Vaccination benefits and cost-sharing policy for non-institutionalized adult Medicaid enrollees in the United States

Vaccine. 2014 Jan 23;32(5):618-23. doi: 10.1016/j.vaccine.2013.11.050. Epub 2013 Nov 27.


Medicaid is the largest funding source of health services for the poorest people in the United States. Medicaid enrollees have greater health care, needs, and higher health risks than other individuals in the country and, experience disproportionately low rates of preventive care. Without, Medicaid coverage, poor uninsured adults may not be vaccinated or would, rely on publicly-funded programs that provide vaccinations. We examined each programs' policies related to benefit coverage and, copayments for adult enrollees. Our study was completed between October 2011 and September 2012 using a document review and a survey of Medicaid administrators that assessed coverage and cost-sharing policy for fee-for-service programs. Results were compared to a similar review, conducted in 2003. Over the past 10 years, Medicaid programs have typically maintained or expanded vaccination coverage benefits for adults and nearly half have explicitly prohibited copayments. The 17 programs that cover all recommended vaccines while prohibiting, copayments demonstrate a commitment to providing increased access to vaccinations for adult enrollees. When developing responses to fiscal and political challenges, the programs that do not cover all ACIP recommended adult vaccines or those that permit copayments for vaccinations, should consider all strategies to increase vaccinations and reduce costs to enrollees.

Keywords: Adult vaccination; Health insurance; Health reform; Medicaid.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cost Sharing*
  • Fee-for-Service Plans
  • Health Care Surveys
  • Humans
  • Insurance Benefits*
  • Medicaid / economics*
  • United States
  • Vaccination / economics*