On June 1, 2016, CMS released a Center for Medicaid and CHIP Services (CMCS) Informational Bulletin, entitled “Medicaid Benefits Available for the Prevention, Detection and Response to the Zika Virus.” In the Bulletin, CMS explains the prevention and treatment services that state Medicaid agencies and stakeholders may choose to cover at their discretion.

As the Bulletin explains, states may cover the following services to prevent, detect and respond to the Zika virus:

  • Over-the-counter insect repellents: State Medicaid programs may choose to cover over-the-counter insect repellents when prescribed by an authorized health professional. In covering repellents, state Medicaid programs would be eligible for Federal Financial Participation (FFP). CDC has recommended that people use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients: DEET, picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-diol.
  • Family planning: State Medicaid programs may offer family planning counseling and coverage for barrier method contraceptives, such as condoms and other methods of contraception that prevent or delay pregnancy. Services provided under the family planning benefit would be eligible for enhanced FFP at 90 percent.
  • Diagnostic tests: State Medicaid programs may offer to cover blood tests to diagnose Zika, as well as follow-up tests for pregnant individuals infected with Zika, including CT scans, MRIs, ultrasounds, and genetic testing.
  • Treatment: State Medicaid programs may offer to cover targeted case management services to assist Medicaid beneficiaries in gaining access to medical, social, educational and other services; physical therapy and related services; prescription drugs related to managing Zika infection symptoms, such as anti-fever, pain medications and electrolyte solutions to prevent dehydration; and long-term services and support for children born with microcephaly or other serious Zika-related disabilities (including, for example, nursing home services or home and community-based long-term services and support).

The Bulletin provides that additional opportunities for states to cover products and/or services related to the prevention, detection, and treatment of Zika may be available through section 1115 demonstrations or through section 1915(b)(3) waivers.

Notably, under the Early Periodic Screening, Diagnostic, and Treatment (EPSDT) Medicaid benefit, states are required to cover, without limit, all medically necessary diagnostic and treatment services related to Zika virus infections for individuals under 21.

Finally, on June 1, 2016, the Centers for Disease Control and Prevention (CDC) updated its (i) interim guidance for health care professionals on counseling patients about family planning and timing of pregnancy after Zika exposure, and (ii) updated interim guidance on preventing sexual transmission by men after Zika exposure.


*Blake Walsh is admitted only in Tennessee. Her practice is supervised by principals of the firm admitted in the District of Columbia.