Skip to Main Content
Don't have an account? Create Account
Don't have an account? Create Account

States Respond to COVID-19: New Balance Billing Efforts

On April 5, Connecticut Gov. Ned Lamont (D) released an executive order to prevent balance billing, or surprise medical bills, during the COVID-19 pandemic and cap the price of bills larger than the Medicare rate for specified services.

Five other states have implemented similar rules during the crisis:

  • The Ohio Department of Insurance issued a bulletin requiring out-of-network insurers to use the highest negotiated in-network provider rates with respect to emergency services, instead of out-of-network rates, to protect consumers from potential out-of-network expenses related to COVID-19;
  • The Idaho and North Dakota departments of Insurance asked out-of-network providers to accept the highest negotiated in-network reimbursement for services related to COVID-19 treatment and testing; and
  • The California and New York insurance departments, which already limit surprise medical billing, issued reminders that the surprise billing laws also apply to services related to COVID-19.

States Seek Medicaid Retainer Payments

Governors are asking the Trump administration to allow Medicaid retainer payments during the COVID-19 pandemic to help providers and ensure business lost during the crisis does not harm essential hospitals and other safety-net organizations.

For example, Arizona has been granted permission to make Medicaid retainer payments for home and community based services; however, Gov. Dug Doucey (R) expressed interest in further expanding retainer payments to all providers. Meanwhile, Georgia requested Medicaid retainer payments for hospitals and skilled nursing facilities.

The National Association of Medicaid Directors sent a letter urging leaders of the Center for Medicaid and CHIP Services and the Office of Management and Budget to allow retainer payments to essential Medicaid providers through Section 1115 waivers during the pandemic.

Additional Section 1135 Waivers Approved

The administration has approved Section 1135 waivers for 47 states, the District of Columbia, and the U.S. Virgin Islands in response to the COVID-19 pandemic. The waivers aim to ensure proper health care services and resources are available to meet demand during the emergency.

Visit the America’s Essential Hospitals coronavirus resource page for more information about the outbreak.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.



About the Author

Abigail Painchaud is a policy associate at America's Essential Hospitals.

Previous Next
Test Caption
Test Description goes like this