Editor’s Note: In a new white paper funded by Pfizer, Inc., Manatt Health discusses the current landscape of Medicaid and Children’s Health Insurance Program (CHIP) coverage and reimbursement for prenatal vaccines, informed by a recent assessment of relevant policies in all 50 states, plus Washington, D.C., and Puerto Rico. The paper examines policies for both fee-for-service (FFS) and managed care programs, as well as policies relevant to various provider types, including physicians, advanced practice clinicians (APCs), pharmacists and Federally Qualified Health Centers (FQHCs). An executive summary is below. Click here to download a free copy of the full white paper, as well as a companion infographic highlighting key findings.

Vaccines play an essential role in our nation’s public health infrastructure. Prenatal vaccines—those administered during a pregnancy—in particular are critically important, providing pregnant women¹ and/or newborns with antibodies against specific communicable diseases.

Despite the demonstrated effectiveness of prenatal vaccines, uptake remains suboptimal, putting pregnant women and their children at higher risk for vaccine-preventable diseases such as influenza, tetanus, diphtheria and pertussis (whooping cough). A 2020 Centers for Disease Control and Prevention (CDC) study found, for example, that fewer than one out of four pregnant women received both of the two federally recommended prenatal vaccines (the influenza vaccine and the tetanus, diphtheria, pertussis (Tdap) vaccine).² A number of factors influence prenatal vaccination rates, including individual factors such as vaccine hesitancy,³ as well as more systemic factors such as the availability and type of health insurance coverage.

Notably, prenatal vaccination rates are lower among people covered by Medicaid and CHIP—joint federal/state programs that provide health coverage to low- and middle-income people—than among people with private health insurance.⁴ These disparities may reflect differences in access to vaccine providers and inadequate provider reimbursement for the costs of acquiring and administering vaccines.⁵

Nationally, Medicaid and CHIP cover more than two out of every five births.⁶ These programs accordingly play a crucial role in prenatal care for low- and middle-income people, as well as for people of color and other historically marginalized groups that are disproportionately served by the Medicaid program. Both Medicaid and CHIP provide some coverage for prenatal vaccines. Currently, such coverage varies depending on a pregnant person’s state of residence, age and timing of enrollment in the Medicaid program.

Actions for Improving Access

There are key actions that states can take to improve access to prenatal vaccines for Medicaid and CHIP enrollees, including:

• Ensuring adequate reimbursement for prenatal vaccinations, including the service of vaccine administration as well as vaccine supply, across all providers eligible to administer such vaccines.
• Optimizing the value of the Vaccines for Children (VFC) program, through which participating providers can receive vaccines free of charge for administration to Medicaid-enrolled youths under the age of 19. To avoid access barriers to prenatal vaccines for pregnant youths, states could consider making all potential vaccinators eligible to participate in the VFC program (including pharmacists) and ensure that pregnant youths are able to receive prenatal vaccines from obstetrician-gynecologists (OB/GYNs) and other prenatal care providers who do not participate in VFC.
• In states with managed care programs, leveraging managed care organizations (MCOs) to enhance prenatal vaccine access by, for example, establishing requirements for provider reimbursement or member outreach and education, or by defining MCO incentives tied to prenatal vaccination.

Conclusion

Supporting healthy pregnancies and healthy babies has been a core goal of the Medicaid and CHIP programs since their inception. Prenatal vaccines are an essential—and highly cost-effective—tool for advancing that goal. Medicaid and CHIP enrollees are, by definition, low- and middle-income, and are disproportionately likely to be people of color—groups that continue to experience serious disparities in health outcomes, including with respect to maternal and infant health.⁷ By implementing robust vaccine coverage and reimbursement standards under Medicaid and CHIP, states can help address those disparities and ensure that program enrollees have convenient opportunities to learn about and receive recommended vaccinations at appropriate times during their pregnancy.

_{¹ Although this paper will generally refer to “pregnant women,” the authors acknowledge that some pregnant individuals may not identify as women.}

_{² CDC, Flu, Tdap, and COVID-19 Vaccination Coverage Among Pregnant Women – United States, April 2022 (February 2, 2023), https://www.cdc.gov/flu/fluvaxview/pregnant-women-apr2022.htm.}

_{³ See HealthyWomen, Perceptions of Vaccines During Pregnancy: Survey of U.S. Patients & Providers, 4–5 (December 2022), https://roar-assets-auto.rbl.ms/files/48832/Perception%20Vax%20During%20Pregnancy_12.08.22.pdf?rand=1670457037404.}

_{⁴ CDC, Flu, Tdap, and COVID-19 Vaccination Coverage Among Pregnant Women – United States, April 2022, https://www.cdc.gov/flu/fluvaxview/pregnant-women-apr2022.htm; CDC, Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020 (October 2, 2020), https://www.cdc.gov/mmwr/volumes/69/wr/mm6939a2.htm.}

_{⁵ The Medicaid and CHIP Payment and Access Commission (MACPAC), Vaccine Access for Adults Enrolled in Medicaid, Report to Congress on Medicaid and CHIP, 24–49 (March 2022), https://www.macpac.gov/wp-content/uploads/2022/03/Chapter-2-Vaccine-Access-for-Adults-Enrolled-in-Medicaid.pdf.}

_{⁶ CMS, Who Enrolls in Medicaid & CHIP? (accessed March 15, 2023), https://www.medicaid.gov/state-overviews/scorecard/who-enrolls-medicaid-chip/index.html; Ushan Ranji, et al., Medicaid Coverage of Pregnancy-Related Services: Findings from a 2021 State Survey, Kaiser Family Foundation (May 19, 2022), https://www.kff.org/report-section/medicaid-coverage-of-pregnancy-related-services-findings-from-a-2021-state-survey-report/.}

_{⁷ Government Accountability Office, Maternal Health: Outcomes Worsened and Disparities Persisted During the Pandemic (October 19, 2022), https://www.gao.gov/products/gao-23-105871.}