New Vaccines and Medicaid

A: The Advisory Committee on Immunization Practices (ACIP) has the advisory role to determine what vaccines should be recommended for administration to children, adolescents, and adults in the U.S. and the operational role to approve which vaccines should be available through the VFC program. The ACIP meets three times a year, and during these meetings newly licensed vaccines may be discussed and recommended for use. Once a vaccine is recommended by ACIP, a vote is taken about whether or not to include the new vaccine in the VFC program through consideration of a VFC resolution. VFC resolutions are specific to each vaccine and include who is eligible to receive the vaccine, the vaccination schedule, and precautions or contraindications to the vaccine. Once the VFC resolution is approved, CDC must negotiate a contract for the vaccine to make it available under the VFC program. VFC resolutions are posted on CDC’s website.

A: CDC and immunization programs that receive VFC funds are required to implement ACIP-recommended vaccines for which there are VFC resolutions and for which federal contracts have been established to purchase these vaccines. When using 317 [52 KB, 1 page], state and local funds for immunizations, implementation of all ACIP recommendations is not required.

A: Section 13631(g) of the Omnibus Budget Reconciliation Act of 1993 (OBRA ’93) provided that vaccination services covered under the Early and Periodic Screening Diagnostic and Treatment (EPSDT) benefit for Medicaid-eligible children will follow the ACIP-established VFC schedule beginning 90 days after establishment of the schedule. CMS considers the 90-day clock to begin on the publication date in the MMWR of ACIP general recommendations for use of a VFC vaccine. Check with the state Medicaid program or CMS for more information regarding the effective date of a new VFC vaccine requirement for EPSDT children and payment of administration fees for such Medicaid children.

Please Note: The 90-day rule does not apply to other categories of federally vaccine-eligible VFC children (i.e., uninsured, underinsured and American Indian/Alaska Natives). The VFC requirement for non-Medicaid federally vaccine-eligible children is effective on the effective date noted in the ACIP VFC resolution for a particular VFC vaccine or the date vaccine is first available through a CDC VFC contract, whichever is later.

A: Yes, all of ACIP's VFC-recommended vaccines are part of the EPSDT benefit package for Medicaid children under age 21. Immunizations through age 18 years are covered by the VFC program. Children 19 years through 20 years are covered by Medicaid program funds.

A: Yes, the state Medicaid agency does have the option to require participation in the VFC Program.

A: This question is outside the scope of the VFC program.

A: This question is outside the scope of the VFC program.