TABLE 3–5 Federal Immunization Coverage Policies for Children Under Medicaid, Vaccines for Children (VFC), and State Children’s Health Insurance Programs (SCHIP)

Program

Eligibilitya

Federal Financing

Medicaid

Children up to age 6:133% FPLb

50–78%

 

Children aged 6–18:100% FPL (through age 21 in the EPSDTc program)

 

 

State option to cover additional children up to state-defined eligibility levels

 

VFC

Children aged 0–18 who are:

Medicaid-eligible

Uninsured

Native American/Alaska Native

Underinsured

100%

100%

100%

Only if vaccinated at FQHCsd

SCHIP (Medicaid)

State sets level using Medicaid coverage flexibility

Enhanced FFPe (65–85%)

SCHIP (freestanding)

Children with incomes above Medicaid but<50% over Medicaid eligibility levels who are uninsured and ineligible for Medicaid

Enhanced FFP (65–85%)

aThe Advisory Committee on Immunization Practices establishes general vaccine schedule recommendations and then prepares a separate resolution for coverage through the VFC Program. CDC publishes the recommendations and negotiates a vaccine contract(s). Funds are awarded to the states, and the vaccine is purchased and supplied by the states to health care providers.

bFederal poverty level.

cEarly and Periodic Screening, Diagnosis, and Treatment Program.

dFederally qualified health center.

eFederal financial participation.

SOURCE: Health Care Financing Administration, 2000c.

zation coverage under Medicaid managed care. A study of contracts between state Medicaid agencies and managed care organizations furnishing comprehensive services revealed that 19 standard contracts in effect as of January 1998 specified coverage of immunizations for adults (Rosenbaum et al., 1998). All contracts specified coverage of childhood immunizations, although the nature of the specifications ranged from



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement