the client’s plan for immunization services provided in the clinical setting. This integration of public health and health financing is important because it reduces missed opportunities for immunization and allows the cost of immunizations to be charged to those who are responsible for the care of public program beneficiaries.


This estimate of Medicaid enrollment for children from birth to age 2 is the midpoint between the proportion of children under age 6 (24 percent) who are covered by Medicaid (U.S. Bureau of the Census, 1999) and the proportion of newborns (38 percent) who are covered by Medicaid (Annie E.Casey Foundation, 1999).


This estimate varies by community. In Detroit, for example, health providers indicated that perhaps 50 percent of the children seen in public health clinics were eligible for Medicaid or SCHIP assistance. However, these children did not have access to primary care services because Medicaid managed care contracting in their area was oversubscribed and underfinanced.

Nationally, state vaccine purchases account for 12 percent of all expenditures under the federal contract; VFC accounts for 65 percent, and Section 317 for 22 percent (information provided by CDC).

Since the inception of VFC, state approaches to vaccine purchase and immunization delivery have fit one of three models: VFC only, enhanced VFC, or universal purchase (see Table 3–7).

VFC Only

The VFC program provides federally purchased vaccine for all eligible children (Medicaid enrollees aged 18 and younger, uninsured children, Native American children) at participating public and private sites. Underinsured children may receive VFC vaccine at federally qualified health centers (FQHCs) and rural clinics only. In 19 states, all children, including those not eligible for VFC, may receive state-supplied vaccines at public clinics. Section 317 and state revenues pay for the vaccines administered in public settings to children who do not qualify for VFC (information provided by CDC).

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