As Florida closes all of its COVID-19 mass public testing, vaccination and treatment sites due to a lack of federal funding, Miami-Dade will continue to offer tests and vaccines free of charge at more than two dozen sites around the county using a different national resource: the Federal Emergency Management Agency.
Though Miami-Dade Mayor Daniella Levine Cava said FEMA would reimburse the county “100%” for providing tests and vaccines to the uninsured through July 1, it’s not clear that the county will need to rely on FEMA that long after a bipartisan group of US senators announced a deal on a $10 billion coronavirus aid package late Monday.
The agreement, which sets aside $5 billion for therapeutics, $750 million to prepare for future variants and the remainder for vaccines and testing, still needs approval from both chambers of Congress, and President Biden’s signature.
Until then, Miami-Dade will use FEMA’s Public Assistance Program to pay for tests and vaccines for the uninsured, Levine Cava said in a memo to commissioners on April 1.
“We will continue to make testing and vaccination as accessible as possible for those with or without insurance, to keep our community protected and our economy growing,” Levine Cava said in an emailed statement. “We will continue testing our wastewater and sequencing test samples to help monitor for new variants, to stay ahead of the curve in case we face future surges.”
New COVID Cases Rising
The issue of funding comes as new reported infections in Florida are rising due to the BA.2 subvariant, which now makes up 60% of new COVID-19 cases in the Southeastern United States, which includes Florida, according to CDC monitoring data.
During the week ended April 5, Florida added 1,505 cases and 39 deaths per day, on average, according to Miami Herald calculations of data published by the CDC — continuing a trend of rising cases that represent the first increase in over a month.
READ MORE: Florida COVID weekly update: New cases trend up for the first time in a month
For individuals with health insurance, COVID-19 tests, treatments and vaccines are typically covered. But the delay in federal pandemic response funding has already led to a reduction in the nation’s supply of monoclonal antibodies that can reduce the risk of hospitalization and death in infected persons.
The Florida Department of Health said the state will continue to distribute COVID-19 monoclonal antibody treatments received from the federal government, which has purchased all of the medications and distributes them to states. But the White House warned in mid-March that the federal government would soon run out of money to buy more monoclonal antibodies, forcing it to scale back allocations to states by more than 30% unless Congress renewed funding by late March.
This week, as federal funds dried up, Florida closed more than a dozen public sites that provided monoclonal antibody treatments free of charge throughout the state, said Steve Vancore, a spokesman for CDR Health, a logistics company contracted to run the sites.
CDR Health has administered more than 4 million COVID-19 tests, 2.7 million vaccines and more than 150,000 monoclonal antibody treatments throughout Florida during the pandemic, Vancore said. But after this week, the company will only offer testing, vaccination and monoclonal antibody treatments at its privately owned clinic in Tallahassee for insured and self-paying patients.
READ MORE: ‘Healthiest people get monoclonal antibodies.’ COVID therapy goes to those who need it less
In Miami-Dade, CDR Health operated state-funded monoclonal antibody treatment sites at Miami Dade College North and Tropical Park. Those sites no longer provide therapeutics but continue to offer vaccination and testing.
Lack of federal funds for COVID-19
Pending renewal of pandemic funding from Congress, the federal government has run out of money to buy COVID-19 tests, treatments and vaccines and provide them to individuals for free. Monoclonal antibody treatments promoted by Gov. Ron DeSantis, and new antiviral pills that reduce disease severity, also are bought in bulk by the federal government and distributed to states, pharmacies, community health centers and other providers for free.
But in March, the White House said the government would be unable to fulfill a planned order for monoclonal antibodies. The Biden administration, which had requested $22.5 billion in emergency funding, also warned that federal programs created to help states and local governments respond to the pandemic would have to end.
As a result, the federal government’s Health Resources and Services Administration or HRSA COVID-19 Uninsured Program stopped accepting reimbursement claims for COVID-19 testing and treatment services on March 22 and stopped accepting claims for vaccine administration on Tuesday.
An outline of the $10 billion agreement announced Monday by Sen. Chuck Schumer of New York, the Democratic majority leader, and Sen. Mitt Romney, a Utah Republican, does not include funding for the HRSA uninsured program. But the deal reportedly has President Biden’s support even though it is less than half of what the White House originally requested.
Uninsured may have to pay for COVID testing, treatment
Though the HRSA program has stopped accepting claims for the uninsured, the current supply of tests, treatments and vaccines was purchased by the federal government and remains free to all individuals regardless of their health insurance coverage status.
But once that supply runs out, the federal government cannot buy more until Congress approves an appropriation. That means people without health insurance will likely have to pay for testing and treatment or rely on safety net hospitals and programs.
The cost of a PCR test — the kind used at hospitals and many state sites — can range from $100 to $200. GlaxoSmithKline’s monoclonal treatment, sotrovimab, costs $2,100 per dose. A dose of Regeneron’s monoclonal antibody treatment costs the same amount.
Without free vaccines, tests and treatments, many Florida adults may be reluctant to seek care for COVID-19, and those who do may need public resources to cover the costs.
About 19.5% of Floridians ages 18 to 64 years old had no health insurance coverage in 2020 — compared with a national average of 14% for the same group, according to the National Health Interview Survey conducted by the Centers for Disease Control and Prevention.
In Miami-Dade, the taxpayer-owned Jackson Health System has seen a decline in the number of uninsured patients during the pandemic, said Mark Knight, chief financial officer. Part of the reason was an overall decline in visits to the emergency room, which many uninsured patients often use as a primary care provider.
As patient volumes have increased, though, Jackson Health is starting to see a return to a more familiar pre-pandemic mix of patients, including more people without health insurance, Knight said
That means the loss of the HRSA fund will add financial strain to Florida’s largest safety net hospital if Congress does not restore funding. In March, Florida legislators voted to eliminate a Medicaid funding pool that subsidized Jackson Health and about two dozen other Florida hospitals with a disproportionately high share of low-income and uninsured patients.
And two years into the pandemic, Jackson Health and other hospitals are struggling with staff burnout and added labor costs for overtime pay, bonuses and travel agency staffing. Knight said Jackson Health has about 1,000 job vacancies, including about 400 for registered nurses, because there’s a shortage of qualified workers and stiff competition for them.
“The impact of all these things is negative,” he said.
READ MORE: ‘We never ran from it.’ COVID left emotional scars on South Florida’s healthcare heroes
Preparing for COVID resurgence
With the omicron subvariant BA.2 fueling an uptick in cases, and a potential pandemic resurgence on the horizon, Miami-Dade’s Emergency Management Director Charles Cyrille said he’s keeping a close eye on the share of recent local tests that come back positive, known as the positivity rate.
Cyrille said most of the county’s 30 sites will continue to provide both tests and vaccines, though some will only provide testing, and hours will vary.
Once FEMA funding runs out, if Congress does not renew COVID-19 response funding Cyrille said he knows, “There will be difficult decisions.”
Cyrille said Miami-Dade’s testing and vaccination “infrastructure is way larger than anyone else in the state. We lead the state in our response efforts.” He said the county was able to respond quickly to the rise of the omicron variant in December and January because it had kept many of those services available to the public.
But Cyrille said he knows that the county could not have done it alone.
“The federal government has shouldered 100% of this,” he said. “It’s not possible to do it without them.”
This story was originally published Apr 5, 2022 4:51 PM.