All 50 states and the District of Columbia in the United States have made vaccinations mandatory for children to attend public school. In 19 states, there are allowances granted for families with religious, philosophical, or medical reasons who choose not to vaccinate their children. Adult vaccination is not mandatory in any state, but adults may also receive their vaccinations and immunizations through Medicaid services.
Medicaid may help by paying for the vaccinations and their administration by a health care provider. Medicaid services assist low-income and low-resource individuals and families in paying for their medical expenses. In order to qualify for Medicaid alone, or as a dual-eligible with both Medicare and Medicaid coverage, applicants must meet the federal and state income requirements. They must also meet one of the following criteria:
- You are 65 years or older
- You are a child under 18, or the parent or caretaker of a child
- You are pregnant
- You have a permanent disability
- You are blind
How Are Vaccinations Covered by Medicaid?
Children younger than 21 who are eligible for Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, are also eligible to receive all the recommended vaccines included on the Advisory Committee on Immunization Practice (ACIP).
The Vaccines for Children (VFC) program provides all of the recommended vaccines for children free of charge if they are enrolled in Medicaid, or if they have insufficient or no health insurance coverage, or if they are American Indian or Alaska Native and 18 years old or younger.
These vaccines are distributed to physicians’ offices and public health clinics that are registered VFC providers. This is where parents can take their Medicaid-eligible children to be vaccinated.
For children receiving Medicaid services, there is no charge for the vaccine administration fee. When children who qualify because they are uninsured or underinsured, parents are charged for the administration fee. The amount varies from state to state.
Adults who wish to be vaccinated may be covered for some vaccines by Medicaid, but it depends on the state of residence. Call or visit your local Medicaid services office for more information.
What Vaccinations are Required for Public School Enrollment?
In the United States, every state and Washington D.C. require that children have the following vaccinations before enrolling in public school:
• Diphtheria, pertussis, tetanus (DTaP)
• Measles and rubella
• Varicella (chicken pox)
In 49 states and D.C., vaccination for mumps is also mandatory, and in 43 states and D.C., Hepatitis B is added to the list of required vaccinations. In some states, middle and high schools require that students have had vaccines and booster shots for meningitis, HPV, and tetanus.
The CDC has a list of mandatory vaccinations for every state.
How are Dual-eligibles Covered for Vaccinations?
In the U.S., over 9 million people are dual-eligible beneficiaries who receive both Medicare and Medicaid health insurance benefits.
Dual-eligible beneficiaries are categorized into two groups. The first group includes those who receive full benefits. They have access to all Medicaid health care coverage together with their Medicare benefits. The second group includes those who receive partial benefits because their income levels are not low enough for full benefits. This group does not get full Medicaid benefits, but Medicaid pays for their Medicare premiums or cost-sharing expenses.
If you qualify for Medicaid and require mandatory vaccinations for your children entering the public school system, or if wish to be vaccinated yourself, contact your state Medicaid office to find out which vaccines are covered by Medicaid, and where you can go to have them administered.
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