Medicaid Doesn't Cover All 13 Recommended Adult Vaccines in Most States

Access to adult vaccines for low-income Americans varies widely by state, and most adult Medicaid beneficiaries do not have access to all 13 recommended vaccines, according to a new study.

“Numerous factors contribute to low vaccination coverage among adults, so achieving higher vaccination rates among low-income adults will require a multi-faceted approach,” study lead author Charleigh Granade, MPH, public health analyst for IHRC, Inc. working as a contractor for the Centers for Disease Control and Prevention, told Contagion^®. “However, the parity of increased vaccination coverage benefits across Medicaid programs and between traditionally eligible and expansion adult populations could decrease income-based health disparities and reduce the proportion of limited program funds expended to treat diseases that can be prevented with safe and cost-effective vaccines.”

The study, published in JAMA Network Open, reviewed Medicaid programs in all 50 states and the District of Columbia and found that only 22 (43%) covered all 13 adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) for both fee-for-service and managed care organization enrollees. Only 14 of the programs covered vaccines without copayments.

“Although the existence of variability across Medicaid programs in different states is well established, it was surprising to see the level of variability within Medicaid programs,” Granade told Contagion^®. “Specifically, learning that adult vaccination services benefits were not always aligned between the fee-for-service and managed care organization arrangements present within Medicaid programs was not anticipated. Additionally, the authors were surprised to find that fewer than half of all Medicaid programs offered all Advisory Committee on Immunization Practices recommended adult vaccinations. The number of vaccinations routinely recommended for adults has increased in the past 8 years, which may partially explain our findings.”

The study found the median reimbursement for a single vaccine ranged from $9.81 to $13.98, which is below the estimated cost to administer vaccines of $15 to $23. In 7 of 13 vaccines included in the study, median reimbursement for purchase also was below private-sector costs. Median reimbursement for vaccine purchase ranged from $204.87 for the HPV vaccine to $18.09 for the Haemophilus influenzae type b vaccine.

Low Medicaid reimbursement for adult vaccines is a disincentive to providers to vaccinate low-income adults, contributing to income-based health disparities and costs of treating vaccine-preventable diseases.

“In 2015, Ozawa et al estimated the financial burden associated with vaccine-preventable disease was approximately $9 billion, with 80% of this burden attributed to unvaccinated individuals,” Granade told Contagion^®. “If expansion of vaccination services benefits coverage for Medicaid beneficiaries led to increased vaccination coverage in this population, Medicaid programs could see decreased spending for health care related to vaccine-preventable illness.”

Granade urged providers to be aware of which vaccines are covered for their low-income adult patients.

“Healthcare provider’s recommendation for vaccination is one of the strongest predictors of vaccine uptake for adult patients and providers may hesitate to recommend vaccines to patients if they think the patients cannot afford them,” Granade told Contagion^®.

Granade said more research is needed to inform future federal and state policy decisions and facilitate parity of increased vaccination coverage.

Angela K. Shen, ScD, HPH, and Walter Orenstien, MD, called the study “a much-needed and timely update to previous work.”

Gaps in access are an ongoing challenge for Medicaid programs, which represent an at-risk pool with higher health risks, greater health care needs, and disproportionately lower utilization of preventive services, Shen and Orenstien wrote in an invited commentary.

“Payment challenges hinder the ability of the patchwork system of practitioners, who care for adults, to optimize the full potential of vaccines,” they wrote. “The study by Granade et al highlights the weaknesses of the fragmented health care delivery system, specifically regarding adult immunization policies. Although complete insurance benefit coverage and higher physician payment do not guarantee higher coverage rates for vaccination, a close look at how to fill program gaps is needed to close the equity gaps in our current fragmented system as the nation works toward a more complete picture of universal health coverage.”