Below is an edited excerpt from a recent Manatt Health paper. Click here to read the full text.
Despite the demonstrated effectiveness of prenatal vaccines, uptake remains low. This puts mothersi and babies at risk. Vaccines administered prenatally (i.e., during a pregnancy) provide protective antibodies to pregnant women and their unborn children.
Prenatal vaccination rates are especially low among the low- and middle-income people covered by Medicaid and the Children’s Health Insurance Program (CHIP).[ii] These disparities may reflect in part lower reimbursement rates compared to commercial insurance, resulting in reduced access to providers who offer prenatal vaccines.iii
This paper reviews the current landscape of Medicaid and CHIP reimbursement for prenatal vaccines, informed by a recent assessment of relevant policies in all 50 states, plus Washington, D.C. and Puerto Rico. We examined policies for both fee-for-service and managed care programs, with a focus on the following types of providers: physicians, advanced practice clinicians (certified nurse-midwives, nurse practitioners, and physician assistants), pharmacists, and Federally Qualified Health Centers, updating and building upon the findings in our 2023 paper (which examined state policies between November 2021 and April 2022).
The paper also describes policy strategies to improve prenatal vaccine access for Medicaid and CHIP enrollees, including:
- Ensure adequate reimbursement for prenatal vaccinations for all vaccinators;
- Optimize the value of the Vaccines for Children Program;
- Leverage managed care organizations to enhance prenatal vaccine access; and
- Support state vaccinator capacity using policy levers outside Medicaid and CHIP
To download the full white paper, click here.
To download the companion infographic, click here.
This analysis was conducted with support from Pfizer.
iAlthough this paper will generally refer to “mothers” and “pregnant women,” the authors acknowledge that some pregnant individuals may not identify as women.
iiCDC, Influenza, Tdap, and COVID-19 Vaccination Coverage and Hesitancy Among Pregnant Women — United States, April 2023 (September 29, 2023), https://www.cdc.gov/mmwr/volumes/72/wr/mm7239a4.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.
iiiThe 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.