Elsevier

Vaccine

Volume 32, Issue 5, 23 January 2014, Pages 618-623
Vaccine

Vaccination benefits and cost-sharing policy for non-institutionalized adult Medicaid enrollees in the United States

https://doi.org/10.1016/j.vaccine.2013.11.050Get rights and content

Highlights

  • Medicaid provides health insurance coverage for poor Americans.

  • Most programs cover at least one recommended vaccine for adult enrollees.

  • Half of all programs permit copayments for adult vaccination services.

  • Most programs have maintained or increased coverage for adult vaccines.

Abstract

Medicaid is the largest funding source of health services for the poorest people in the United States. Medicaid enrollees have greater health care, needs, and higher health risks than other individuals in the country and, experience disproportionately low rates of preventive care. Without, Medicaid coverage, poor uninsured adults may not be vaccinated or would, rely on publicly-funded programs that provide vaccinations. We examined each programs’ policies related to benefit coverage and, copayments for adult enrollees. Our study was completed between October 2011 and September 2012 using a document review and a survey of Medicaid administrators that assessed coverage and cost-sharing policy for fee-for-service programs. Results were compared to a similar review, conducted in 2003. Over the past 10 years, Medicaid programs have typically maintained or expanded vaccination coverage benefits for adults and nearly half have explicitly prohibited copayments. The 17 programs that cover all recommended vaccines while prohibiting, copayments demonstrate a commitment to providing increased access to vaccinations for adult enrollees. When developing responses to fiscal and political challenges, the programs that do not cover all ACIP recommended adult vaccines or those that permit copayments for vaccinations, should consider all strategies to increase vaccinations and reduce costs to enrollees.

Section snippets

Methods

Between October 2011 and September 2012, we conducted a document review and developed and administered a survey assessing coverage and cost-sharing policy for Medicaid fee-for-service programs. The results were compared to our 2003 study entitled The Epidemiology of US Immunization Law: Medicaid Coverage of Immunizations for Non-Institutionalized Adults (2003 study) [12].

Survey response and characteristics of respondents

By October 1, 2012, 42/51 programs (82%) responded to the survey. Of the 9 programs that did not complete the survey, 2 programs (WV, WI) declined to participate and 7 (IL, KS, NH, NC, OH, PA, and RI) did not respond.

The 42 responding programs cover approximately 16 million of the more than 19 million Medicaid enrollees ages 19 through 64 [4]. Respondents included 6 of the 10 largest programs and covered 41% of all enrollees ages 19 through 64. The median respondent program has approximately

Discussion

Medicaid enrollees have few assets and generally cannot afford medical insurance in the private market [5], [19]. Medicaid policy related to vaccinations for adult enrollees directly impacts both the enrollee's personal health status and the public's health. Programs that cover all ACIP recommended vaccines and prohibit any form of cost-sharing support the Healthy People 2020 goals related to seasonal flu, pneumococcal, hepatitis B, and zoster vaccinations for adults [20], [21].

Federal rules

Acknowledgements

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The CDC provided funding for the study. CDC scientists collaborated with GW researchers to design the survey, review project findings, and develop this manuscript. The authors thank the Medicaid program administrators who, despite limited resources and busy schedules, completed the survey and provided their expertise.

References (27)

  • Social Security Amendments of 1965 (Title XIX of the Social Security Act), Pub. L. No. 89-97, 79 Stat. 286.(Jul. 30,...
  • HHS.gov/Recovery [Internet], Department of health and human services: state and territories Medicaid program awards-...
  • Medicaid [Internet]

    National conference of state legislatures: Medicaid

    (2013)
  • US Department of Commerce

    Income, poverty, and health insurance coverage in the United States: 2011. Final report

    (2012 Sep)
  • Kaiser Family Foundation

    Medicaid, a primer. Final report

    (2010 Jun)
  • Center for Health Care Strategies, Inc.

    The faces of Medicaid: the complexities of caring for people with chronic illnesses and disabilities

    (2011)
  • J. Holahan et al.

    The health status of new Medicaid enrollees under health reform. Final report

    (2010 Aug)
  • A. Schneider et al.

    Medicaid benefits

    Kaiser Family Foundation

    (2003)
  • K Swartz

    Health care for the poor: for whom, what care, and whose responsibility

    (2009)
  • The Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119-1025 (Mar. 23, 2010) and The Health...
  • C.M. Perlino, Medicaid, prevention and public health: invest today for a healthier tomorrow. Final report, American...
  • S. Rosenbaum et al.

    The epidemiology of US immunization law: Medicaid coverage of immunizations for non-institutionalized adults. Final report

    (2003 Nov)
  • HowTo.gov [Internet], US general services administration office of citizen services and innovative technologies: basics...
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