There are many factors that state and local officials, as well as individual schools or school systems, are likely to consider as they decide when and how to reopen in the upcoming school year. One set of issues involves the myriad of practical considerations needed to keep students, teachers and others who work at schools safe, particularly those who may be at higher risk of severe illness if they become infected with coronavirus. Doing so is challenging, however, given the concentration of students and teachers in relatively tight spaces, limited budgets to cover additional expenses for personal protective equipment (PPE) and physical space reconfiguration, along with the difficulty in enforcing social distancing and safe habits among school-age children. For these reasons, there is a concern that transmission will occur in schools, potentially placing students and teachers at risk. Our prior analysis shows one in four teachers are at-risk of becoming seriously ill if they contract COVID19. So far, the effects of opening schools in other countries has been mixed.

Another concern is that children may become infected at school and carry the virus back to their homes, potentially infecting others in their household. It is still unclear how frequently children transmit the virus to others. While experts believe children are not the main source of infection in communities, transmission from children does occur. Evidence so far indicates that children are at a lower risk of infection, present with milder symptoms, and are much less likely to die from the infection compared to older adults, but they still could present a risk to others in their household, especially in households with people at higher risk, such as older adults and others with pre-existing conditions. To better understand how big this group might be, we used data by state on family composition to analyze the number of older adults with at least one school-age child at home.

Our analysis finds about 6% of people age 65 or older, or about 3.3 million people, lived in a household with a school-age child (ages 5-18) in 2018 (Figure 1).  Looking the other way, 4.1 million school-age children, about 7% of those between the ages of 5 and 18, live in a household with someone 65 or over.

While nearly half of older adults living with a school-age child are White, older people of color are significantly more likely to live with a school-age child compared to their White counterparts. Nearly one in five (19%) Asian and Native Hawaiian or Other Pacific Islander older adults live with a school-age child, as do 17% of Hispanic older adults, 13% of American Indian or Alaska Native older adults, and over one in ten (11%) Black older adults. In contrast, 4% of older White adults lives with a school-age child. COVID19 already has disproportionately affected people of color, and if schools become a source of infection, older people of color would be at increased risk of exposure through school- age children.

There is considerable variation in the share of older adults living with a school age child across the country (Figure 3), California, Texas, and Florida each have relatively large numbers of seniors who cohabitated with a school-age child (590, 321 and 279 thousand respectively) (Table 1). The highest share is in Hawaii, where 15% of seniors live with a school-age child, and 20% of school-age children lives with an adult age 65 or older.

The risk posed by COVID-19 to older family members is just one of the many factors that state and local officials will need to consider as they develop plans to safely reopen schools, but as we’ve shown here, these decisions could affect several million older adults. In addition, these decisions are likely to disproportionately affect older people of color who are more likely than older White adults to live in households with a school-age child.

A new KFF analysis of what large hospitals nationwide charge for out-of-network COVID-19 tests show a wide range of publicly posted prices — from $20 to $850 for a single test. In many cases, the prices exceed what Medicare pays for COVID testing, which is either $51 or $100 depending on the test.

Federal law now requires private insurers, Medicare and Medicaid to cover COVID-19 tests without any cost to the patient and provides funding to support free testing for some people without health insurance, though it does not guarantee access to no-cost tests for the uninsured. Those laws ensure that most people will not have to pay out of pocket for COVID tests, though limits to the federal requirements mean that some people with and without health insurance could receive bills for COVID-19 tests.

The analysis finds:

• The median price for a COVID-19 was $127, and about half of hospitals price their tests between $100 and $199. About one in five price their tests at more than $200.
• Some hospitals list a discounted rate for self-pay individuals, which range from $36 to $180. Other hospitals indicate that uninsured or self-pay individuals could receive free or discounted care through their financial assistance programs.
• Prices also vary for COVID-19 antibody tests, which are not used to diagnose active infections, from $35 to $300 at hospitals that list their prices.

The analysis set out to examine publicly posted prices at the two largest hospitals in each state and the District of Columbia. Although federal law requires hospitals to make COVID-19 prices publicly available on their websites, prices could only be found for 78 of the 102 hospitals examined. The prices reflect what they would charge for out-of-network services. Data on the negotiated rates for in-network services is not available.

As COVID-19 cases and hospitalizations continue to surge, Gilead has announced that it will charge most payers $3,120 for a five-day inpatient course of treatment with the anti-viral drug remdesivir and a lower price of $2,340 for government purchasers in the U.S. Remdesivir is not a cure for COVID-19, but it has been recommended for the treatment of hospitalized patients with severe COVID-19, based on preliminary evidence suggesting that it may shorten recovery time. Gilead donated the first 120,000 treatment courses of remdesivir, and the federal government has announced it will be distributing 500,000 additional treatment courses of the drug to hospitals through September 2020 at the $3,120 price.

The lower price for remdesivir that is available for government purchasers will not be paid by Medicare. That price is reserved for entities buying directly from the federal government, which includes the Department of Veteran’s Affairs (VA), the Department of Defense, the Public Health Service, and the Coast Guard, which buy drugs directly from the federal government and get price discounts that are required by law. But unlike these other governmental entities, Medicare does not purchase prescription drugs directly for its beneficiaries.

Prescription drugs are reimbursed differently under Medicare Parts A, B and D. The cost of drugs that are administered in inpatient settings covered under Part A is included in Medicare payments to hospitals for each patient stay. Under Part B, Medicare reimburses providers for infused medicines that they purchase directly and administer on an outpatient basis, including many cancer treatments. The vast majority of spending on prescription drugs used by Medicare beneficiaries is through private prescription drug plans that contract with Medicare under the Medicare Part D program. Part D covers retail prescription drugs filled at a pharmacy, typically in pill form but sometimes injected by patients themselves.

Remdesivir is expected to be covered under Medicare Part A, which pays for inpatient care, because the drug was administered on an inpatient basis in clinical trials. In this brief, we discuss how drugs provided in inpatient hospital settings are covered and reimbursed for beneficiaries in traditional Medicare under current law.

How Are Drugs Covered and Reimbursed Under Medicare Part A?

In traditional Medicare, Part A covers inpatient hospitalizations and eligible stays in skilled nursing facilities (SNF). Any drugs that Medicare beneficiaries use during an inpatient stay in a hospital are reimbursed through Part A. Instead of reimbursing providers for those drugs directly, as is done for outpatient infusions covered through Part B, Medicare typically reimburses hospitals a fixed amount for all services received by each patient. Those fixed-amount payments are based on diagnosis-related groups (DRGs) – a payment that includes the cost of any medicines a patient receives during the inpatient stay, as well as costs associated with other treatments and services.

Each DRG has a payment weight assigned based on the average resources required to treat Medicare patients for a set of included conditions. Those weights are then adjusted for hospital-based factors such as local labor costs and case mix, as well as patient-specific factors such as severity and comorbidities. Hospitals that treat a higher share of low-income Medicare and Medicaid patients receive increased reimbursements, as do teaching hospitals. Medicare also makes additional so-called “outlier” payments to reimburse hospitals for cases that are particularly costly.

In some cases, Medicare payments to the hospital are increased for beneficiaries who receive a qualifying new technology, which could mean a new treatment modality, device, or drug. Because DRG payment rates are calculated annually and are based on previous Medicare claims, this can create a lag of two to three years before new technologies are factored into DRG payments. To address that lag, Congress created the “new technology add-on payment,” which is a temporary additional payment for hospitals using qualifying new technologies. In order to qualify for an add-on payment, the new technology is evaluated on several factors, including whether the technology significantly improves clinical outcomes for the Medicare population as compared to other available treatments.

A recent example of a new technology that qualified for an add-on payment is chimeric antigen receptor (CAR) T-cell therapy treatment for cancer. The CAR-T therapies currently on the market are made by Novartis and Gilead’s subsidiary Kite and cost between $373,000 and $475,000 for the treatment itself, with additional costs related to the hospital stay. The new technology payment for these medicines was originally set at $186,500 and was later increased to $242,450. In May 2020, CMS proposed a separate DRG for CAR-T therapies because the period when the treatments are eligible for the new technology add-on payment is set to expire later this year.

The process for applying for a new technology add-on payment takes time. Applications were due in the Fall of 2019 for an add-on payment for 2021. These new technology add-on payments do not need to be offset by other spending reductions, so they can increase overall Medicare spending. At the time Gilead made its pricing announcement, the company did not say if it was planning to ask for an add-on payment.

How Will Hospitals Obtain Remdesivir for Medicare and Other Patients?

According to the federal government’s agreement with Gilead, initial doses of remdesivir will be distributed to hospitals at the $3,120 price. This arrangement is unconventional but reflects the unique challenges associated with ensuring access to remdesivir while supplies of the treatment are constrained. More typically, hospitals purchase inpatient and outpatient medicines through group purchasing organizations (GPOs), which make bulk purchases of prescription drugs, devices and other items for many hospitals at one time. GPOs can often negotiate discounts on drugs, but their ability to negotiate significant discounts for a given drug may be limited if there are no competing products on the market. If new and effective COVID-19 drug treatments enter the market at a later date – or if drugs currently on the market for other purposes are shown to be effective alternatives to remdesivir for COVID-19 treatment – that could increase GPO leverage to obtain discounts for remdesivir in the future or shift utilization to lower cost therapies.

What Are the Implications of the Price of Remdesivir?

Currently, there are a range of DRG payments that hospitals can receive for Medicare COVID-19 patients, depending on a given patient’s principal and secondary diagnoses. According to recently-released Medicare claims data for COVID-19 patients, the average Medicare payment per hospitalization for patients in traditional Medicare is $23,000. For the most severely ill patients who are on a ventilator for more than four days, reimbursement is estimated to be about $40,000. These amounts include a temporary 20% increase in inpatient reimbursement for COVID-19, which was authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act and will last for the duration of the COVID-19 public health emergency.

Assuming no add-on payment or modification of these DRG payments, the price of remdesivir accounts for roughly 8% to 13% of total Medicare payments for DRGs associated with COVID-19. Because the DRG covers both prescription drug costs and other costs of a hospitalization, whether hospitals experience net savings or costs from using remdesivir for any given patient depends in part on the cost of other treatments provided to that patient and whether the use of remdesivir might yield savings through fewer inpatient days or lower utilization of other inpatient services.

The direct cost impact of remdesivir for Medicare, at least in the short term, is limited to spending under traditional Medicare, which covers two-thirds of Medicare beneficiaries. The other one-third of beneficiaries are enrolled in Medicare Advantage plans, which receive capitated payments from the federal government to provide all services covered under Parts A. Medicare Advantage plans negotiate prices directly with providers and the amount of those payments will not change in the near term to account for a newly approved medicine. There is some evidence that Medicare Advantage plans typically pay rates that are similar to payments under traditional Medicare. If Medicare rates per DRG increase under traditional Medicare, they may do the same under Medicare Advantage.

The price of remdesivir is only one side of the total Medicare spending equation. There is also great uncertainty about quantity, i.e., how many Medicare patients will receive the drug? Quantity depends on several factors that cannot yet be measured or known precisely, including how widely the coronavirus continues to spread, how many beneficiaries are infected and become seriously ill enough to require hospitalization, which types of patients receive the drug, duration of treatment, and whether treatment protocols change in the future in a way that modifies who gets the drug, in which setting, and how much is used.

How Does the Price of Remdesivir Affect Beneficiary Out-of-Pocket Costs?

For Medicare beneficiaries with COVID-19 who receive remdesivir during an inpatient stay, the price of drug treatment is not a factor in their costs. What patients pay for inpatient hospital stays is generally unrelated to the cost of any services they receive. Traditional Medicare beneficiaries pay a $1,408 deductible in 2020 and daily copays for extended stays; Medicare Advantage enrollees typically pay a flat amount for each hospital stay and/or day, and most Medicare Advantage plans have waived cost-sharing for COVID-19 treatment. If spending on remdesivir leads to higher Part A spending in the future, there could eventually be some impact on traditional Medicare beneficiaries’ out-of-pocket costs for Part A, because increases in Medicare’s Part A deductible and copays are based on percentage increases in payment rates to hospitals.

Conclusion

While the out-of-pocket cost to Medicare COVID-19 patients will not change under any current or future pricing scenario for remdesivir as long as it is provided as part of an inpatient hospital stay, the drug’s price matters to public programs and private payers. Based on the current $3,120 price of remdesivir for hospitals, it is uncertain whether, over time, Medicare’s current reimbursement for hospitalized COVID-19 patients will be appropriate to fully cover the cost of remdesivir for all patients who need it.

The House Appropriations Committee approved the FY 2021 Labor, Health and Human Services, and Education (LHHS) appropriations bill (and accompanying report) on July 13, 2020. The LHHS appropriations bill includes funding for U.S. global health programs provided to the Centers for Disease Control and Prevention (CDC) and some funding for global health research activities provided to the National Institutes of Health (NIH). The bill also includes emergency funding for COVID-19 response efforts. Key highlights are as follows (see Table 1 for additional detail on global health funding and Table 2 for additional detail on emergency funding for COVID-19):

• Funding provided to CDC for global health totaled $572.8 million, a slight increase of $2 million (0.4%) above the FY 2020 enacted level ($570.8 million) and $40.6 million (8%) above the President’s FY 2021 request ($532.2 million). This includes:
  • $128.4 million for global HIV/AIDS, matching the FY 2020 enacted level and $58.9 million (85%) above the FY 2021 Request ($69.5 million).
  • $9.2 million for global tuberculosis (TB), $2 million (27%) above the FY 2020 enacted and FY 2021 Request levels ($7.2 million).
  • $226 million for global immunization, matching the FY 2020 enacted level and $20 million (10%) above the FY 2021 Request ($206 million). Within this total are the following:
    • Funding for polio totals $176 million, matching the FY 2020 enacted level and $11 million (7%) above the FY 2021 Request ($165 million).
    • Funding for CDC’s other global vaccines/measles program totals $50 million, matching the FY 2020 enacted level and $9 million (22%) above the FY 2021 Request ($41 million).
  • $26 million for parasitic diseases and malaria, matching the FY 2020 enacted level and $1.5 million (6%) above the FY 2021 Request ($24.5 million).
  • $183.2 million for the global public health protection program, which includes funding for global health security, matching the FY 2020 enacted level and -$41.8 million (-19%) below the FY 2021 Request ($225 million). [1]
  • Funding for the Fogarty International Center (FIC) at NIH totaled $86.5 million, a $5.7 million (7%) increase above the FY 2020 enacted level ($80.8 million) and $12.9 million (18%) above the FY 2021 Request ($73.5 million).
  • Emergency funding for COVID-19 response efforts totaled $24.5 billion, of which $1 billion was for global disease detection and emergency response at CDC. See Table 2 for detailed funding on non-global-health funding.

Resources:

• FY2020 Labor, Health and Human Services, and Education Appropriations Bill
• FY2020 Labor, Health and Human Services, and Education Appropriations Report

Table 1 (.xls) below compares global health funding in the FY 2021 House LHHS appropriations bill to the FY 2020 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2020” (P.L. 116-94; KFF summary here) and the President’s FY 2021 request (KFF summary here). Table 2 provides a summary of emergency funding in the FY 2021 House LHHS appropriations bill.

[1] Funding for “Global Public Health Protection,” includes “Global Disease Detection and Emergency Response,” “Global Health Security,” and “Global Public Health Capacity”. The full breakdown among areas is not yet known for the House FY21 bill.

As the nation continues to struggle to contain the spread of coronavirus, there is considerable debate about when and how to reopen schools. Education is primarily a state and local concern, and although they have received mixed guidance from federal officials, the decisions over reopening will be made at the state and local level.

One of the myriad of issues these officials will face will be how to keep school employees safe at work, particularly those who are at increased risk of serious illness if they become infected with coronavirus. The Centers for Disease Control have identified a number of factors that put individuals at increased risk of serious illness if infected; these include several health conditions, including having diabetes, chronic obstructive pulmonary disease (COPD), heart disease, moderate or severe asthma, having a body mass index (BMI) of greater than 40, or having a compromised immune system, which for example, may occur during cancer treatment. Being age 65 and older also is considered to be a risk factor. In a previous study, we reported that almost one in four workers are at higher risk of severe illness if they were to become infected. While children are at less risk for serious illness from coronavirus than adults and often have mild or no symptoms when infected, the teachers and other adult staff in schools face higher risk. We used a similar approach to look at teachers and other instructors, and we find that one in four teachers (24%, or about 1.47 million people), have a condition that puts them at higher risk of serious illness from coronavirus (Figure). This percentage is the same as the one we found for workers overall; the challenge for school systems and for teachers in particular is the sheer volume of traffic and tight quarters in many school environments, which may make social distancing a significant challenge in many settings. For higher-risk teachers, failure to achieve safe working conditions could have very serious results.

Given the difficulty of maintaining social distancing in a crowded school environment, these at-risk teachers may be reluctant to return to their schools until infection rates fall to much lower levels. At the same time, teaching is not a particularly high-paying profession, so many teachers may feel economically compelled to return to their schools if they reopen, even if those teachers do not feel safe. How state and local officials balance the desire to reopen schools and other facilities with the need to assure the safety of students, parents, and school personnel will have significant health and economic consequences for both people and the communities they live in. Assuring the safety of teachers and others at higher risk of serious illness from coronavirus is a crucial part of the calculation around reopening.

Methods

This analysis uses data from the 2018 National Health Interview Survey (NHIS) to look at the share of workers who would be at increased risk of becoming seriously ill if they become infected with coronavirus. The risk factors we were able to analyze were having diabetes, chronic obstructive pulmonary disease (COPD), heart disease, a body mass index (BMI) above 40, and a functional limitation due to cancer. As we previously discussed we included 62% of those with asthma none of the other risk factors, as at risk. In addition, the CDC criteria consider all people over age 65 to be at increased risk. We define teachers as individuals whose occupation is “primary, secondary, and special education school teachers” or “other teachers and instructors,” and are employed in the “Education Services Industries” industry. Only teachers who are currently working, looking for work or on a temporary absence such as a planned vacation, maternity leave or temporary medical leave were included.

Every week we recap the past week in the coronavirus pandemic from our tracking, policy analysis, polling, and journalism.

The number of COVID-19 cases in the U.S. is expanding rapidly. On Wednesday, July 8, the United States surpassed another grim milestone when the day ended with more than 3 million confirmed cases. While the locations of outbreaks continue to move across the country, surging in some states and falling in others, much of the recent case growth has been occurring in the South and West.

As of July 8^th, we identified 33 states as hotspots (experiencing recent increases in cases for 14 days and an increasing positivity rate or positivity rate over 10%), 23 of which were in the South and West. The shifting surge in outbreaks to the South and West will likely exacerbate the disparate effects of COVID-19 for people of color, who already are facing a higher burden of cases, hospitalizations, and deaths as well as a larger economic toll compared to their White counterparts. Hispanic people may be particularly hard hit as outbreaks rise in these regions of the country.

The coronavirus pandemic and resulting economic downturn have taken a toll on mental health for many people, with over 30% of adults in the U.S. now reporting symptoms consistent with an anxiety and/or depressive disorder. KFF polling during the pandemic has consistently found large shares of the public saying that worry and stress related to the coronavirus have had a negative effect on their mental health. This is coming at a time when mental health resources were already strained, and people with mental health diagnoses often face barriers to care. Our new fact sheets examine national and state-level data on mental health prior to the pandemic, which is expected to place additional strains on the system.

Here are the latest coronavirus stats from KFF’s tracking resources:

Global Cases and Deaths: Total cases worldwide passed 12 million between July 2 and July 9– with an increase of approximately 1.4 million new confirmed cases. There were also approximately 33,500 new confirmed deaths worldwide between July 2 and July 9, bringing the total to approximately 555,000 confirmed deaths.

U.S. Cases and Deaths: Total confirmed cases in the U.S. surpassed 3 million this week. There was an approximate increase of nearly 374,500 confirmed cases between July 2 and July 9. Approximately 4,500 confirmed deaths in the past week brought the total to over 133,000 confirmed deaths in the U.S.

U.S. Tests: There have been over 38 million total COVID-19 tests with results in the U.S. In the past 7 days, 1.4% of the total U.S. population was tested.

Race/Ethnicity Data: Black individuals made up a higher share of cases/deaths compared to their share of the population in 30 of 48 states reporting cases and 33 of 44 states reporting deaths. In 6 states (KS, WI, MO, MI, TN, and IL) the share of COVID-19 related deaths among Black people was at least two times higher than their share of the total population. Hispanic individuals made up a higher share of cases compared to their share of the total population in 37 of 45 states reporting cases. In 7 states (KY, TN, IA, WI, NE, SD, and MN), Hispanic peoples’ share of cases was more than 4 times their share of the population. COVID-19 continues to have a sharp, disproportionate impact on American Indian/Alaska Native as well as Asian people in some states.

Adults at Higher Risk of Serious Illness if Infected with Coronavirus: 38% of all U.S. adults are at risk of serious illness if infected with coronavirus (92,560,223 total) due to their age (65 and over) or pre-existing medical condition. Of those at higher risk, 45% are under age 65 and at increased risk of serious illness if infected with coronavirus due to their existing medical condition such as such as heart disease, diabetes, lung disease, uncontrolled asthma or obesity. Among nonelderly adults — low-income, American Indian/Alaska Native & Black adults have a higher risk of serious illness if infected with coronavirus. In both cases – for race and household income – the higher risk of serious illness if infected with coronavirus is chiefly due to a higher prevalence of underlying health conditions and longstanding disparities in health care and other socio-economic factors.

State Reports of Long-Term Care Facility Cases and Deaths Related to COVID-19 (Includes Washington D.C.)

• Data Reporting Status: 47 states are reporting COVID-19 data in long-term care facilities, 4 states are not reporting
• Long-term care facilities with known cases: 11,644 (across 44 states)
• Cases in long-term care facilities: 283,973 (across 43 states)
• Deaths in long-term care facilities: 56,143 (in 42 states)
• Long-term care facilities as a share of total state cases: 12% (across 43 states)
• Long-term care facility deaths as a share of total state deaths: 44% (across 42 states)

State Social Distancing Actions (includes Washington D.C.):

• Status of reopening: Proceeding in 26 states, paused in 10 states, new restrictions in 7 states, reopened in 8 states
• Stay At Home Order: Original stay at home order in 6 states, stay at home order eased or lifted in 39 states, no action in 6 states
• Mandatory Quarantine for Travelers: Original traveler quarantine mandate in place in 9 states, new traveler quarantine mandate in place in 3 states, traveler quarantine mandate eased or lifted in 16 states, no action in 23 states
• Non-Essential Business Closures: Some or all non-essential businesses permitted to reopen (some with reduced capacity) in 43 states, new business closures or limits in 3 states, no action in 5 states
• Large Gatherings Ban: Original gathering ban/limit in place in 5 states, gathering/ban limit expanded or lifted in 42 states, new gathering/ban limit in place in 3 states, no action in 1 states
• Restaurant Limits: Restaurants reopened to dine-in service in 48 states, newly closed to dine-in service in 1 state, new capacity limits in 1 state, no action in 1 state
• Bar Closures: Closed in 9 states, reopened in 34 states, newly closed in 8 states
• Face Covering Requirement: Required for general public in 23 states, required for certain employees in 18 states, allows local officials to require them for general public in 5 states, no action in 7 states
• Primary Election Postponement: Postponement in 15 states, no postponement in 36 states
• Emergency Declaration: There are emergency declarations in all 51 states.

State COVID-19 Health Policy Actions (Includes Washington D.C.)

• Waive Cost Sharing for COVID-19 Treatment: 3 states require, state-insurer agreement in 3 states; no action in 45 states
• Free Cost Vaccine When Available: 9 states require, state-insurer agreement in 1 state, no action in 41 states
• States Requires Waiver of Prior Authorization Requirements: For COVID-19 testing only in 5 states, for COVID-19 testing and treatment in 6 states, no action in 40 states
• Early Prescription Refills: State requires in 17 states, expired in 1 state, no action in 33 states
• Premium Payment Grace Period: Grace period extended for all policies in 3 states, grace period extended for COVID-19 diagnosis/impacts only in 4 states, expired in 9 states, no action in 35 states
• Marketplace Special Enrollment Period: Marketplace special enrollment period still active in 5 states, ended in 7 states, no special enrollment period in 39 states
• Paid Sick Leave: 13 states enacted, 2 proposed, no action in 36 states

State Actions on Telehealth (Includes Washington D.C.)

• New Requirements for Coverage of Telehealth Services: Parity with in-person services in 6 states, broad coverage of telehealth services in 6 states, limited coverage of telehealth services in 6 states, no action in 33 states
• Waiving or Limiting Cost-Sharing for Telehealth Services: Waived for COVID-19 services only in 7 states, waived or limited for all services in 8 states, expired in 1 state, no action in 35 states
• Reimbursement Parity for Telehealth and In-Person Services: Required for all services in 17 states, no action in 34 states
• Require Expanded Options for Delivery of Telehealth Services: Yes in 34 states, for behavioral health services only in 1 state, expired in 1 state, no action in 15 states

Approved Medicaid State Actions to Address COVID-19 (Includes Washington D.C.)

• Approved Section 1115 Waivers to Address COVID-19: 4 states (HI, NC, NH, WA) have approved waivers
• Approved Section 1135 Waivers: 51 states have approved waivers
• Approved 1915 (c) Appendix K Waivers: 50 states have approved waivers
• Approved State Plan Amendments (SPAs): 46 states have temporary changes approved under Medicaid or CHIP disaster relief SPAs, 1 state has an approved traditional SPA
• Other State-Reported Medicaid Administrative Actions: 51 states report taking other administrative actions in their Medicaid programs to address COVID-19

The latest Coronavirus Policy Watch posts:

• Growing COVID-19 Hotspots in the U.S. South and West will Likely Widen Disparities for People of Color (CPW Post, News Release)

The latest KFF COVID-19 resources:

• Mental Health and Substance Use State Fact Sheets (State Data, News Release)
• Updated: State Data and Policy Actions to Address Coronavirus (Interactive)
• Updated: COVID-19 Coronavirus Tracker – Updated as of July 8 (Interactive)
• Updated: Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19 (Issue Brief)
• Trump Administration Notifies U.N. Of U.S. Withdrawal From WHO; Move Draws Concern, Criticism From Lawmakers, Global Health Experts (KFF Daily Global Health Policy Report)

The latest KHN COVID-19 stories:

• Colorado, Like Other States, Trims Health Programs Amid Health Crisis (KHN)
• Lost On The Frontline (KHN, The Guardian)
• Amid Surge, Hospitals Hesitate To Cancel Nonemergency Surgeries (KHN, LA Times)
• KHN’s ‘What The Health?’: ‘Open The Schools, Close The Bars’ (Podcast)
• As COVID Testing Soars, Wait Times For Results Jump To A Week — Or More (KHN, LA Times)
• Could Trump’s Push To Undo The ACA Cause Problems For COVID Survivors? Biden Thinks So. (KHN)
• High Court Allows Employers To Opt Out Of ACA’s Mandate On Birth Control Coverage (KHN)
• Analysis: How A COVID-19 Vaccine Could Cost Americans Dearly (KHN, NY Times)
• ‘Please Tell Me My Life Is Worth A LITTLE Of Your Discomfort,’ Nurse Pleads (KHN)
• How We Reported ‘Underfunded And Under Threat’ (KHN, AP)
• In Texas, Individual Freedoms Clash With Efforts To Slow The Surge Of COVID Cases (KHN)
• COVID Cuts A Lethal Path Through San Quentin’s Death Row (CHL, Daily Beast)
• COVID Catch-22: They Got A Big ER Bill Because Hospitals Couldn’t Test For Virus (KHN, NPR)
• What Seniors Should Know Before Going Ahead With Elective Procedures (KHN, NY Times)
• COVID-Tracking Apps Proliferate, But Will They Really Help? (CHL, SF Chronicle)
• Lost On The Frontline (KHN, The Guardian)
• Life Beyond COVID Seclusion: Seniors See Challenges And Change Ahead (KHN)
• Coronavirus Crisis Disrupts Treatment For Another Epidemic: Addiction (KHN, LA Times)
• Social Media Image About Mask Efficacy Right In Sentiment, But Percentages Are ‘Bonkers’ (KHN, PolitiFact)

The COVID-19 pandemic and resulting economic downturn are taking a toll on mental health for many Americans, with large shares of the public saying that related worry and stress is having a negative effect on their mental health.

A new KFF analysis and series of state fact sheets examine mental health and substance use disorder needs in the states and capacity to meet residents’ needs prior to the pandemic, which is expected to place additional strains on the system. Average weekly data for June 2020 found that 36.5% of adults in the U.S. report symptoms of anxiety or depressive disorder, up from 11.0% in 2019. Louisiana (42.9%), Florida (41.5%) and Oregon (41.3%) have the highest shares reporting such symptoms, while Wisconsin (27.2%), Minnesota (30.5%) and Nebraska (30.6%) have the lowest.

The analysis highlights the wide range of needs and resources across states. For example:

• The share of adults with any diagnosable mental, behavioral or emotional disorder ranged from a high of 25.3% in Utah to a low of 16.1% in New Jersey in 2017-2018. Utah also has the highest prevalence of adults with serious mental illness (6.4%), while New Jersey has the lowest (3.6%).
• Nationally, more than a third (34.3%) of adults with serious mental illness did not receive treatment. This includes about half of those in Alaska, Louisiana and Georgia, and less than a quarter of those living in Tennessee, Vermont, South Dakota and Washington State.
• Suicide is one of the top 10 causes of death in the U.S. and has increased in almost every state over time. Age-adjusted suicide rates are about three times as high in New Mexico, Montana and Wyoming as they are in the New York, New Jersey and the District of Columbia.
• Deaths due to drug overdose increased nearly fourfold nationally from 1999 to 2018. West Virginia and Delaware have the highest age-adjusted overdose death rates – more than five times the rate in South Dakota and Nebraska, which have the lowest rates.

The state fact sheets compile key information on mental illness prevalence; substance abuse and related deaths; suicide; mental health workforce; unmet need and barriers to care; private insurance coverage and costs; and Medicaid benefits.

They are designed to allow policymakers, health care professionals, patient groups and journalists to quickly assess the mental health and substance use landscape in each of the 50 states and the District of Columbia.

The fact sheets draw on dozens of indicators in KFF’s State Health Facts data collection related to mental health and substance use disorder. The data collection allows for quick comparisons across states and allows the creation of custom reports for select states and indicators.

This work was supported in part by Well Being Trust. We value our funders. KFF maintains full editorial control over all of its policy analysis, polling and journalism activities.

The geographic shift of the nation’s worst COVID-19 outbreaks to states in the South and West is expected to intensify the well-documented disparities in the health and economic impacts of the pandemic on people of color — especially Hispanics, according to a new KFF analysis.

Twenty-three of the 33 states identified as coronavirus hotspots as of July 8 are in the South and West. The 23 states account for just over half (51%) of the nation’s overall population, but are home to more than 7 in 10 of all Hispanic individuals (71%) in the U.S. Overall, nearly two-thirds of all people of color (62%) in the U.S. reside in these states, compared to less than half of Whites (43%). Moreover, in a number of these states, people of color account for a larger share of the population compared to their share of the U.S. population overall.

Data already show that the pandemic has taken a harder toll on people of color in many of these states, with these groups accounting for a higher share of cases and deaths relative to their share of the population. The disproportionate impacts of COVID-19 for people of color mirror and compound underlying inequities in social and economic circumstances that leave people of color at higher risk of being exposed to the virus, experiencing serious illness if they contract the virus, facing barriers to accessing health care, and experiencing financial challenges due to the economic disruption caused by the pandemic.

The findings point to the importance of continuing to prioritize health equity as part of response and relief efforts and directing resources to communities who are at the highest risk and experiencing disproportionate effects.

As local, state and federal official debate when and how to reopen schools across the nation, a new KFF analysis estimates nearly 1.5 million teachers have health conditions that put them at higher risk of serious illness if they were to contract COVID-19. This represents nearly one in four (24%) of all teachers around the country, creating challenges for schools trying to provide in-person classroom education safely for students and teachers alike.

While children are at less risk for serious illness from COVID-19 than adults and often have mild or no symptoms when infected, teachers and other adult staff in schools face higher risk.

The analysis finds teachers are similar to the broader workforce in terms of the share who are considered high risk for serious illness from COVID-19 as identified by the Centers for Disease Control and Prevention.  Factors that put someone at risk include being at least 65 years old; having diabetes, chronic obstructive pulmonary disease, heart disease, or moderate or severe asthma; being severely obese; and having a compromised immune system, as often occurs during cancer treatment.

Education is primarily a state and local concern, and although they have received mixed guidance from federal officials, decisions over reopening will be made at the state and local level.

One challenge for school systems is the sheer volume of traffic and tight quarters in many school environments, which may make social distancing difficult in the classroom and other settings. How state and local officials balance the desire to reopen schools with the need to assure the safety of students, parents, and school personnel will be have significant health and economic consequences for people and communities.