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CMS says states can use Medicaid funds to combat Zika; WHO updates guidance on virus; Washington Post lambasts delay on Zika response efforts

June 2, 2016 — CMS on Wednesday announced that states may use Medicaid funding to cover preventive measures, including contraception and family planning services, to combat the spread of the Zika virus, Modern Healthcare reports (Ross Johnson, Modern Healthcare, 6/1).

According to The Hill, the announcement is among the first steps that the Obama administration has taken since the start of the Zika outbreak to explain how existing state funding can be used for Zika response efforts. The letter comes amid congressional delays on the Obama administration's request for additional funding to combat the virus (Ferris, The Hill, 6/1).

Background on Zika

The Zika virus is a mosquito-borne disease that has spread across Latin America over the past year. Researchers recently learned that Zika can also be transmitted through sexual activity. The virus is not easily diagnosed, and it does not have a cure or vaccine. It is linked to the birth defect microcephaly, a condition in which an infant is born with an abnormally small head and brain. The condition is fatal for some infants, while others experience permanent disabilities.

Officials in Brazil and Honduras have issued guidance recommending that women avoid pregnancy. El Salvador's recommendation is that women not get pregnant until 2018. However, many countries in Latin America restrict access to contraception and often ban abortion. In addition, women have been advised to protect themselves against mosquitos, but insect repellant can be unaffordable for low-income women.

The World Health Organization (WHO) has declared the outbreak and its link to microcephaly a public health emergency of international concern. Separately, the United Nations High Commissioner for Human Rights issued a statement directing nations affected by the Zika virus to remove bans on access to sexual and reproductive health care services.

U.S. response efforts

The White House has called for $1.9 billion to combat the virus. Amid congressional delays on the funding request, a senior administration official in April said the administration would transfer more than $500 million in funding allocated to combating the Ebola virus to Zika response efforts. CDC in May announced that it will allocate more than $85 million to U.S. states and territories to combat the Zika virus.

The House and Senate have proposed separate bills in response to the funding request, which must be merged in conference committee.

The Senate proposal -- an amendment (SA 3900) included in a larger appropriations bill (HR 2577) -- is relatively similar to the White House's request. However, the amendment does not repay much of the reallocated Ebola money, nor does it provide funding to assist the Medicaid program in Puerto Rico, which is considered a Zika "hot spot." A provision in the measure would allocate $248 million to address Zika abroad through maternal and child health programs, mosquito control and public information campaigns. It does not require the government to offset the funding allocations with spending cuts elsewhere.

The House bill (HR 5243) would provide $622 million to address the Zika virus. The measure, which requires offsets, would fund U.S. response efforts through September. The House also approved a bill (HR 897) that would ease pesticide regulations to help efforts to spray for Zika.

Both the House and Senate proposals include language from the Hyde Amendment, which prohibits the use of federal funding for most abortion care. The White House has threatened to veto the House measure, calling it an inadequate response to the Zika virus (Women's Health Policy Report, 5/27).

CMS announcement details

In the letter, Vikki Wachino, director of HHS' Center for Medicaid and CHIP Services, outlined how state officials could use Medicaid funding to help low-income beneficiaries protect themselves against the virus, USA Today reports (O'Donnell, USA Today, 6/1).

For example, the letter noted that Medicaid funding can be used to cover 90 percent of costs for all family planning services, such as condoms, oral contraceptives and emergency contraceptives (The Hill, 6/1). States also can use the funding to cover intrauterine devices and implants (Modern Healthcare, 6/1). The letter emphasized that such services are "critical," considering the virus' link to birth defects.

In addition, the letter for the first time said Medicaid reimbursement will be available for over-the-counter insect repellents if they are prescribed by a health care provider. The letter also noted that states "are required to cover all medically necessary diagnostic services related to the detection of a Zika virus infection" (The Hill, 6/1). According to USA Today, that includes diagnostic tests for microcephaly and other birth defects.

In the letter, Wachino also said Medicaid managed care plans can offer services beyond those mandated by Medicaid, such as covering the cost of screen installation in homes to protect residents against mosquitoes (USA Today, 6/1).

Baltimore City Health Commissioner Leana Wen applauded the CMS announcement. However, noting that local and state health officials will need additional funding, she called on Congress to meet Obama's $1.9 billion funding request. "This is an all-hands-on-deck effort," she said, adding, "We must prepare for this, the consequences are too great to ignore" (Modern Healthcare, 6/1).

Separately, Joan Alker, executive director of the Georgetown University Health Policy Institute, warned that existing coverage gaps could undermine Zika response efforts. For example, she noted that undocumented immigrants do not have access to health insurance, while more than half of U.S. states require lawfully present immigrants to wait five years before being able to enroll in Medicaid, even if they become pregnant (USA Today, 6/1).

WHO updates Zika guidance

In related news, the World Health Organization on Tuesday updated its Zika guidance for people returning from regions affected by the virus, Reuters reports (Nebehay/Miles, Reuters, 5/31).

In its guidance, WHO recommended that people returning from regions affected by the Zika virus either use safe sex practices or abstain from sex for eight weeks. The announcement doubles WHO's original advisory, which recommended a four-week period.

Christian Lindmeier, a spokesperson for WHO, said the organization updated its guidance following research showing that the virus can remain in the bloodstream or in other bodily fluids for a longer time period than previously thought. Lindmeier added that a man showing symptoms of the Zika virus should follow safe sex practices or abstain entirely for a period of six months.

When asked how the guidance affects pregnancy for individuals in Brazil, which has been affected by the virus for more than a year, Lindmeier said, "The guidance is to delay or consider delaying pregnancy, certainly recognizing that this is tough for some populations" (Reuters, 5/31).

Washington Post editorial board calls on Congress to pass funding for Zika response efforts

In other related news, a Washington Post editorial lambasts conservative leadership in Congress for "inexcusably dither[ing]" on President Obama's request for $1.9 billion in funding to combat the Zika virus.

The editorial explains that the "virus is mild for most people but in pregnant women can lead to fetal neural defects, and the prospect that local transmission will soon begin in the United States is very real." According to the editorial, "When Congress failed to act quickly" on Obama's funding request, "the administration redirected existing funds in order to scale up an initial response."

While the House and Senate eventually "passed widely divergent bills, neither entirely fulfill[ed] the president's request," the editorial continues. The editorial notes that while the bipartisan Senate proposal, which provides $1.1 billion in funding without offsets, is a "serious start," the House's "woefully inadequate" proposal would provide only $622 million and "would raid accounts for Ebola and other important work, such as emergency preparedness, and would last only through September." According to the editorial, conservative lawmakers in Congress "are playing games with a public-health emergency."

The editorial quotes CDC Director Thomas Frieden, who explained that the Aedes egypti mosquito, which carries the Zika virus, is "'capable of rapidly spreading the infection'" and warned that "'[t]here is no example of effective control of this mosquito in the modern era.'" According to the editorial, the congressional delay on responding to the Zika funding request is "undermining" both the time and resources required to combat an outbreak.

The editorial states, "Vaccine development, now underway, is a long-term project; surveillance is a multi-year endeavor; creating rapid diagnostics is a major undertaking; mosquito control is fragmented in local governments, often uneven and urgent. Those on the front lines need to know -- now -- that programs to fight Zika will not start and stop." The editorial concludes by calling on the House and Senate to "immediately go to conference and pass emergency supplemental funding, along the lines of the Senate bill, to enable a determined and serious battle against the Zika virus" (Washington Post, 5/30).