would help remove financial barriers to immunization for some families, but ERISA exemptions mean that such laws cannot eliminate problems of underinsurance.

Dr. Simpson also pointed to efforts to strengthen partnerships between public-sector agencies. In July 2000, the Center for Medicare and Medicaid Services (CMS; formerly the Health Care Financing Administration) authorized the use of Medicaid funds to support the development and operation of immunization registries. Because many young children are eligible for Medicaid-financed immunization services, CMS has an interest in ensuring that those children are neither under- nor over-immunized. The amount of funding available from Medicaid will depend on the proportion of Medicaid-eligible children in the registry and the state Medicaid agency’s level of control over the registry. At the time of the workshop, 5 states had submitted applications for Medicaid funds for their registries; 13 more have plans to do so.

CDC’s second strategy focuses on ensuring that states make full use of VFC to provide vaccines to all eligible children. For example, states have made only limited use of VFC to comply with ACIP recommendations for vaccination of high-risk children against influenza or vaccination of high-risk adolescents against hepatitis B. Dr. Simpson noted that even though influenza is an important source of vaccine-preventable illness among children, especially those with chronic illnesses such as asthma, only 10 percent of high-risk children are vaccinated against influenza each year. Health care providers could provide immunizations against influenza to young children through their usual primary care services, but reaching high-risk adolescents would be more challenging. For them, it might be necessary to offer immunization services at sites such as sexually transmitted disease clinics or jails. Dr. Simpson noted that Texas has already instituted a hepatitis B vaccination program in its prisons.

Finally, CDC is emphasizing more effective and efficient management of available resources. This includes improving management processes and strengthening accountability. Dr. Simpson cited as an example of such efforts the VFC funding awarded to Texas to support automation of the state’s pharmacy inventory system, which is used to manage VFC vaccine purchase and distribution in the state. For VFC and the Section 317 program, CDC is seeking an appropriate balance between a necessary level of federal accountability and protecting flexibility and ease of use for health departments and health care providers within each state. States are being asked to document their spending for immunization infrastructure and to account for in-kind support, such as the work that school nurses may do when they review students’ immunization records. CDC is also developing forecasting tools to improve the ability of states to estimate



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