Less than half of state Medicaid programs cover all adult immunizations

Most adult Medicaid beneficiaries do not have access to all adult vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP), researchers found.

Specifically, Charleigh J. Granade, MPH, from the CDC, and colleagues, found that less than half of the country’s Medicaid programs cover all 13 of the ACIP-recommended vaccinations.

Their study was published in JAMA Network Open.

Medicaid currently provides insurance to an estimated 37.5 million adults in the United States. And, while adults with health insurance tend to have a higher uptake of preventive services, research shows that individuals with private insurance generally have better vaccination coverage than those on public insurance.

And, according to the authors, low immunization rates place a high burden on the country’s health systems, with vaccine-preventable diseases in adults costing an estimated $9 billion in health care costs and lost productivity in 2015.

Adult vaccination services are not federally mandated for traditionally eligible Medicaid beneficiaries, but instead are determined by the individual states. In this study, Granade and colleagues evaluated access to adult vaccination services among Medicaid beneficiaries across the 50 states, as well as the District of Columbia.

The study included a public document review conducted from April 2, 2018, to April 30, 2019 in order to gather information related to benefits coverage of, payment for, and copayments for Medicaid adult vaccination services. In addition, the CDC’s Public Health Law Program and Immunization Services Division developed a survey designed to evaluate vaccination services benefits in fee-for-service and managed care organization arrangements across the country.

The researchers assessed coverage benefits these 2018 ACIP-recommended adult immunizations:

  • Influenza.
  • Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap).
  • Measles, mumps, and rubella (MMR).
  • Varicella.
  • Recombinant zoster.
  • 9-valent human papilloma virus (9vHPV).
  • Pneumococcal conjugate.
  • Pneumococcal polysaccharide (PPSV23).
  • Hepatitis A.
  • Hepatitis B.
  • Serogroup A, C, W, and Y meningococcal.
  • Serogroup B meningococcal.
  • Haemophilus influenzae type b (Hib) vaccines.

Forty-four Medicaid programs (86%) validated document review findings and completed the survey. While most Medicaid programs provided some level of reimbursement for adult vaccine administration, the authors found that less than half (22) of state Medicaid programs covered all 13 ACIP-recommended adult immunizations under both fee-for-service and managed care organization arrangements. Of those, only 14 provided vaccination benefits without copayments.

The authors also determined that vaccination coverage and access varied between fee-for-service and managed care organization arrangements within Medicaid programs.

Regarding vaccination reimbursement, Granade and colleagues found that the median reimbursement amount to health care professionals for administration of a single adult vaccination via injection was $13.62, and $13.98 for the intranasal administration of a single adult vaccination.

These median reimbursement levels, the authors observed, were below the per-dose costs to administer vaccines to adults that were estimated by this recent study. They also found that the median reimbursement for vaccine purchase was below the manufacturer-reported private sector costs for more than half (7 of 13) vaccinations covered in this study.

“[O]ur findings regarding median reimbursement and the wide variation among programs suggest that Medicaid payments for adult vaccination might fail to cover health care professionals’ costs in many instances.” wrote Granade and colleagues, who further noted that reimbursements that don’t cover practitioners’ costs could reduce vaccination access for low-income adults.

“Even in programs providing complete vaccination coverage benefits, reimbursement amounts to health care professionals for vaccine purchase and administration may not fully cover costs to provide vaccination, disincentivizing health care professionals to vaccinate low-income adults,” they wrote.

In a commentary accompanying the study, Angela K. Shen, ScD, MPH, Immunization Action Coalition, St. Paul, Minnesota, and Walter Orenstein, MD, Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, wrote that in addition to the financial barriers to adult vaccination that result from the inability of practitioners to cover the costs of vaccinations, Medicaid patients face financial barriers as well.

“Without complete benefit coverage for all Advisory Committee on Immunization Practices–recommended vaccines, Medicaid enrollees will most likely face financial barriers to receiving all adult vaccinations, because Medicaid is their primary source of funding for health-related services,” they wrote.

Shen and Orenstein pointed out that Medicaid enrollees have higher health risks, and greater health care needs that can be complex, and costly. Consequently, they suggested that reducing those financial barriers to vaccination “could be central in reducing vaccine-preventable disease burden and the associated mortality and morbidity, as well as costs to the health care system and productivity costs to society, for this population.”

  1. Most Medicaid beneficiaries don’t have access to all of the adult vaccination recommended by the Advisory Committee on Immunization Practices.

  2. Less than half of state Medicaid programs covered all 13 ACIP-recommended adult immunizations, while only 14 required vaccination benefits without co-payments.

Michael Bassett, Contributing Writer, BreakingMED™

Shen is a public health consultant to public and private sectors.

Cat ID: 150

Topic ID: 88,150,287,730,125,190,31,192,150,60,925