Vaccines
for Children Program (VFC)
For Parents |
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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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