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Quality of Care Vaccines

Medicaid plays a key role in the prevention of disease through facilitating access to vaccines and vaccine activities. All children under the age of 21 who are eligible for the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit receive all Advisory Committee on Immunization Practice (ACIP) recommended vaccines. Additional information on Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Plan (BHP) coverage and payment of vaccinations can be found in the “Coverage and Payment of Vaccines and Vaccine Administration under Medicaid, the Children’s Health Insurance Program, and Basic Health Program” toolkit.  The federally funded Vaccines for Children (VFC) program provides vaccines at no cost to children who are enrolled in Medicaid, uninsured, underinsured, or an American Indian or Alaska Native through age 18.

Vaccines for Children Program

Under the VFC program, the Center for Disease Control (CDC) purchases vaccines at a discount and distributes them to grantees, such as state health departments and certain local and territorial public health agencies. These grantees distribute the vaccines at no charge to private physicians' offices and public health clinics that are registered as VFC providers. Because the federal government pays for the vaccine, providers are not paid for the cost of the vaccine product. Instead, they are paid an administration fee for the costs that the provider incurs in administering the vaccine. For children enrolled in Medicaid, the Medicaid program pays the vaccine administration fee. For uninsured and underinsured children enrolled in VFC, the parents are billed for the administration fee. The administration fee varies by state. 

For additional information regarding vaccines for children, visit the CDC Vaccines for Children.

Vaccines for Adults

State Medicaid agencies must cover for most beneficiaries approved adult ACIP-recommended vaccinations, including those not found on the adult immunization schedule or considered routine, without cost-sharing. For adults in the Affordable Care Act (ACA) adult group who receive all essential health benefits (EHB), states must cover all ACIP-recommended vaccinations found on the CDC/ACIP adult immunization schedule, without cost-sharing. 

For additional information regarding vaccines for adults, see SHO #23-003 “Mandatory Medicaid and Children’s Health Insurance Program Coverage of Adult Vaccinations under the Inflation Reduction Act” and the associated Fact Sheet.