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Vaccines for Children Program

posted on Wed, Jun 7 2017 12:59 pm by Western Region

The Vaccines for Children Program (VFC) is a federally-funded program in the United States providing no-cost vaccines to children who lack health insurance or who cannot otherwise afford the cost of vaccination. A public health worker from Arizona recently contacted the Network asking several questions about the VFC Program and insurance coverage.

The VFC Program requires a screening to determine eligibility status prior to each administration of vaccine. Screening results must be documented at each immunization visit, even if there is no change in eligibility status. The Vaccines for Children Eligibility Screening Record states that verification of responses is not required.

Children under 19 years old who meet one of the following criteria are eligible to receive VFC vaccine:

  • Medicaid-eligible: A child who is eligible for the Medicaid program. For VFC program purposes, "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.
  • American Indian or Alaska Native: A child who meets the definition as defined by the Indian Health Care Improvement Act.
  • Underinsured: A child who has health insurance, but the coverage does not include vaccines or covers only selected vaccines (in which case the child is only eligible for vaccines not covered by the insurance plan). For insured children, providers must verify prior to vaccine administration, that insurance does not cover the vaccine to be administered. Additionally, only Federally Qualified Health Centers, Rural Health Centers, County Health Departments, and “Deputized Providers” approved by the VFC program office can vaccinate underinsured children.

According to the Arizona VFC Program Operations Guide, providers may charge an administration fee, up to $21.33 per immunization to patients who are not covered by Medicaid. For Medicaid patients, the administration fee will vary based on the specific health plan, but $21.33 is the maximum fee set by Arizona’s Medicaid Agency. Patients themselves may be charged an administration fee, but only if they are able to pay it. A VFC eligible child cannot be denied a vaccine for failure to pay an administration fee. 

Network attorneys are available to answer questions on this and other public health topics at no cost to you, and can assist you in using law to advance your public health initiatives. Contact a Network Attorney in your area for more information.

The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.