Making Sure NJ’s Poor Are Covered When It Comes to Zika

Lilo H. Stainton | September 6, 2016 | Health Care
Reworking state Medicaid to include ‘reasonable reimbursement rates’ for products and services to prevent and treat mosquito-borne virus

The Zika virus has not infected mosquitoes in New Jersey, but it has revealed itself in the blood of at least 120 state residents who contracted the disease while traveling abroad — including a mother who gave birth to a baby with severe birth defects.

Some experts have said it is unlikely the disease will take hold in local insect populations, given the state’s climate and other factors.

But one New Jersey lawmaker wants to make sure low-income residents would be protected against catching or spreading the infection and that their children, born with potentially devastating impacts, would get the care they need. Officials believe that, with one in five residents born abroad, the Garden State is particularly susceptible.

On Thursday the Senate Health, Human Services and Senior Citizens Committee will consider a measure by Sen. Joseph Vitale (D-Middlesex), the panel’s chairman, that would require New Jersey’s Medicaid program to spell out in benefit packages how it will cover — and provide “reasonable reimbursement rates” for — products and services designed to prevent Zika and treat the outcomes.

A growing number of public officials and health experts have rallied to encourage the Republican-led U.S. Congress to grant President Barack Obama’s request for $1.9 billion in funding to support further Zika research, including human tests of a rapidly developed potential vaccine. Republican Gov. Chris Christie vetoed a Democratic request for $5 million in additional state funding for Zika prevention in the current budget, but the state has welcomed at least $3 million in federal funding distributed to help mosquito control, testing programs, and local health efforts, among other work.

The mosquito-borne virus has now infected more than 624 people nationwide. While all but a handful of these patients contracted the disease while traveling to other countries where the disease is rampant, officials have now identified two neighborhoods in Miami in which local mosquitoes have tested positive for Zika.

While Zika causes only mild symptoms in some patients, it can cause devastating impacts for pregnant woman, leading to babies born with microcephaly, a syndrome that stops the skull and brain from fully developing and leads to lifelong complications. It has also been linked to Guillain-Barre syndrome, which leads to muscle weakness and a deterioration of the nervous system.

Vitale’s bill (S-2476) would require the state to ensure that publicly funded health insurance pays for medically prescribed mosquito repellents, family-planning services and contraceptives, and diagnostic testing for the disease. It would also cover targeted case management services and physical and other rehabilitative treatments for children born with Zika-related disabilities.

Democratic Senate staff said the bill is designed to set a minimum threshold for coverage; officials in the state Department of Human Services, which oversees Medicaid, could also go further, they said. The measure also calls on DHS to obtain any federal waivers that might be required to implement needed changes. Medicaid now covers more than 1.7 million New Jersey residents.

The proposal builds on guidance issued in June 2016 by the federal Centers for Medicare and Medicaid Services designed to help states use their Medicaid programs to help combat Zika’s spread in the United States. The bulletin suggested a number of ways states can use the joint federal and state-funded Medicaid program to help reduce the spread of the virus through prevention and diagnostic testing and also underscored that the program can be used to pay for a range comprehensive treatment and case management services for patients under 21, who may be born to parents with Zika.

Vitale is certainly not alone in focusing attention on the mosquito-borne virus, which has continued to cause growing concerns in the United States as reports of locally acquired cases emerged this summer in Florida. U.S. Sens. Bob Menendez and Cory Booker (both D-NJ) led a preparedness summit early this spring and Menendez reiterated the urgency in early August when he revealed during a press event that his own daughter is five months pregnant and living in Miami.

Congressman Frank Pallone (D-Monmouth) was joined at a press conference in August by state Sen. Patrick Diegnan, (D-Middlesex), mosquito control officials, a Rutgers University biologist, healthcare experts, and local officials to underscore the need for full federal funding for research. Much of the work that has been done to develop a potential Zika vaccine – achieved in record time, over months instead of years, and with unusual cooperation among entities that often compete – has been fueled by money originally intended for Ebola studies.

While Democrats have been the most outspoken, a growing number of Republicans have also called out for Congressional action to provide additional funding. In late July, state Sen. Steven Oroho, (R-Bergen), sent letters to all members of the Garden State’s federal delegation urging them to support the president’s call for additional resources.

“This is a national problem that requires a national response,” Oroho said in the letter. The senator said he also supported a request to include $500,000 in additional state funding in the current budget year, part of the funding Christie vetoed.