The Centers for Medicare & Medicaid Services has released more information on mandatory state Medicaid and Children’s Health Insurance Program (CHIP) coverage of adult vaccines, originally announced last year.

Beginning Oct. 1, state Medicaid and CHIP programs must provide coverage for vaccines that are Food and Drug Administration-approved for use in adult populations and administered in accordance with federal recommendations, the agency announced Tuesday in a letter to states and in a fact sheet. The programs will not cover vaccines that have received emergency use authorization only. 

Nearly all full-benefit adult beneficiaries (aged 19 years and older) are included in the coverage with no cost sharing.

Flu and shingles vaccines

This required coverage is a provision of the Inflation Reduction Act (IRA) of 2022. Coverage includes any category of recommendations made by the Advisory Committee on Immunization Practices (ACIP), which advises the Centers for Disease Control and Prevention. 

Under the requirements, full coverage applies to vaccines that the CDC or ACIP include on their immunization schedules or recommend for routine use, including vaccines identified on the CDC/ACIP adult immunization schedule. Shingles and influenza vaccines are covered, for example, as long as the beneficiary meets the ACIP recommendation’s criteria.

States will receive regular Medicaid and CHIP matching funds for their expenditures on these programs, CMS noted.

Improving access, preventing infection

The coverage provision of the IRA is meant to improve access to vaccinations for adult Medicaid and CHIP beneficiaries, Daniel Tsai, deputy administrator and director of the Center for Medicaid and CHIP services wrote in the letter to states.

“This change also has the potential to prevent hospitalizations and deaths, and reduce costs associated
with preventable infections,” he concluded.

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