State Policies on Access to Vaccination Services for Low-Income Adults

Abstract

IMPORTANCE State vaccination benefits coverage and access for adult Medicaid beneficiaries vary substantially. Multiple studies have documented lower vaccination uptake in publicly insured adults compared with privately insured adults. OBJECTIVE To evaluate adult Medicaid beneficiaries' access to adult immunization services through review of vaccination benefits coverage in Medicaid programs across the 50 states and the District of Columbia. DESIGN, SETTING, AND PARTICIPANTS A public domain document review with supplemental semistructured telephone survey was conducted between June 1, 2018, and June 14, 2019, to evaluate vaccination services benefits in fee-for-service and managed care organization arrangements for adult Medicaid beneficiaries in the 50 states and the District of Columbia (total, 51 Medicaid programs). EXPOSURES Document review of benefits coverage for adult immunization services and supplemental survey with validation of document review findings. MAIN OUTCOMES AND MEASURES Benefits coverage for adult Medicaid beneficiaries and reimbursement amounts for vaccine purchase and administration. RESULTS Public domain document review was completed for all 51 jurisdictions. Among these, 44 Medicaid programs (86%) validated document review findings and completed the survey. Only 22Medicaid programs (43%) covered all 13 Advisory Committee on Immunization Practicesrecommended adult immunizations under both fee-for-service and managed care organization arrangements. Most fee-for-service arrangements (37 of 49) reimbursed health care professionals using any of the 4 approved vaccine administration codes; however, 8 of 49 programs did not separately reimburse for vaccine administration to adult Medicaid beneficiaries.

Survey of Physician Practices, Attitudes, and Knowledge Regarding Recombinant Zoster Vaccine

“… 45 Medicaid coverage is also variable. 46 , 47 Our study suggests addressing these voids in coverage will be important to improving national RZV vaccination rates.…”

Health Care Providers’ Knowledge, Practices, and Barriers to Hepatitis Vaccination Guidelines

“…For covered vaccines, provider reimbursement often does not fully account for costs. 19 A study of 13 United States medical practices similarly showed Medicaid payments were often insufficient. 20 Reducing financial barriers to providers is part of the United States Department of Health and Human Services's strategy to increase hepatitis vaccination coverage and prevent new infections.…”

Hepatitis A and B vaccination in adults at risk: A survey of US healthcare providers’ attitudes and practices

“…At least eight state programs do not provide separate reimbursement for vaccine administration, and no state provides separate reimbursement for vaccine counseling if a patient refuses vaccination. 26 , 27 Moreover, Medicaid reimbursement payments for adult vaccine administration have been found to be substantially lower than payments from Medicare and private payers. 28 HCP concerns over reimbursement may therefore be a significant barrier to the vaccination of low-income individuals.…”