In 1998, SCHIP was initiated to provide grants to the states to help finance health care services for children in low-income families without health insurance. As discussed in Chapter 3, SCHIP is a block grant program that provides federal resources allowing states to extend services to low-income children who are ineligible for Medicaid but otherwise uninsured (e.g., the “working poor”). States are required to cover all ACIP-recommended vaccines and their administration to children as part of the annual federal SCHIP allotment.
The creation and implementation of the VFC and SCHIP programs have raised questions about the mission and role of the Section 317 program. During the first half of the 1990s, the budget for Section 317 state immunization infrastructure grants grew substantially, but funding levels for state infrastructure awards have declined significantly in the past 4 years (see Figures 1–2 and 1–3). Since the federal government now relies heavily on the private sector to administer programs such as VFC and SCHIP to improve the quality of health care for disadvantaged children, the potential for overlap and duplication of effort between these programs and Section 317 awards may exist and requires consideration and oversight. Opportunities may exist to leverage public and private investments and integrate programs to achieve multiple goals or to diminish unnecessary bureaucracy associated with the administration of separate funding streams. At the same time, if different federal programs perform separate but related missions, appropriate measures need to be in place that can be used to assess the performance of individual units in contributing to national goals and objectives.
The separate federal immunization initiatives undertaken over the past several decades have responded to new problems and addressed new dimensions of the immunization system. But certain features have remained consistent over time. One historical review of federal immunization policy identifies the following as critical components of federal immunization policy in the 20th century (Johnson et al., forthcoming):
From the beginning, immunization financing was explicitly structured to be a federal–state–private-sector partnership.
Federal policy makers never expected federal funds to be sufficient to cover the full cost of vaccine purchase and delivery for disadvantaged groups.