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Availability of Adult Vaccination Services by Provider Type and Setting

  • Charleigh J. Granade
    Correspondence
    Address correspondence to: Charleigh J. Granade, MPH, National Center for Immunization and Respiratory Diseases, 1600 Clifton Road, Northeast, Mail Stop H24-4, Atlanta GA 30329.
    Affiliations
    Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

    IHRC Inc., Atlanta, Georgia
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  • Russell F. McCord
    Affiliations
    Public Health Law Program, Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia

    Cherokee Nation Assurance, Arlington, Virginia 5Merck & Co., Inc, Kenilworth, New Jersey
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  • Alexandra A. Bhatti
    Affiliations
    Public Health Law Program, Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia

    Cherokee Nation Assurance, Arlington, Virginia 5Merck & Co., Inc, Kenilworth, New Jersey

    Merck & Co., Inc, Kenilworth, New Jersey
    Search for articles by this author
  • Megan C. Lindley
    Affiliations
    Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Published:February 22, 2021DOI:https://doi.org/10.1016/j.amepre.2020.11.013

      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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