and adults. In the case of uninsured children and a small number of underinsured children, federal policy provides a guarantee of coverage under the VFC program for ACIP-recommended immunizations, once a federal vaccine purchase contract has been completed. In addition, as noted earlier, 15 states have established universal purchase programs that provide access to free vaccine regardless of insurance coverage; however, these programs are limited to children.
Finding 3–5. Complex eligibility criteria and coverage conditions for the multiple federal and state programs supporting vaccine purchase and delivery have left gaps and omissions in the financial coverage of immunizations for children and adults. States respond to these residual needs by continuing to provide free vaccines in public health clinics, financed by a combination of Section 317 funds and state revenues.
Finding 3–6. The broad mission and general standards of service associated with the Section 317 program result in some overlap with more tightly constructed federal programs (such as VFC and SCHIP), but the amount of overlap is not large, and it should be seen as complementary rather than duplicative. The overlap allows the states to bridge coverage gaps, respond to timely needs, and advance the national goal of preventing disease through immunization.
VFC and SCHIP provide federal support for the purchase of vaccines for increasing numbers of disadvantaged children. However, residual needs remain, causing states to continue to rely on Section 317 vaccine purchase grants to serve at-risk children and adults who are ineligible for other federally supported vaccines. The scope of these residual needs varies among the states, depending on Medicaid eligibility and private health plan participation in meeting the health needs of low-income families.
The following specific factors contribute to the scale of residual needs within each state:
The eligibility requirements for VFC are more restrictive than those for Section 317 funds. Underinsured families that cannot afford to pay for vaccines or the administration fees charged by private practitioners may be ineligible for VFC but still seek vaccines from a local public health clinic.
Families enrolled in Medicaid or SCHIP may encounter delays in service or other access barriers in seeking care from private providers and thus return to public clinics for timely immunizations. The latter encoun-