Universal purchase states supply vaccine for all children in the state, regardless of whether administration takes place in public clinics or participating private provider sites. VFC thus becomes one source of funding within a vaccine purchasing system for which all children are eligible, regardless of their insurance status. The 15 states with universal purchase programs, all of which were in existence prior to VFC, commit the highest level of state resources to vaccine purchase and to immunization programs overall (information provided by CDC), although not all universal purchase states buy all recommended vaccines.
Generally, the introduction of VFC resulted in savings to states, as funding for the purchase of vaccines for most Medicaid-enrolled children could be shifted from the state to the federal level. The extent of those savings depended on several variables, include the following:
the extent of Medicaid enrollment,
the prices Medicaid paid for vaccines prior to VFC, and
whether states required Medicaid providers to enroll in VFC or discontinued reimbursing providers for privately purchased vaccine.
The way states used these Medicaid savings was highly variable. In response to the 1999 IOM state survey, 25 states said that Medicaid payment levels for vaccine administration or other pediatric care had increased, but only 4 states identified those increases as being related to savings from VFC (in one state, for example, the vaccine administration fee increased because the state Medicaid agency misinterpreted HCFA’s maximum allowable reimbursement as the minimum). Three states said these savings were used in other ways, such as increasing support for local health departments or purchasing vaccine for groups not covered by VFC. In most states, however, VFC-related savings did not accrue directly to the immunization program.
With Section 317 funds becoming increasingly limited, some states have restricted the availability of vaccine in public clinics. For example, for non-VFC-eligible children, a vaccine may not be available or may be restricted to certain age groups. In some states, public clinics are now required to check insurance status and refer children back to their private provider if they are not VFC- or 317-eligible. Though many states still adhere to the policy that free vaccines are available in the public sector to all children, practices in several urban areas suggest that some states have