Zika: A new reason to expand Medicaid

While Congress continues to debate whether to allocate $1.9 billion to combat the Zika virus, state policymakers are urging Congress to take action in addition to calling on their state public health departments to begin efforts to prevent and monitor the spread of Zika. However, state-level efforts may be minimal given that the Great Recession led many states to cut spending on public health initiatives. North Carolina has continued to cut public health spending since 2013, which not only impacts the state’s public health infrastructure, but the health department’s capacity to address potential outbreaks like Zika or even Ebola while continuing surveillance of other public health concerns like the flu. This fiscal year, both the House and Governor McCrory allocate $750,000  in their respective budgets to strengthen NC’s public health infrastructure to conduct surveillance of the mosquito that acts as a vector for the Zika virus, detect the spread of Zika, prevent, and respond to the potential outbreak. The Senate’s budget only has a net appropriation of $477,500 to address the potential Zika epidemic in NC.

Despite federal and even NC policymaker’s decision on how much to fund Zika detection and prevention, other federal agencies recognize the urgency to research, prevent, and respond to the spread of the Zika virus in the U.S. The CDC activated its Emergency Operations Center (EOC) in January, advanced its activation to the highest level in February, and has borrowed $50 million from other public health efforts to jump-start its efforts in fighting Zika. Last week, CMS issued a letter to state Medicaid programs outlining services that will aid in the detection, prevention, and treatment of Zika. In the letter, CMS states that Medicaid dollars can help with prevention efforts such as prescribing repellents and providing family planning counseling; support detection efforts through testing for Zika; and respond to Zika by offering long term services and supports to children and individuals with Zika-related disabilities and even offer extended Medicaid services to pregnant women. As recently as June 1st, the CDC reported that there were 618 cases of Zika in the U.S., 12 of which are in NC. While no cases of Zika have been acquired locally, there are approximately 300 pregnant women in the U.S. that may have been infected, and 3 babies have been born with Zika-linked health concerns. It is also important to note that there is no vaccine for Zika and that  health researchers are still learning about the health outcomes in babies (such as microcephaly) and even about the sexual transmission (including oral sex) of Zika.

Given that the official start of summer is just a few weeks away, people have plans to go on summer vacation (potentially to places that increase one’s risk of acquiring the Zika virus), and are spending more time outside with mosquitos, NC should do all it can to address the potential long term fiscal and health impacts of Zika. Considering CMS’ statement last week, the one obvious way to boost NC’s efforts to detect, prevent, and treat Zika is Medicaid expansion. NC’s Medicaid program would receive increased levels of federal dollars to provide health care to Tar Heels in the coverage gap, which would help combat Zika. In NC there are 500,000 individuals that could be at risk as they lack health coverage to seek help in detecting and preventing the spread of Zika. Without Medicaid expansion, health providers may have to provide more uncompensated care or families may face financial instability as they try to pay for long term health services. Instead of passing legislation that has zero impact on “protecting” mothers and children, NC lawmakers should expand Medicaid which has evidence of protecting and promoting the health of children, families, and individuals.

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