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



Federal Financing


Children up to age 6:133% FPLb



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



Children aged 0–18 who are:



Native American/Alaska Native





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

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