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Vaccination Disparities in the Medicaid Program

By Emily Blanford  |  May 18, 2022

Vaccines remain a key strategy for controlling the coronavirus pandemic. Overall, 82% of the national population has received at least one COVID-19 vaccine dose, but vaccination rates for Medicaid beneficiaries lag behind those with private insurance coverage.

Medicaid clients are more likely than the general population to have chronic health conditions, making them more susceptible to severe illness and death from COVID-19. To help limit the spread of the disease and maintain hospital capacity, states are implementing strategies to increase access to and uptake of vaccines for Medicaid beneficiaries.

According to Kaiser Health News, the COVID-19 vaccination rate among Medicaid enrollees in some states was more than 25% lower than the overall state vaccination rate in February 2022. Two U.S. senators have requested the Government Accountability Office study the reasons driving this gap. But these disparities are nothing new.

Rates Lower for Medicaid Enrollees

Prior to COVID-19, routine vaccine coverage for children who rely on Medicaid was 2.5% to 12% lower than those with private coverage, depending on the vaccine type. Data from the National Committee for Quality Assurance measuring health plan performance shows flu vaccination rates for adults on Medicaid have significantly lagged behind those of adults on private health plans for years.

One long-standing strategy to increase vaccinations among children enrolled in Medicaid is the Vaccines for Children program administered by the Centers for Disease Control and Prevention. Through this program, the CDC purchases vaccines at a discount and provides them to states for distribution among participating providers. Most children in the program are enrolled in Medicaid, helping to increase access to vaccines for children while reducing administrative burdens on pediatricians and other vaccine providers. States are leveraging this existing infrastructure for COVID-19 vaccines. Texas, for example, has enrolled more than 70% of its Vaccines for Children providers as COVID-19 vaccine providers to expand access, particularly for low-income families in rural areas.

While vaccine coverage is provided for eligible children through Medicaid and the Vaccines for Children program, vaccines are not a mandatory benefit for all adults in Medicaid. The Medicaid and CHIP Payment and Access Commission conducted interviews with state and federal officials to assess Medicaid coverage of vaccines for adults and options to increase coverage. Most interviewees said they preferred mandating vaccine coverage. Other strategies included creating a federal purchasing program similar to Vaccines for Children; increasing provider reimbursement; and expanding education and outreach to Medicaid beneficiaries.

State Strategies

Some states have implemented such strategies specifically to increase COVID and flu vaccination rates. Arizona increased reimbursement rates for the flu vaccine by 10%, and Massachusetts is reimbursing more than the Medicare rate for COVID-19 vaccinations. Some states, including North Carolina, are providing Medicaid reimbursement for education and counseling about the benefits of the COVID-19 vaccine.

Other state methods to bolster vaccination rates include data integration and data sharing so that Medicaid providers have access to vaccine data from state immunization information systemsOhio, for example, created a platform to share data across agencies and share enrollee vaccination status with managed care organizations.

Strategies including managed care organizations can help increase vaccine access as well, since 75% of Medicaid beneficiaries are enrolled in some kind of managed care program. Ohio is working with its managed care organizations on additional efforts, including individual incentives such as gift cards for vaccination; incentives for pharmacists to provide education and outreach for people picking up unrelated prescriptions; and working with managed care network providers to deliver in-home vaccination or services outside of regular business hours.

States are continuing to explore these and other strategies to increase their flu and COVID vaccination rates. With an unseasonal increase in flu cases and COVID-19 booster shots recommended for all over the age of 12, these strategies remain critical to increasing access to vaccines, slowing the spread of illnesses, and reducing burdens on the health care system—now and in future coronavirus waves and flu seasons.

Emily Blanford is a program principal in NCSL’s Health Program.

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services as part of a financial assistance award totaling $300,000 with 100% funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. government.

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