Changes coming to adult vaccine Medicaid coverage

The Centers for Medicare & Medicaid Services recently released guidance to state Medicaid agencies outlining new vaccine coverage requirements and incentives for adult beneficiaries, based on what was enacted in the Inflation Reduction Act (IRA). Key points to know:

• Effective Oct. 1, 2023, state Medicaid programs (both fee-for-service and managed care) must cover all Food and Drug Administration (FDA)-approved adult vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends, even those that are not on the immunization schedules. They also must cover vaccine administration. This includes the Children’s Health Insurance Program (CHIP) (which covers beneficiaries up to age 19).
• Medicaid and CHIP programs must cover COVID-19 vaccines without cost-sharing through Sept. 30, 2024. After that, FDA-approved COVID-19 vaccinations for adults administered in accordance with any category of ACIP recommendation will be covered without cost sharing as part of the IRA-required adult vaccination coverage.
• Payment rates for covered vaccines and their administration will be set by the states or their Medicaid/CHIP managed care plans.

— Kent Moore, AAFP Senior Manager for Payment Strategies

Posted on Aug. 24, 2023