Congress is currently debating the level of federal funding that should be made available to fight to reduce the spread of Zika. Administration officials working with local public health agencies on the ground have recently expressed fear that the funding levels are insufficient to prevent the disease from spreading. What is one overlooked concern? State budgets.

Medicaid is jointly funded by states and the federal government and serves as a key financer of health care services if Zika spreads across the country this summer. The Centers for Medicare and Medicaid Services (CMS) recently released a bulletin to state Medicaid Directors outlining how Medicaid funds can be used to both prevent the spread of Zika and treat people infected by the disease and infants born with microcephaly. With Medicaid covering roughly half of the births in America today, the program will finance many pregnancies potentially affected by Zika.

What does the bulletin do?

Foremost, the bulletin does not change current Medicaid policy; it only outlines and explains agency policy. CMS regularly releases guidance in this form that explains federal flexibilities that states can implement; however, states are not required to make these changes to their Medicaid programs.

The guidance does not change Medicaid’s potential responsibility for the cost of many Zika-related medical services. Instead, the guidance recommends ways to reduce the spread of disease so that spending on high-cost medical services may be lower in the future. CMS recommends states utilize these flexibilities to prevent the spread of Zika, detect any potential infections, and treat residents who become infected.


Until a vaccine is available to control the spread of Zika, efforts are focused on mosquito deterrents to reduce infection and contraception. Medicaid can finance Mosquito repellents such as DEET when prescribed by health professionals if the state chooses to include it as a benefit.

For women who do not wish to become pregnant and to protect against the infant infection of Zika, contraception services are available. Family planning services continue to receive an enhanced federal matching rate of 90 percent. While family planning services are a mandatory benefit under Medicaid, states vary considerably in how these services are offered to beneficiaries, for example, the coverage of long acting reversible contraceptives (LARCs) after pregnancy.


States can ensure that all pregnant women and people that may be infected with the virus receive the blood tests and other services needed to detect microcephaly or Guillain-Barré syndrome. This will mean some states may consider relaxing benefit restrictions to ensure that potentially infected pregnant women can receive additional screenings and treatment. States are required to cover diagnostic treatment for Medicaid beneficiaries under the age of 21 through Early Periodic Screening, Diagnostic, and Treatment (EPSDT).


The EPSDT program has been an important aspect of the Medicaid program since its inception in 1967. The program provides screening and treatment for all children under the age of 21 covered by Medicaid or the Children’s Health Insurance Program (CHIP). The program provides children with all medically necessary treatment options, even those not covered for adults. For any children with Medicaid infected by Zika, these services will help finance their health care needs. Additionally, non-traditional medical services such as targeted case management, physical therapy, speech therapy, and long-term care services for nursing home or home and community-based services can all be paid for to assist children with microcephaly and other conditions.

All of the medical treatments for this disease will be costly for Medicaid programs. Medicaid is already straining state budgets and increases in spending reduce the amount of state funds available for other purposes. Working to prevent the spread of Zika and the incidence of infants born with microcephaly and Guillain-Barré syndrome can prevent spikes in Medicaid spending.

Medicaid’s vital safety-net role

This isn’t the first time this year that a public health crisis involved Medicaid funds. In March, 45,000 residents of Flint, Michigan were provided enhanced Medicaid benefits in response to lead exposure.

As Sara Rosenbaum recently wrote, Medicaid has a history of providing coverage in emergent situations such as following the World Trade Center attacks and Hurricane Katrina. Further, Medicaid coverage of certain addiction medications can improve opioid addiction treatment, helping reduce the current nationwide opioid epidemic. Medicaid’s role in preventing, detecting, and treating Zika is part of its vital role as a safety-net provider for all Americans. Mosquitos can bite anyone and the prevention of this disease is not limited to any income group or health care provider.

This will not be the last time Medicaid plays a key role in providing health benefits to areas inflicted by disease outbreaks or public health emergencies. Public health experts estimate that disease outbreaks such as Zika and Ebola will be occurring with increasing frequency.

The spread of mosquito born illness leaves the Southern United States with increased burden of disease. This is the same region of the country where millions of Americans fall into the coverage gap because their states have decided not to expand Medicaid as part of the Affordable Care Act. Had these states expanded Medicaid coverage, more people may have had access to these health services outlined here to prevent the spread of disease. Medicaid spending is impacted by public health events and in turn the way we respond to public health events is influenced by Medicaid coverage decisions.