Low cost immunizations no longer available to insured residents at Public Health clinics

Tuesday, December 04, 2012

Due to a change in federal vaccine policy, beginning January 1, 2013, Boulder County Public Health will no longer provide low-cost vaccinations to children 0-18 years who have health insurance.

Per federal guidelines, health insurance is defined as any type that covers the cost of vaccine, including those with high deductibles or co-pays, or when claims for the cost of the vaccine and its administration are denied because deductibles have not been met.

“We estimate that nearly 38% of the people who receive vaccinations at our clinics have health insurance,” said Sophia Yager, Boulder County Public Health Immunization Program coordinator.

The federal changes were made in response to limited funds and increased scrutiny of federal entitlement programs, like the Vaccines for Children (VFC) Program.
“Fortunately, the Affordable Care Act (ACA) now requires that health care providers provide vaccinations without a co-pay or office visit,” said Bernadette Albanese, Boulder County Public Health medical director. “We hope this change will make it more affordable for families to see their primary health care providers for immunizations.” 
The change is also a nod to evidence that patients do best if they receive all of their medical care, including immunizations, from their “medical home” because their health care providers are familiar with all aspects of their health and wellness.
“Ninety-eight percent of visitors to our immunization clinics reported that they have a primary care provider,” said Albanese. “Ideally, we would like for them to also see their doctor for immunizations.”
Children and adolescents (0-18 years of age) who are uninsured, are on Medicaid or are Medicaid-eligible, as well as children of American Indian/Alaskan Native heritage can receive low-cost vaccinations through the VFC Program. If their health care providers do not participate in the VFC program, they may still receive their immunizations at Boulder County Public Health clinics.
Federal vaccine funds may be used in some limited circumstances, including during an outbreak response, for disaster relief efforts, and during mass vaccinations.
The Vaccine Assistance Act, or Section 317 of the Public Health Service Act, was enacted in 1962. It was initially designed to purchase polio, diphtheria, pertussis, tetanus, and measles (added in 1965) to reduce vaccine-preventable disease by maintaining high immunization coverage rates. As more vaccines have become available, the program has been used to purchase all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). Historically, the emphasis had been on children whose health insurance did not cover immunizations, although the program was also authorized to purchase vaccine for all children and adults.
Due to the rise in cost of vaccines and new recommendations, the ability of Section 317 funds to fund the cost of fully vaccinating children has declined. All states have reported difficulty in meeting their vaccine needs because of a lack of Section 317 funds.

Chana Goussetis
Marketing and Communications Specialist
Boulder County Public Health

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