VFC Medicaid FAQs and Other Eligibility Issues

Question and Answer

Q: Our State covers children 19 and 20 years of age under the Medicaid EPSDT program. Are these children eligible for vaccine purchased by the VFC program?

A: No. The VFC law defines eligible children as those 18 years of age and under. Medicaid would be responsible for providing necessary vaccination for EPSDT-eligible persons 19-20 years of age. Consult your State Medicaid agency for further details.

Q: How does a VFC program registered provider, who is not already a Medicaid provider, file for Medicaid reimbursement for the vaccine administration?

A: A VFC program registered provider is not required to become a Medicaid provider in order to receive publicly purchased vaccine. If the child is uninsured or underinsured, billing arrangements are made between the parent and the provider. The provider cannot charge for the vaccine supplied by public sources. However, it is necessary to become a Medicaid provider in order to receive payment from Medicaid for vaccine administration services provided to Medicaid eligible children. Consult your State Medicaid agency about the procedures necessary to become a Medicaid provider.

Q: Can a State require Medicaid providers to become VFC program registered providers, in order to ensure that Medicaid eligible children receive vaccine under the VFC program?

A: Yes, your State Medicaid agency does have the option to require participation in the VFC Program. Some state agencies do not specifically require Medicaid providers to register as VFC providers, but they may refuse to cover the cost of vaccines that are obtained through private sources. It is to the benefit of the Medicaid agency to require provider participation in the VFC program because of reduced vaccine costs.

Q: Are children who are enrolled in the State’s Child Health Insurance Program eligible for VFC?

A: If the State has chosen the option of expanding its’ Medicaid program under SCHIP, the children are Medicaid-enrolled and may be served by the VFC program as are all other Medicaid-enrolled children.

If the State has established an SCHIP program that is not a Medicaid expansion, the children who are enrolled are considered insured and do not qualify for VFC vaccine.

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Page last reviewed: December 17, 2014