Vaccines for Children Program (VFC) For State Immunization Projects
VFC Eligibility FAQs FAQs about State Immunization Projects
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How is the term "VFC eligible" defined? How does “Medicaid enrolled” differ from “Medicaid eligible”? How can you determine if a health benefits organization is a health insurance company when determining a child’s VFC eligibility? If a family has a medical savings account or health savings account does that account affect a child’s VFC eligibility? The 2002 VFC Operations Guide states that underinsured children are eligible to receive VFC vaccine only if they are served by an FQHC or RHC.   What is the definition of "served by"? If a child presents for vaccines and does not have health insurance but the parent plans to insure the child, would this child be eligible for VFC vaccine? If a child is eligible for insurance and the parents choose not to insure the child, would the child be eligible for VFC vaccine? Can VFC vaccines be administered to the underserved population? If a child is eligible for a Title V program that pays for medical care for that child, is the child VFC eligible? Are all children enrolled in Medicaid programs automatically VFC eligible? If a VFC-eligible child starts a vaccine series (such as hepatitis B) at age 18, can the series be completed using VFC vaccine after the child turns 19? Can juveniles who are incarcerated and lose access to their health insurance be considered uninsured and be served with VFC vaccine? If an adolescent presents for family planning services at a Title X clinic without insurance information, would the adolescent be eligible for the VFC program?

1. How is the term “VFC eligible” defined?
   

   Children through 18 years of age who meet at least one of the following criteria are considered federally vaccine-eligible and therefore eligible to participate in the VFC program:

   Medicaid eligible: a child who is eligible for the Medicaid program. (For the purposes of the VFC program the terms Medicaid-eligible and Medicaid-enrolled are equivalent and refer to children who have health insurance covered by a state Medicaid program)

   Uninsured: a child who has no health insurance coverage

   Indian (American Indian or Native American): as defined by the Indian Health Care Improvement Act (25 U.S.C. 1603)

   Underinsured: Children who have commercial (private) health insurance but the coverage does not include vaccines, children whose insurance covers only selected vaccines(VFC- eligible for non-covered vaccines only), or children whose insurance caps vaccine coverage at a certain amount-- once that coverage amount is reached, these children are categorized as underinsured. Underinsured children are eligible to receive VFC vaccine only through a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC).

2. How does “Medicaid enrolled” differ from “Medicaid eligible”?
   

   For the purposes of the VFC program both terms, “Medicaid enrolled” and “Medicaid eligible,” are equivalent and refer to children who have health insurance covered by a state Medicaid program.

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3. How can you determine if a health benefits organization is a health insurance company when determining a child’s VFC eligibility?
   

   Health insurance is subject to t he Employee Retirement Income Security Act of 1974 ( ERISA) or is regulated by a state’s Insurance Commissioner as insurance. ERISA is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans. Contact the state Insurance Commissioner to determine if an organization is a health insurance company.

4. If a family has a medical savings account or health savings account does that account affect a child’s VFC eligibility?
   

   Individuals covered by medical savings accounts or health savings accounts must also have high deductible health plan coverage. Therefore, such individuals are insured.

5. The 2002 VFC Operations Guide states that underinsured children are eligible to receive VFC vaccine only if they are served by an FQHC or RHC.   What is the definition of "served by"?
   

   In the VFC program, “served by” means that underinsured children are seen in or under the auspices of an FQHC or RHC to obtain the VFC vaccine.

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6. If a child presents for vaccines and does not have health insurance but the parent plans to insure the child, would this child be eligible for VFC vaccine?
   

   If the child has no health insurance on the day he/she presents at the office for immunizations, the child would be VFC eligible because he/she is uninsured. VFC eligibility screening must take place with each visit even though the patient screening form needs to be updated only when the eligibility status of the child changes.

7. If a child is eligible for insurance and the parents choose not to insure the child, would the child be eligible for VFC vaccine?
   

   If the child has no health insurance on the day he/she presents at the office for immunizations, regardless of the reason, the child would be VFC eligible because he/she is uninsured.

8. Can VFC vaccines be administered to the underserved population?
   

   VFC does not have a category specifically for the underserved. The term “underserved” refers to a geographic location such as a county or a census tract or a population living in a specific geographic location that has been designated by HRSA as medically underserved. For further information on medically underserved areas or population, please visit the Health Resources and Services Administration (HRSA) website at http://www.bhpr.hrsa.gov/shortage/muaguide.htm. It is common for VFC-eligible children to live in medically underserved areas or to be members of medically underserved populations.

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9. If a child is eligible for a Title V program that pays for medical care for that child, is the child VFC eligible?

   Title V is not a type of health insurance so it has no effect on VFC eligibility of a child. To be eligible for VFC a child has to meet the age and eligibility criteria of the VFC program. To learn more about the Title V program see the HRSA website: https://perfdata.hrsa.gov/mchb/mchreports/Search/search.asp

10. Are all children enrolled in Medicaid programs automatically VFC eligible?
    

    Yes, all children from birth through 18 years of age who are covered by Medicaid are considered VFC eligible because of their Medicaid status.

11. If a VFC-eligible child starts a vaccine series (such as hepatitis B) at age 18, can the series be completed using VFC vaccine after the child turns 19?
    

    No. Children are eligible to participate in the VFC program only through age 18 years regardless of the child’s immunization status (series completed or series not completed) when they age out of VFC.

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12. Can juveniles who are incarcerated and lose access to their health insurance be considered uninsured and be served with VFC vaccine?
    

    Yes, an individual who loses access to benefits under his/her insurance while incarcerated is uninsured for purposes of the VFC program.

13. If an adolescent presents for family planning services at a Title X clinic without insurance information , would the adolescent be eligible for the VFC program?

    A person under 19 years of age who may have insurance but because of the circumstances for seeking services does not have access to that insurance coverage is uninsured for the purposes of the VFC program. The Title X clinic must screen these adolescents for VFC eligibility using the form: “Patient Eligibility Screening Record Vaccines for Children Program for Title X Programs” (.doc). In addition, each Title X clinic must document all VFC vaccines administered to unaccompanied minors without insurance information on the administration log titled “Title X Unaccompanied Minor without Insurance Information VFC Vaccine log” (.doc). The completed logs should be submitted to the immunization program on a monthly basis. Both documents are available at the end of this questions and answers document.

    Please Note: The VFC program in no way regulates the issue of medical consent for the provision of medical care to minors. The assumption is that the clinic provides any such care in conformance with the state’s medical consent laws as they pertain to minors.

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This page last modified on June 4, 2007