Medicaid service coverage associated with Zika

Prevention through Family Planning Services, Repellants and Prevention of Exposure

Family Planning

For pregnant women with a male partner who has traveled to an area of active Zika transmission or has been diagnosed with Zika, the CDC recommends:

• Use condoms consistently and correctly or abstain from sex for the duration of the pregnancy.
• Sex includes vaginal, anal, and oral (mouth-to-penis) sex.

For women of child bearing age and men, and who have been to an area with Zika, the CDC recommends:

• If the woman has symptoms, use condoms or abstain after symptoms starts for at least 8 weeks.
• If the woman has no symptoms, use condoms or abstain for at least 8 weeks after exposure.
• If the man has symptoms, use condoms or abstain after symptoms starts for at least 6 months.
• If the man has no symptoms, use condoms or abstain for at least 8 weeks and talk to your healthcare provider.

Repellants and Prevention of Exposure

Pregnant women and Medicaid beneficiaries of child bearing age should take steps to prevent mosquito bites by using EPA registered insect repellents as directed, avoiding travel to areas with Zika, wearing long-sleeved shirts and long pants, utilizing window and door screens to keep mosquitoes outside, and staying away from mosquito breeding sites such as areas of standing water. 

Detection of Zika Infection

The CDC currently recommends testing for Zika among people with Zika symptoms AND among women who are pregnant and have traveled to a Zika affected area or have had unprotected sex with a man who has recently traveled to a Zika affected area regardless of whether she is symptomatic.  Implementation of testing would be of no additional cost to Medicaid.

Medicaid Repellant Prescription Information

Mosquito repellent shall be covered as a pharmacy benefit when local mosquito-borne transmission of Zika virus has occurred. The Louisiana Department of Health (LDH) will notify providers when coverage will be implemented.

Coverage will be limited to Medicaid recipients:

1. Who are pregnant OR
2. of childbearing years (women and men ages 14-44) who are trying to conceive

To view the affected areas visit: (http://www.cdc.gov/zika/geo/active-countries.html)

Repellants approved for coverage for eligible Medicaid beneficiaries are:

One bottle of mosquito repellent every rolling 30 days will be allowed. A prescription will be required to cover one of the following products:

Zika is a reportable disease in Louisiana. If you suspect Zika, immediately contact the Louisiana Office of Public Health Infectious Disease Epidemiology hotline

(800) 256-2748 for testing & treatment guidance.

Visit the CDC website addressing Zika among pregnant women: http://www.cdc.gov/zika/hc-providers/tools.html