Most State Medicaid Programs Don't Cover All 13 ACIP-Recommended Vaccines


Disparate reimbursement policies disincentivize clinicians from vaccinating adults with lower incomes.

Lower vaccination coverage has been recorded among children who are uninsured or insured by Medicaid, leaving children from working-class families at heightened risk for contraction of serious but vaccine-preventable disease.

Adults living in lower income households also face barriers in terms of access to vaccination services. The investigators of a recent article published in JAMA Network Open looked into the level of access to vaccination services afforded to adult beneficiaries of Medicaid, finding disparate reimbursement policies and a majority lack of access to the full suite of 13 Advisory Committee on Immunization Practices (ACIP)-recommended adult vaccines.

The investigators conducted a survey of state Medicaid programs, reviewing public documents on benefits coverage. Document review was validated with a supplemental telephone survey between June 1, 2018, and June 14, 2019.

All 50 states and the District of Columbia were examined, for a total of 51 Medicaid programs assessed altogether. Ultimately, 44 of these programs validated document review findings and completed the supplemental survey. Document review was completed for all 51 jurisdictions.

Out of 51 programs, only 22 covered all of the adult vaccines recommended by ACIP for both fee-for-service and managed care organization enrollees.

The majority (37 of 49) of fee-for-service arrangements reimbursed health care professionals for any of the 4 approved vaccine administration codes. Despite this, 8 of these programs did not separately reimburse for vaccine administration for adult Medicaid participants.

Median reimbursement for adult vaccine administration varied based on route of administration, ranging from $9.81 to $13.98 per dose. The highest median per-dose reimbursement, $204.87, was distributed for the 9-valent human papilloma virus vaccine. The lowest median per-dose reimbursement, $18.09, was for Haemophilus influenzae type b vaccine. Reimbursement was below the private market price for 7 of the 13 vaccines examined.

Earlier research has suggested that these price dynamics reduce incentives for health care providers to vaccinate adults with lower household income.

“A 2014 survey of family and general internal medicine physicians found that 55% of respondents thought they lost money administering vaccines to adult Medicaid beneficiaries, while 25% or fewer of respondents thought they lost money administering vaccines to adults covered by other public and private payers,” investigators wrote.

The findings suggest that a majority of adult Medicaid beneficiaries do not have equitable access to the 13 ACIP-recommended adult vaccines. In programs with full vaccine benefits coverage, clinicians are still disincentivized, as reimbursement for health care professionals may not cover vaccine-provision costs.

The problem is also not simply a matter of funding for state programs, as even well-funded Medicaid programs contain barriers. The investigators point out that Florida has the third-largest state Medicaid program in the US, but adult vaccination coverage benefits are available only for adults aged 19-20 years or limited to pharmacy services for fee-for-service recipients living in residential facilities.

There is often contentious public debate over vaccine legislation pertaining to philosophical exemptions. But it seems that even putting vaccine skeptics aside, there are serious barriers for some adults who wish to follow expert recommendations for routine vaccination.

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