Feds remind states that Medicaid can cover costs of contraception, bug spray to prevent Zika infections

Bug repellent and condoms are allowed under Medicaid, the feds remind states.

Federal regulators are telling state Medicaid programs that they may cover mosquito repellent and condoms to prevent the spread of Zika — guidance that drew praise from public health officials, but might not result in much change for low-income residents enrolled in the public health insurance programs.

Medicaid programs already are required to cover family planning and contraception, and can cover bug spray, though it’s not clear how many do.

Public health officials said the move keeps the subject in the news, and could spur some patients to initiate a conversation with their health care providers.

That could help some avoid the effects of the virus, which is spread through mosquito bites and sexual contact.

Zika can cause microcephaly, a devastaing birth defect characterized by small brains and heads.

“This reminds states what they have on the table,” said Dr. Georges Benjamin, executive director of the American Public Health Association and a former Maryland health secretary. “And it could reinvigorate the conversation between doctors and patients.”

Maryland Medicaid officials haven’t said whether they will begin covering mosquito repellent under the Medicaid program, in which more than 1.2 million are enrolled.

The officials are “evaluating the latest federal guidance,” said Christopher Garrett, a spokesman for the state Department of Health and Mental Hygiene. He noted that the department has already distributed 10,000 kits to pregnant women that included bug spray, larvicide and condoms.

The state response has also included coordination with the state agriculture department, which is spraying insecticide, and working with local health departments on public education programs.

Dr. Leana Wen, Baltimore’s health commissioner, said the guidance from the U.S. Centers for Medicare & Medicaid Services was important as mosquito season approaches.  But she called on Congress to fund a request from President Barack Obama for $1.9 billion for a comprehensive response that she said could be particularly helpful in urban areas such as Baltimore.

“The mosquitoes that carry Zika are ‘container breeders’ that only need a capful of water, so their impact will be felt most in our cities,” Wen said. “Baltimore — and urban jurisdictions around the country — still needs Congress to provide additional resources to ensure that all of our residents are fully prepared to combat this public health emergency.”

The CDC reports 618 cases of Zika in the United States. One hundred and ninety-five patients are pregnant women. State officials have reported 19 cases in Maryland, including at least one pregnant woman.

All cases so far involve patients who have traveled or contracted the virus through sexual transmission, but officials warn that locally transmitted cases are likely to come.
Most cases now are in Central and South America.

Adam Sonfield, a senior public policy associate at the Guttmacher Institute, said the guidance from federal officials could help keep local transmission down, especially if more women take advantage of services offered through Medicaid and private insurance.

The Guttmacher Institute is a research and policy organization that promotes abortion rights.
The Affordable Care Act requires coverage for contraception, Sonfield noted. But he said services and types of contraception vary from state to state, and 19 states did not expand their Medicaid programs under the Affordable Care Act, limiting access to family planning services.

Many without insurance can’t afford contraception, or even bug repellent, on their own.
“This continues the conversation,” he said. “It’s a good reminder to state that there are things within their power to prevent Zika.”

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