Vaccines for Children (VFC) Program Update: Revised Eligibility for Underinsured Children and Adolescents

The Centers for Disease Control and Prevention (CDC) recently updated federal Vaccines for Children (VFC) program guidance which revised the definition of underinsured children and adolescents to help assure access to vaccines. 

VFC Eligibility

A child through 18 years of age is eligible to receive VFC vaccine if the child meets at least one of the following criteria:

  • Child Is Medicaid eligible.
  • Child is uninsured.
  • Child is American Indian or Alaska Native.
  • Child is Underinsured: An underinsured child is eligible to receive VFC vaccine only through a federally qualified health center (FQHC), rural health clinic (RHC), or a public health department that receives deputized authority from a FQHC or RHC.

 

Revised Eligibility for VFC Underinsured Children and Adolescents

For the purposes of the VFC Program, a child now meets VFC eligibility as underinsured if the child has health insurance that does not provide first-dollar coverage for any vaccine recommended by the Advisory Committee on Immunization Practices (ACIP).

If the child’s health insurance requires the parent of the child to pay out-of-pocket for any co-pay, co-insurance, or deductible that applies to the cost of the vaccine, then this child is now considered underinsured according to the following definition.

A child through 18 years of age is considered underinsured if the child has health insurance but the policy:

  • Does not cover any ACIP-recommended vaccines. (Underinsured for all vaccines).
  • Does not cover certain ACIP-recommended vaccines. (Underinsured for non-covered vaccines only).
  • NEW: Does not provide first dollar coverage (which includes co-pays, co-insurance, or deductibles) for ACIP-recommended vaccines. (Underinsured for vaccines until the child has health insurance with first-dollar coverage for vaccines.)
  • Covers ACIP-recommended vaccines but has a fixed dollar limit (or cap) for payment. (Underinsured once the policy reaches the fixed dollar cap).

A child who is considered underinsured is eligible to receive VFC vaccines only at a:

  • Federally Qualified Health Center (FQHC).
  • Rural Health Clinic (RHC).
  • Deputized local health department*.

* Most health departments in Ohio are deputized and can provide VFC vaccine to underinsured children.

Please note that this new eligibility only applies to the cost of the vaccines – it does not apply to any administration fees or office visit fees (which may have a separate co-pay or co-insurance). Co-pay or co-insurance for administration fees or office visits do not impact the underinsured definition.

A child through 18 years of age is not eligible for VFC vaccine if the child has health insurance that covers all ACIP-recommended vaccines. (Not VFC eligible for any vaccines).

Please ensure your staff are aware of this updated definition and apply it appropriately when screening for VFC eligibility and referring patients for vaccine services.

VFC providers are encouraged to reach out to the Ohio Department of Health’s Immunization Program at 1-800-282-0546 with any questions regarding this update.

Thank you for your continued support to assure that Ohio’s children have access to life-saving vaccines.