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Calling the Shots: Immunization Finance Policies and Practices
BOX 3–1Examples of Residual Needs That Require State Vaccine Purchase
The following are examples of the types of children and adults who require assistance for vaccines purchased with both Section 317 and state-level funds:
Families that are eligible for either Medicaid or SCHIP but are not enrolled in these programs. This group includes families that are unaware of their eligibility or are reluctant to apply for public benefits, as well as families that frequently change residences and recent immigrants who are unfamiliar with or have not yet completed the enrollment process.
Children enrolled in Medicaid or SCHIP plans whose provider does not participate in the VFC program or otherwise fails to offer reduced-cost immunizations.
Families with insurance that does not cover vaccines (the “underinsured”). Such families may also have income that disqualifies them for Medicaid or SCHIP but is not sufficient to cover out-of-pocket fees for vaccine services on a routine basis.
Families with private insurance that lack access to vaccines because of cultural barriers, or difficulties in scheduling appointments or establishing routine medical care.
Children who are enrolled with a private provider through a freestanding SCHIP plan—one that is not an extension of the state’s Medicaid program. Such children do not qualify for VFC since they are considered “insured”; legislation has been proposed to reverse this policy, and clarification on this issue is needed by HCFA.
School-aged children who have not received vaccines required for school entry and who need swift access to immunization services.
Families that require ACIP-recommended vaccines not available within the VFC or SCHIP vaccine schedule (such as rabies and meningococcal, and tetanus for persons 7 years of age and older).
Adolescents and young adults who lack insurance for immunizations and do not meet their state’s age requirements for Medicaid or SCHIP or are not qualified for VFC because they are older than 18.
Adults who lack insurance for immunizations and who do not yet qualify for Medicare coverage, particularly adults with chronic disease (such as diabetes or chronic heart disease) who may be especially vulnerable to infectious disease.