Introduction
Knowledge regarding the benefits for adult vaccination services under Medicaid's fee-for-service
arrangement is dated; little is known regarding the availability of vaccination services
for adult Medicaid beneficiaries in MCO arrangements. This study evaluates the availability
of provider reimbursement benefits for adult vaccination services under fee-for-service
and MCO arrangements for different types of healthcare providers and settings.
Methods
A total of 43 Medicaid directors across the 50 U.S. states and the District of Columbia
participated in a semistructured survey conducted from June 2018 to June 2019 (43/51).
The frequency of Medicaid fee-for-service and MCO arrangements reporting reimbursement
for adult vaccination services by various provider types and settings were assessed
in 2019. Elements of vaccination services examined in this study were vaccine purchase,
vaccine administration, and vaccination-related counseling.
Results
Under fee-for-service, 41 Medicaid programs reimburse primary care providers for adult
vaccine purchase (41/43); fewer programs reimburse vaccine administration and vaccination-related
counseling (33/43 and 30/43, respectively). Similar results were observed for obstetricians–gynecologists,
nurse practitioners, and pharmacies. Although 24 fee-for-service (24/43) and 23 MCO
(23/34) arrangements cover adult vaccination services in most settings, long-term
care facilities have the lowest reported reimbursement eligibility.
Conclusions
In most jurisdictions, vaccination services for adult Medicaid beneficiaries are available
for a variety of healthcare provider types and settings under both fee-for-service
and MCO arrangements. However, because provider reimbursement benefits remain inconsistent
for adult vaccination counseling services and within long-term care facilities, access
to adult vaccination services may be reduced for Medicaid beneficiaries who depend
on these resources.
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Article Info
Publication History
Published online: February 22, 2021
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Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
