for nursing home staff (28.43 per 1,000) than for nursing residents (18.75 per 1,000), both of which were higher than the overall U.S. average (9.03 cases per 1,000). Nursing homes reported 0.54 resident deaths per 1,000 residents, which is over 25 times the death rate reported in the general population (0.02 deaths per 1,000). Higher case rates may be attributed to the highly transmissible nature of Omicron and the nature of congregate care settings. Higher death rates may be attributed to the high-risk status of those who reside in nursing homes.

How have vaccination rates changed over time for nursing home residents and staff?

Staff vaccination rates remained five percentage points lower than resident vaccination rates as of the week ending January 2^nd (87% vs. 82%), though staff vaccination rates increased by nearly 26 percentage points between June and early January 2022 (Figure 2). Residents and staff started receiving vaccinations in December 2020 through the Pharmacy Partnership for Long-Term Care. Resident uptake was initially higher than that of staff, leading to higher early vaccination rates. When nursing home vaccination data first became available in June 2021, a much larger share of residents (79%) than staff (56%) were vaccinated. A key reason staff vaccination may have increased since June 2021 is that the Biden administration announced a nursing home staff vaccine mandate in August 2021 as a condition for facilities to continue receiving Medicare and Medicaid funding² . Lawsuits have been filed challenging the mandate, but Supreme Court has ruled that the mandate can take effect while the cases play out in the lower courts.  The increase in staff vaccination rates may also be partially attributed to unvaccinated staff leaving their positions. For the most recent period, a larger share of facilities reports very high (85%+) vaccination rates among residents (in 71% of facilities) than among staff (in 44% of facilities) (Appendix Table 2).

What do we know about the boosters for nursing home residents and staff?

In the week ending January 2^nd, about 54% of nursing homes (8,043) reported data on cases, deaths, and boosters. In this sample of nursing homes, about 55% of residents had received a booster compared to just 22% of staff (Figure 3). These values represent the share of all residents and staff who have received their booster, although some may not have been eligible for their booster by January 2^nd. Individuals who received the Pfizer-BioNTech or Moderna vaccines become eligible for boosters five months after completing their primary vaccination series. Individuals who received Johnson & Johnson’s Janssen vaccine are eligible for boosters two months after receiving their shot. Since many residents received their vaccinations earlier than the staff, residents were likely eligible and received their booster earlier than staff. The share of residents and staff who are boosted will continue to increase as more residents and staff become eligible, though data on vaccinations suggests that staff booster rates may not reach levels of resident boosters regardless of eventual eligibility.

Among the nursing homes in the sample reporting data for the week ending January 2^nd, a small share (7%) reported staff booster rates of 50% or higher, while over two thirds (67%) of these nursing homes reported resident booster rates of 50% or higher (Appendix Table 2). Previous research suggests a myriad of factors impact cases and deaths in nursing homes including, but not limited to, resident acuity, surrounding community spread, and facility size. Recent hospital data showing higher levels of severe illness and death among those who are unvaccinated suggests that vaccination and booster rates may be a key consideration as well. Our analysis found that nursing homes with low resident booster rates reported higher average resident cases and higher average resident deaths in the week of data analyzed. Similarly, facilities with low staff booster rates reported higher average staff cases (Figure 3). While vaccination and booster rates should be considered alongside other factors, they likely play a key role in protecting those who live and work in these congregate care settings.

Looking Ahead

This data notes suggests that the Omicron variant has made its way into nursing homes, once again raising concerns about the impact on residents and staff. While there is growing evidence that Omicron is less likely to cause severe illness than previous variants, older adults and those with other health conditions are still at greater risk. Given the particularly high-risk nature of residents in these settings and the experience of residents and staff earlier in the pandemic, nursing homes may see a significant increase in deaths following this increase in cases. Numerous studies have shown that those that are fully vaccinated and boosted are highly protected against the new variant, a finding which increases the urgency to increase vaccination and booster rates among unvaccinated and unboosted residents and staff in nursing homes. Lawsuits have been filed challenging the vaccine mandate for health care staff, a key policy lever that policymakers and other stakeholders can use to increase vaccination rates among unvaccinated staff. However, the Supreme Court has ruled that the mandate can take effect while the cases play out in lower courts. As Omicron continues to break case and hospitalization records, increasing vaccination and booster rates will be an important protection against illness and death for nursing home residents and staff.

Appendix Tables

1. This statistic was calculated by adding the nearly 187,000 long-term care COVID-19 deaths identified from KFF data collection efforts that ended June 30th, 2021 with the approximately 8,700 COVID-19 deaths nursing homes have reported to CMS since June 30th, 2021. This death count is an undercount since CMS data does not account for deaths in non-nursing home settings and not all nursing homes report complete data. ↩︎
2. The new rule applies to Medicare and Medicaid providers that are directly regulated by CMS and therefore does not reach all Medicaid providers, such as certain home and community-based services (HCBS) providers. The rule applies to nursing homes, hospitals, outpatient rehab facilities, federally qualified health centers, rural health centers, and home health agencies, among other provider types. ↩︎

It’s been more than two months since the Centers for Disease Control and Prevention (CDC) recommended Pfizer’s COVID-19 vaccine for children, ages 5-11, in the United States. We previously assessed pediatric vaccination uptake, finding that, after initial high demand, it had already slowed significantly. We also found a wide range in vaccination rates by state. Since that time, Omicron has become the dominant variant in the U.S. and COVID-19 cases, hospitalizations, and deaths are rising again.

Here, we provide an update on the vaccination status of 5-11 year-olds, through January 18, 2022. It is based on analysis of national and state-level vaccination data obtained from the CDC’s Data Tracker (see methods below). Overall, we find that the number of first doses newly administered to 5-11 year-olds remains far below its early peak and although there was a slight uptick for a period in December, it has again declined. There also remains a large gap – of 52 percentage points – between the most vaccinated and least vaccinated states. Specific findings include:

• Nationally, more than a quarter (28.1%) of 5-11 year-olds had received at least one COVID-19 vaccine dose as of January 18, 2022. This represents just over 8 million of the approximately 28 million children in this age group in the United States. Given the two dose Pfizer regimen, administered three weeks apart, and the need for a two-week period afterward to be considered to have completed the vaccine series, just 18.8% of children have reached this point.
• The rate of vaccination among 5-11 year-olds reached its peak before Thanksgiving and then dropped steeply. Vaccination rates among 5-11 year-olds, as measured by first doses administered daily, rose sharply for the two-week period after the recommendation was first made on November 2, hitting its high point on November 14, at 264,000 (based on the 7-day rolling average). It then dropped steeply through the beginning of December. After a slight uptick over the next two weeks, it dropped again and has hovered between 50,000 and 75,000 new doses administered per day, based on the 7-day rolling average, since the holiday period (Figures 1 and 2).
• Significant variation remains at the state level with a 52 percentage point difference between the top and bottom ranking states in the share of children with at least one dose. This difference is much larger than the span for adults (27 percentage points). The share of children having received at least one COVID-19 vaccine dose ranged from 63.1% in Vermont to just 11.2% in Mississippi (Table 1). The top ten states have vaccinated more than a third of 5-11 year-olds, with three states at more than 50%; the bottom ten states have vaccinated fewer than 20%. The spread between top and bottom ranking states for those fully vaccinated is 47 percentage points, and ranges from 52% in Vermont to 5.3% in Alabama.
• Some regional differences persist. Five of the top ten states, by share of 5-11 year-olds with at least one vaccine dose, are in New England (Vermont, Rhode Island, Massachusetts, Maine, and Connecticut). Eight of the ten states with the lowest vaccine coverage among 5-11 year-olds are in the South (South Carolina, Georgia, West Virginia, Oklahoma, Tennessee, Louisiana, Alabama, and Mississippi). Similar patterns are also seen among the share fully vaccinated.

More than two months following authorization of the COVID-19 vaccine for children ages 5-11, the vaccination rate for this group is quite low, and there is significant variation across the country, with a more than 50 percentage point gap between the highest and lowest ranking states among those having received at least one dose. This likely reflects a complicated interplay between the efforts made by state and county governments, schools, and pediatricians to vaccinate children, and the makeup of the citizenry itself and its interest in vaccination. With the highly transmissible Omicron variant surging across the U.S., the vaccine, which has proven very safe for children, offers the most effective protection against severe disease and hospitalization. In addition, while vaccination during the Omicron surge may not prevent all school disruptions, it does help to mitigate them. Identifying opportunities to reach parents and caregivers, many of whom have been reluctant to get their younger children vaccinated, with information about vaccination and providing multiple, accessible, avenues for pediatric vaccination, will continue to be important.

In this column for the JAMA Health Forum, Larry Levitt examines how the No Surprises Act that prohibits unexpected out-of-network charges for patients could lead to lower payment rates and revenues for some doctors and other care providers.

An updated KFF analysis finds that counties that voted for Biden continue to have higher COVID-19 vaccination rates compared to counties that voted for Trump. As of January 11, 65% of those in Biden counties were fully vaccinated versus 52% of those in Trump counties. Even with the Omicron variant spreading across the country, the gap between Biden and Trump counties has widened from 9 percentage points in June to 13.2 percentage points currently.

There is currently no gap between Biden and Trump counties in the share of those who are fully vaccinated and who have gotten booster doses. However, because of the underlying gap in vaccination rates, there is also a gap in the share who are boosted across the two groups, and that gap has been widening over time.

Vaccines and boosters have shown to be effective against COVID-19, including against the Delta and Omicron variants. With rising hospitalization rates, those unvaccinated remain at greater risk for more severe COVID-19.

Not only has COVID-19 vaccination divided along partisan lines, our polling has found that political partisanship is a stronger national predictor of vaccination than other demographic factors. Partisanship in vaccination rates has borne out at the county level. In our tracking of COVID-19 vaccination rates in counties that voted for Trump compared to counties that voted for Biden, we found a widening gap between April and September of last year.

This update examines vaccination rates since the vaccination effort began, and through January 11, 2022. It also looks at booster dose rates since December 15 (when such data first became available at the county level). It is based on analysis of data on the share of the population fully vaccinated and share of the fully vaccinated who have received a booster dose by county from the Centers for Disease Control and Prevention’s (CDC) COVID-19 Integrated County View and data on the 2020 Presidential election results by county from here (for more detailed methods, see: https://www.kff.org/coronavirus-covid-19/issue-brief/vaccination-is-local-covid-19-vaccination-rates-vary-by-county-and-key-characteristics/). We find that:

• Biden counties continue to have higher COVID-19 vaccination rates than Trump counties. Although overall vaccination rates have risen over time, people living in Biden counties continue to be more likely to be fully vaccinated than those in Trump counties. As of January 11, 65% of those in Biden counties were fully vaccinated compared to 52% of those in Trump counties.
• The gap between Biden and Trump counties has widened over time. The current gap of 13.2 percentage points between the share fully vaccinated in Biden counties versus Trump counties is the highest to date. The difference was about 12 percentage points in the last few months of 2021 and less than 9 percentage points last June.
• There is no gap between Biden and Trump counties in the share of the fully vaccinated with booster doses. At the same time, the share of fully vaccinated individuals who have received a booster dose is the same (37%) in each group. Furthermore, the gap in booster rates between Biden and Trump counties has been very small since December 15, with the largest gap being a 1 percentage point difference. This could reflect a greater inclination on the part of those already vaccinated to get a booster shot, especially given the spread of the Omicron variant, as suggested by recent polling. The same poll found that the unvaccinated remained unmoved.
• Still, given the underlying gap in vaccination rates, there is also a gap in the share who are boosted across the two groups, and that gap has been widening over time. On December 15, the share of those in Biden counties with boosters was 16% compared to 14% in Trump counties, a 2 percentage point difference. By January 11, it had widened to a 6 point difference, with 25% of those in Biden counties with boosters compared to 19% of those in Trump counties.

Vaccinations, and boosters in particular, have been shown to be effective in providing protection against COVID-19, including the Omicron variant. Lower levels of vaccination leave communities more vulnerable to severe illness, especially as cases are surging. In several states, data have demonstrated that hospitalizations and deaths are higher among unvaccinated individuals compared to those who are vaccinated, both during the earlier Delta wave and during the current Omicron surge. The ongoing disparity in vaccination rates across Biden and Trump counties continues to put some communities at greater risk of more severe COVID-19 disease.

The new season of the “American Diagnosis” podcast will explore the impact of hundreds of years of adversity on the health of Indigenous peoples in America, examining the resilience of the Navajo Nation during the covid-19 pandemic as an entry point into this history.

Early in the coronavirus pandemic, the Navajo Nation made headlines for having the nation’s highest covid infection rates. And yet the Navajo people, also known as the Diné, rebounded spectacularly. They rallied around their elders. They banded together to make sure their communities had the food, water, and protective equipment they needed. And they’ve led the way in getting their people vaccinated.

In “Rezilience: Surviving Manifest Destiny,” a 12-episode series premiering Tuesday, Jan. 18, host Dr. Céline Gounder investigates how covid is but the latest chapter in a long history of Indigenous resilience to adversity—on the “rez” (reservation) and beyond. The series will feature conversations with Indigenous leaders, scholars, health workers, activists, historians, and poets.

With this season, its fourth, “American Diagnosis” is becoming part of KFF’s Kaiser Health News (KHN). New episodes will be available every two weeks here. Topics will include (among others):

• The largest accidental release of radioactive material in U.S. history and why you’ve likely never heard of it
• The push to restore Indigenous food sovereignty
• How greater tribal sovereignty could help protect Native women from gender-based violence

The extraordinary lengths some go to provide clean drinking water for their community

KHN also created and produces the popular “What the Health?” podcast, in which host Julie Rovner leads a panel of top reporters, all of them women from leading media outlets, in a weekly discussion about health policy news in Washington, D.C. KHN also co-produces the podcast “Where It Hurts” with St. Louis Public Radio, which examines health system failures in overlooked parts of America, and “An Arm and a Leg,” a podcast created and hosted by former Marketplace reporter Dan Weissmann that focuses on the cost of health care. In addition, KHN has collaborated with This American Life as well as Reveal to produce episodes of these popular podcasts. You can check out these other podcasts produced by KHN here.

About KFF and KHN

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.