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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

It's not so easy to get an at-home coronavirus test through Medicaid

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

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Happy Thursday, where this morning we learned a new life lesson: how to take apart a curling stone. Send us tips and other life hacks at rachel.roubein@washpost.com. 

Today, the surgeon general seeks to ease concerns of parents about vaccines for very young children, and there are also renewed questions over the “Havana Syndrome.” But first: 

Getting at-home coronavirus tests can be complicated for Medicaid enrollees

As the lack of Medicare coverage for at-home tests sparks public outcry, another critical government-run program is working to ensure vulnerable Americans can get the tests for free. 

Officials overseeing state Medicaid programs are hammering out complex logistics to better make at-home tests accessible for some of the nation’s poorest citizens. And this week, more states made it easier for the safety net program to reimburse pharmacies for providing the tests at no cost. 

This comes as the Biden administration attempts to bolster the nation’s supply of at-home tests. Amid the omicron surge, many Americans scoured retail stores and the web to find rapid at-home tests to no avail. 

Here are the rules for covering coronavirus tests for those on Medicaid:

  • In late August, the Centers for Medicare and Medicaid Services issued guidance to states on a requirement to cover at-home tests under the coronavirus relief bill passed in the spring.
  • But some states are facing “operational considerations and challenges,” according to a CMS slide deck from a Jan. 11 call with states, shared with The Health 202. On the call, CMS said it's available to help any states seeking technical assistance.

Key quote: “How we operationalize this, that's what we're grappling with now,” said Jason McGill, an assistant director of the Washington State Health Care Authority.

How it's going

At issue: The Biden administration recently required private insurers to cover coronavirus tests, but plans are allowed to pay people back for buying them on their own. But there isn’t a mechanism in Medicaid to dole out similar reimbursements. 

  • What that means: Even if those in the program could afford to pay for the tests out-of-pocket, they couldn't get their money back, according to a Kaiser Family Foundation report.
  • “Medicaid enrollees are working in jobs where they’re at high risk of contracting or being exposed to covid — retail, food service, cashiers, those kinds of jobs are among the top for Medicaid enrollees,” said Robin Rudowitz, a vice president at KFF. “So it's even more important to have access to home tests.”

States are setting up their programs in varying ways. One approach states have taken — and CMS notes in its slides — is to issue a so-called “standing order.” Some state laws require prescriptions, but such an order would let those with Medicaid coverage get a free test at a pharmacy without a separate doctors’ note. 

  • For instance: North Carolina has issued such an order, and Washington state took a similar approach last week.
  • Other states released more information this week. Both Indiana and Arkansas sent providers a notice Tuesday with details on how Medicaid would reimburse pharmacies for at-home tests.
  • In Oklahoma, state officials spent a few weeks updating their payment systems, allowing people to get a test without a prescription from a doctor. Those changes were made in December, and the state has since seen 1,401 claims for tests, some of which come in packs of two, according to Terry Cothran, the senior pharmacy director at the Oklahoma Health Care Authority.

Up next: The National Association of Medicaid Directors says the next phase of its conversations around at-home Medicaid tests will likely revolve around getting tests to those who are homebound and creating mail order programs, according to Jack Rollins, the group’s director of federal policy. 

Supply, supply, supply

Another key question states have been working through: How many tests to cover. 

  • “We’re all under a bit of a supply constraint on testing availability,” Rollins said. “You need to kind of strike that balance between availability at that point of sale without straining the overall supply of tests.”

Here’s a snapshot of states’ approaches: In Arizona, those on Medicaid can get one kit, which can consist of two tests, per month, according to an FAQ sheet updated Tuesday. In Arkansas, that number is eight total tests per month. Delaware can also get eight. A state official said it was generally aligning with the number of tests private insurers cover.

Coronavirus

Vivek Murthy tries to reassure parents of young children about the Pfizer vaccine

U.S. Surgeon General Vivek Murthy sought yesterday to reassure parents that the Pfizer-BioNTech coronavirus vaccine for young children will be thoroughly reviewed.

“Please know that the FDA will not cut any corners in their review process. They know that they are the gold standard that all of us rely on,” Murthy said during a White House news briefing.

News that coronavirus vaccines may be available by the end of February for children ages 6 months to 5 years came as a surprise and relief to some. But it also unleashed a wave of questions that could prevent some of the country’s youngest children from receiving the shot, our colleagues Frances Stead Sellers and Yasmeen Abutaleb report.

Confusion reigns: Pfizer and BioNTech have begun submitting data on the safety and efficacy of the first two doses, though a third will likely be needed as well. Some parents are confused about the approach and say they’re skeptical about getting their children vaccinated when the risk of serious infection remains relatively low. And experts worry that hesitancy could grow. 

For many parents, the decision to vaccinate could come down to the advice they receive from their pediatrician. Past studies show that 3 in 4 parents trust their child’s doctor to share reliable information. 

Agency alert

A possible explanation for the mysterious ‘Havana syndrome’

Pulsing radio frequencies from an external energy source may be to blame for perplexing symptoms that have been plaguing dozens of overseas U.S. personnel, a panel of experts found yesterday. The conclusion, while not definitive, suggests a foreign power could have mounted attacks on diplomats, intelligence officers and others abroad, The Post’s Shane Harris reports. 

The first reported case of the unusual ailments, dubbed “Havana syndrome,” came from officials stationed at the U.S. Embassy in Havana in late 2016, when U.S. personnel said they were suffering from a variety of symptoms ranging from dizziness to headaches. 

Since then, the U.S. government has investigated more than 1,000 similar cases, many of which could be explained by preexisting medical conditions or other factors. The remaining unsolved cases, though, were found to be “genuine and compelling” and may have been from an external source.

  • The announcement comes after a January report from the CIA, which found that a foreign power is unlikely to be behind a global attack aimed at U.S. officials. While experts on the panel convened by U.S. intelligence agencies stopped short of pointing the blame for the electronic pulses, their finds suggest that an outside operator or device could be responsible for the symptoms.

From our notebook

Now airing: Ads calling for global vax funding: A new nationwide campaign urges lawmakers to set aside billions of dollars in additional funding for global vaccinations, our colleague Dan Diamond tells us.

The ads, developed by the Campaign to End COVID Now and airing on major networks, are the first to specifically target the need for global vaccinations, the campaign's leader, Liz Jaff, told Dan. The $250,000-plus ad buy was devised in consultation with global health advocacy groups seeking to improve the infrastructure to deliver shots in low-income nations.

Congressional Democrats and advocates have amped up calls for at least $17 billion in additional global covid funding, warning that the U.S. Agency for International Development is just weeks away from exhausting its funds to help carry out global vaccinations. The White House is closing in on a supplemental funding request, sources tell Dan.

Meanwhile, experts have warned that the global health challenge remains considerable.

  • "The $17 billion really only reflects what's necessary for the health response to the pandemic," said Rachel Hall, executive director of government advocacy at Care, a global humanitarian organization. "What it doesn't include is what's necessary for things like rising rates of food insecurity, rising rates of [gender-based violence], rising rates of poverty because of the impact of the pandemic."

In other health news

  • The Army will join other U.S. military branches in beginning to “immediately discharge” soldiers, active-duty reservists and cadets who have failed to comply with the Pentagon’s August vaccine mandate, our colleague Brittany Shammas writes. Those awaiting a decision on their medical exemption or religious accommodation requests will be temporarily exempt. 
  • A Tennessee ban on abortions because of a fetus’s race, sex or prenatal diagnosis of Down syndrome will go into effect once again after a federal appeals court reinstated the law, The Associated Press reports.
  • On the move: Kimberlee Trzeciak is joining the FDA as the agency’s new associate commissioner for legislative affairs. She was previously the chief health adviser for the House Energy and Commerce Committee.

Second opinion

Moving forward by looking to the past

As new cases of the omicron variant begin to wane in cities across the country, John M. Barry the author of “The Great Influenza: The Story of the Deadliest Pandemic in History” — offers advice for navigating life after the third wave of the coronavirus based on mistakes and lessons learned from another deadly virus: the 1918 flu epidemic. 

  • “The only thing certain is that future variants, if they are to be successful, will elude immune protection,” Barry wrote in an opinion essay for The New York Times. New variants will continue to pose additional threats long after the majority of the country has built up a natural immunity to the virus from vaccinations or previous infections, just as they did in 1920 — one year after most historians say the flu epidemic ended.
  • Pandemic weariness won't stop the virus. Individuals should keep up pandemic practices like getting vaccinated, social distancing and avoiding crowds. Not doing so, Barry argues, would be ceding control to the virus.

Sugar rush

Thanks for reading! See y'all tomorrow.

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