SACRAMENTO — California is still offering free covid testing to uninsured residents, even though the federal government has run out of money to pay for it.
As Congress debates whether to invest more money in free testing, California is building on programs it already had in place: special state-based coverage for uninsured Californians, school tests and free tests offered by clinics, counties and other groups. In the absence of free options, people without health insurance could pay up to several hundred dollars disbursed depending on where they are tested.
At the same time, demand for community testing — from residents with and without insurance — has dropped precipitously.
On a recent Thursday, only three people could be tested at seven Sacramento County testing sites. Staff members at these locations — from the once-bustling mass testing site at the state fairgrounds to a tiny kiosk in a church parking lot — said almost no one showed up anymore, even though the tests are still important to monitor and reduce the spread of covid-19. They mostly see regulars showing up for routine tests required by their employer or school.
Sacramento County public health officer Dr. Olivia Kasirye said the county sends samples to a state lab at no cost to the county, which has helped keep free testing services running. California is quietly ending its contract with a central lab, but the state says it will shift testing to a network of commercial labs. State officials told California Healthline there would be no changes for patients.
“I think we can maintain the services” for now, but the future is uncertain, Kasirye said.
Since the start of the pandemic, the federal government has reimbursed providers for testing, treating and vaccinating uninsured people for covid-19. But the Administration of health resources and services stopped accepting claims for tests and treatments on March 22 and for vaccinations on April 5, saying the money had run out. The government reimbursed suppliers $36 to $143 per test.
Since then, states and counties have been monitoring their case rates and coffers to see if they can continue testing uninsured residents.
In Alabama, Dr. Scott Harris, the state health officer, said offering free testing to people five days a week through county health departments is “probably not something we we’ll be able to endure much longer,” especially in pockets of the state with large uninsured populations.
“We won’t have any service for these people,” Harris said. “And no possibility of inducing suppliers to see them.”
The Congress returns from recess at the end of April but may not renew the program. Lawmakers had previously considered expanding it, but chose not to include money for it in a $10 billion covid funding deal which has been pending since early April.
The uninsured group Covid-19
Health care advocates say California was able to continue free testing for uninsured people, including residents without legal documentation, because of the way it used separate federal funding. Although 15 other states also leveraged pandemic support, advocates believe California has extended the benefits the most.
In August 2020, California created an insurance program with pandemic relief funds to cover covid-related treatments, tests and vaccines for those who are uninsured or whose insurance plans do not cover not these services. The Covid-19 uninsured group essentially acts like Medicaid for covid, but without income requirements. It’s different from the traditional Medicaid program of Medi-Cal, California, which is for low-income people.
Coverage will end when the Federal Public Health Emergency occurs. On April 13, the US Department of Health and Human Services renewed the emergency declaration for 90 days, extending it to mid-July.
The state program is a smart way to use federal dollars, said David Kane, senior attorney at the Western Center on Law & Poverty. But he noted that there were downsides. People have to be registered before they can get services, and they can’t register themselves. Only certain health care providers, mainly hospitals and clinics, can enroll people.
“The program was never meant to exist in isolation,” Kane said, “but now it does.”
About 291,000 people were enrolled in the program as of April 4, according to Anthony Cava, spokesman for the state Department of Health Services, which administers Medi-Cal. Approximately 3.2 million Californians, or about 9.5% of people under 65, are uninsured.
Kane suggested people find a qualified supplier from a maintained database by the Ministry of Health Care Services or by calling Medi-Nurse line and register as soon as possible, especially if they are used to going to a test site and not paying anything.
The challenge is to get people to sign up before they get sick or need a test, Kane said, and to sustain the program with the additional patient load.
Public schools are another major source of free testing in California.
California distributed more than 14.3 million home tests to schools before the pupils leave for the spring holidays. Schools in turn distributed the rapid tests to families so they could screen students before sending them back to campus. The state had a similar program for winter vacations.
Winter testing has been “incredibly effective,” according to Primary Health, the company that runs the program for the state. On 77% of K-12 families voluntarily reported their results to a sample of schools, according to the company.
Additionally, the state is paying Primary Health to operate more than 7,000 free testing sites — most of which are in schools — using leftover federal covid relief money given to states at the start of the pandemic.
The duration of this funding is unclear.
“It looks like the federal government is stepping back and saying this part of health care is health care as we know it,” said Abigail Stoddard, executive director of government and public programs at Primary Health.
Stoddard’s conversations with schools outside of California vary. Instead of conducting surveillance testing to determine if the virus is circulating on campus, as California does, many are turning to testing only children with symptoms, she said.
For example, Primary Health operates in minnesotawhere schools apply for grants to fund the tests and will decide whether the tests will be for sick, healthy students or just staff members.
Free local tests
Free testing is still available in California at some hospitals, community clinics, local health departments and private companies working with the state, though it’s unclear how long these options last.
In Sacramento County, the loss of federal funding to test the uninsured has gone mostly unnoticed so far. “Our hope is that we have enough services and resources in the community that removing supplemental coverage doesn’t have a huge impact,” Kasirye said.
The county health department is still offering free community testing to uninsured people every day in churches or community centers.
But they can become harder to find. Testing company Curative previously offered free lab PCR testing and rapid antigen testing statewide, but now that federal funding has run out, it is only offering free PCR testing to uninsured people. The company also reduced the number of its sites, from 283 on April 14 to 135 on April 19.
In some states, Curative has either stopped testing uninsured people — or billed them from $99 to $135 per test.
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