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. 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
All ACIP-recommended vaccinations are covered without cost-sharing for adults in the Affordable Care Act (ACA) adult group who receive all essential health benefits (EHB). For adults who are not subject to the EHB, most state Medicaid agencies cover at least some adult immunizations but may not offer coverage of all ACIP-recommended vaccines.