As Geraldine Long approached the front door of the community center in Southwest Baltimore, José de Jesús Mendoza rushed to greet her: Had she been vaccinated against COVID-19? Did she need a boost?

A community outreach worker with the Baltimore City Health Department, Mendoza has been a staple at the Fayette Street Outreach center, where he and a small team set up shop once a month to offer vaccines along with other supplies such as free condoms and diapers.

The city’s vaccination efforts are entering their third year but have remained constant, with “ambassadors” such as Mendoza answering questions and directing people at small mobile clinics rather than mass vaccination sites offered by the state and some neighboring counties. City officials have no plans to stop offering shots in intimate settings — or conveying their importance in stemming hospitalizations and deaths — even as the federal public health emergency comes to an end May 11.

But for many Marylanders, this spring will mark a shift in how they access COVID tests and vaccines, and who pays for them. Federal funding and other measures that have made the supplies free to many will begin to wind down. Here’s what to know about the coming changes:

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Why is the public health emergency ending?

Federal health officials announced an end to the emergency order citing an 80% drop in hospitalizations and deaths nationwide since the pandemic’s peak a year ago, but there are still hundreds of deaths a day nationally and up to a dozen in the state. Hospital and medical associations continue to urge people to get vaccinated and boosted with the newest bivalent vaccine, which offers more protection against the latest strains.

This doesn’t mean the threat from COVID-19 is over, or that outreach and education about the importance of vaccines and other measures will end, especially in areas with lower vaccination rates.

The pandemic hit minority and low-income neighborhoods harder, with higher hospitalization and death rates, particularly in the pandemic’s early days. Access to tests and vaccines has been more limited than in other neighborhoods. The gaps have closed but not entirely — according to government tracking, nearly 92% of Maryland residents have gotten at least one dose, compared with 86% of Baltimore City residents.

State health officials say they will ramp up their messaging as the deadline approaches to make sure people are aware of how the end of the emergency declaration may affect them.

What will happen to Baltimore’s free mobile clinics?

City health officials plan to distribute vaccines, as well as tests and treatments, for free at city sites even after federally funded supplies dwindle in coming months — a message they hope doesn’t get lost as the state and federal health leaders seek to spread the word out about ways to access shots and supplies once the emergency declaration ends.

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Dr. Letitia Dzirasa, Baltimore’s health commissioner, says the mobile vaccination clinics have been labor-intensive but necessary. Some residents struggle to find transportation to appointments outside their neighborhoods, while others have been dodging shots they don’t trust.

“We knew going in that there was the potential for great inequities,” she said, “and who received access to support and treatment, who received access to testing, who received access to vaccines.”

The mobile clinic at the Fayette Street Outreach Center offers vaccines along with other supplies, such as free condoms and diapers, once a month. (Kaitlin Newman/The Baltimore Banner)

If the U.S. Congress continues to balk at approving further funds, Baltimore officials plan to tap American Rescue Plan dollars to replenish supplies for a time at city-supported sites. The community ambassadors vaccine program is funded until the end of 2024.

The continued push is essential, said Dr. Josh Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School for Public Health.

Sharfstein, a former city health commissioner, said the city’s “creative and diligent efforts” have saved lives. “They’re right to keep spreading the word about COVID,” after the public health emergency ends.

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He said the mobile vaccination clinics and door-to-door vaccination efforts will be difficult to sustain as other public health priorities emerge. The end of the emergency declaration will add to the challenges, as people find they have additional costs depending on their insurance and where they seek services.

“When costs go up, people use services less; that’s why they made it free,” he said. “I think we’ll see the reemergence of some inequities that may have been minimized by emergency provisions.”

When will patients have to pay for vaccines and tests?

Shots and at-home tests handed out at vaccination centers, libraries and through federal mail order will be free while federal supplies last, probably for months, according to federal health officials. Then, for most people, public and private insurance will take over. Insurers may charge a share of the cost of vaccines at doctors’ offices and pharmacies, or even at publicly run sites.

The U.S. Centers for Disease Control and Prevention has added COVID-19 vaccines and boosters to its list of routine vaccines for adults and children, though like the flu vaccines, they are not required. The U.S. Affordable Care Act and Maryland law does require the COVID-19 vaccine be covered by insurance along with other recommended vaccines, though private insurance could begin charging when users go to out-of-network providers. Some providers may choose not to carry the vaccines, particularly in low-demand areas.

Private insurers’ coverage of at-home tests will vary, federal and state health and insurance officials said. They could also limit the number of lab tests they cover, or cover only in-network labs.

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Medicare, the federal health program for seniors, will no longer cover at-home tests after the public health emergency ends. Doctor-ordered lab tests will be covered, but some may have administration fees.

State regulators will be monitoring insurers for compliance with rule changes, said Craig Ey, spokesman for the Maryland Insurance Administration.

“In addition to the rules and guidance that have already been released, the federal government has committed to providing states with additional guidance on insurance coverage issues related to the end of the [emergency] at least 60 days before” it terminates, he said, adding that would be in coming weeks.

What about uninsured patients?

An estimated 363,000 Marylanders do not have health coverage, and may have to pay full price for tests and vaccines — the cost of which can vary by manufacturer and provider. Some tests, however, are likely to be available for free at pharmacies and community sites catering to low-income populations.

Many uninsured residents are eligible for free or subsidized health insurance, according to the Maryland Health Benefit Exchange, which oversees the state’s health insurance marketplace. That’s where residents can enroll in private insurance or Medicaid, the federal-state health program for the poor. Medicaid will continue to cover COVID tests and treatments until September 2024, then could limit their use or add costs.

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Maryland enrolled a record number of people in Medicaid during the pandemic, and the program now serves 1.25 million. An estimated 80,000 people in the state could lose coverage at the end of the public health emergency, when officials begin checking to see if people still qualify, said Michele Eberly, the exchange executive director, in testimony to the state Senate finance committee last month.

Exchange and health officials say they will seek to move people to private insurance, giving them access to health care that includes COVID-19 vaccines and supplies.

A state program allows residents to check boxes on unemployment and tax forms to receive information. So far, officials report 133,000 people have requested information and 13,000 have enrolled since 2020.

Speaking at a news conference last week, U.S. Sen. Chris Van Hollen, a Maryland Democrat, said interest has been so strong he planned to introduce a national version.