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Vaccines for Children Program (VFC)
For Parents
VFC is vaccines for children

Which Children are Eligible
for the VFC Program?


Which children are eligible?
Through the VFC program, public purchased vaccine is available at no charge to enrolled public and private health care providers for eligible children.

Children 18 years of age and under that meet at least one of the following criteria are eligible for VFC vaccine:

  • Medicaid eligible - a child who is eligible for the Medicaid program (in some States, children who are <1 year of age are automatically entitled to Medicaid benefits, if their mother is enrolled).
  • Uninsured - a child who has no health insurance coverage.
  • American Indian or Alaska Native - as defined by the Indian Health Services Act.
  • Underinsured - a child whose health insurance benefit plan does not include vaccinations. Underinsured children are eligible to receive VFC vaccine only if they are served by a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC).

Underinsured children are defined as those children who have health insurance but coverage does not include vaccines. Children whose health insurance cover only select vaccines or caps the vaccine cost at a certain limit are categorized as underinsured; thus only eligible for VFC program benefits at an FQHC or RHC.

Children whose health insurance covers the cost of vaccinations are not eligible for VFC program benefits, even when a claim for the cost of the vaccine and its administration would be denied, if submitted to the insurance carrier for payment, because the plan’s deductible had not been met.

The Children’s Health Insurance Program (CHIP), known as Title XXI, enabled States to expand health insurance coverage for uninsured children. Title XXI children enrolled in a separate State children health insurance program (S-SHIP) are not VFC-eligible because they are neither Medicaid-eligible nor uninsured as required under Title XIX. However, Title XXI children enrolled in a Medicaid Expansion (M-SHIP) are Medicaid eligible and entitled to VFC program benefits.

What is an FQHC?
FQHC (Federally Qualified Health Center) - A center that provides health care to a medically underserved population may apply to the Bureau of Primary Health Care (BPHC), part of the Health Resources and Services Administration (HRSA), for FQHC status. If the application is approved and the health center meets the Health Resources and Services Administration qualifications, FQHC status is conferred. FQHC’s include community and migrant centers, special health facilities such as those for the homeless and persons with Acquired Immunodeficiency Syndrome (AIDS) that receive grants under the Public Health Service (PHS) Act, and "look-alikes" which meet the same qualifications but do not actually receive grant funds. They also include health centers within public housing and Indian health centers. There are about 1,400 designated FQHC’s nationwide.

What is an RHC?
RHC (Rural Health Clinic) - The Rural Health Clinic program was established in 1977. Its two-fold purpose was to increase access to health care for rural underserved communities, and to expand the use of nurse practitioners (NP’s), physician assistants (PA’s), and certified nurse midwives (CNM’s) in rural communities. To be eligible for certification as an RHC, a clinic must be located in a Health Professional Shortage Area, Medically Underserved Area, or a Governor-Designated Shortage Area. RHC’s are required to be staffed by PA’s, NP’s, or CNM’s at least half of the time the clinic is open.

There are about 1600 RHC’s nationwide. Currently, RHC’s make up one of the largest outpatient primary care programs for rural underserved communities. It is also one of the fastest growing Medicare programs. RHC’s provide comprehensive family-oriented primary health services to medically underserved and disadvantaged populations experiencing financial, geographical, or cultural barriers to care.


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This page last modified on January 27, 2004

   

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