The next 2 years will be a time of transition for how vaccines are delivered and paid for in the US- as national policy shifts to the new order under the Affordable Care Act. In the short-term there’ll be some transition challenges- but in the long run- it should be easier to keep up our vaccination rates.
In a couple of weeks, the CDC will stop allowing federally purchased vaccines to be used for immunizing privately insured kids. They’re doing this to ensure that federal vaccine only go to those who have no other options for vaccination… and to assure that all insured children are vaccinated through their insurance policy rather than taking advantage of free federally purchased vaccine.
In the past, county public health clinics that get federally purchased vaccine through our Immunization Program have used federally purchased vaccine to ensure that any child who has not been able to access vaccine elsewhere is able to get immunized, even when the child is insured. Because not all counties will have a mechanism to bill private insurance companies for services- some might not be fully ready to immunize privately insured children next week… meaning that insured children will need to receive all of their immunizations in their medical home. The second policy change will be implemented mid-year 2013… when the CDC will stop allowing underinsured kids to get immunized for free with federal, except at specified locations. “Under-insured” means that a child has insurance, but the insurance doesn’t cover one or more immunizations. Those are the short-term challenges.
The good news is that there’s still plenty of federal vaccine for Vaccines for Children eligible kids (including kids on AHCCCS), the uninsured and Native Americans. The best news is that it’ll be easier to maintain high vaccination rates starting in January of 2014 because the Affordable Care Act provides for “first dollar” coverage for vaccines for all kids… plus there’ll be fewer under-insured children. So, the real key is to get over the 2013 hump- because beginning in January of 2014 things will get easier.