Public shots for insured kids cut

All public providers for Vaccines for Children (VFC), such as the Yuma County Public Health Services District, school programs, public clinics and several fire departments, will no longer be authorized to provide immunizations to insured patients 18 years and younger in Arizona due to recent federal and state policy changes and cuts.

Effective Oct. 1, insured patients must receive vaccinations from their primary care provider. Insured children include those with a policy that covers the cost of vaccines even if it includes a deductible or co-pay or if a claim for the cost of vaccine and its administration fee would be denied for payment by the insurance carrier because the plan's deductible had not been met.

Karen Lewis, the medical director for the immunization program office at the Arizona Department of Health Services, said the Centers for Disease Control informed them in 2011 about the change.

“Vaccines are important, that's why we have so little disease around, but federally funded vaccines were provided as a safety net for those who didn't have insurance and so with the economic challenges that we're having, the CDC has changed the policy to make it just for the uninsured,” said Lewis.

She noted that in the past, if parents couldn't get their children into their primary care provider, they would use federally funded vaccines for a variety of reasons at public health facilities.

“With vaccines being so expensive, some of the private providers stopped carrying the more expensive vaccines — for example the meningococcal vaccine — and children needed them, so they would go to their county health department that had the vaccines because otherwise they couldn't get them. But because of economic challenges, the CDC has sent out guidance saying that federally purchased vaccines are only to be used for the uninsured, the AHCCCS eligible, and Native American or Alaskan Native children,” said Lewis.

She said pharmacies can still vaccinate children 6 years and older with a doctor's prescription, with the exception of the influenza vaccine, which doesn't require a prescription. Pharmacies may bill insurance companies and/or charge the parent an out-of-pocket fee.

Underinsured patients, whose insurance policies don't cover vaccines or only certain vaccines, will still allowed to be immunized with federally purchased vaccines, Lewis added, but the discretionary “317” funding earmarked for that will run out by March or April.

“2013 is just going to be harder because of this transition. Hopefully by 2014 with the Affordable Care Act, there will not be any underinsured patients and so we just have to figure out ways of getting kids through this next year.”

The Affordable Care Act, signed by President Barack Obama in 2010, will have first-dollar coverage for vaccines, which means people will not be expected to have a co-payment or a deductible for vaccines.

Public health nursing supervisor Leigh Ann Howell said that the Yuma County Public Health Services District has served approximately 8,000 kids per year, and approximately 4 percent report being privately insured.

“For that 4 percent, there are many reasons why they come to the health district for vaccines, ranging from the $10 flat fee to the walk-in availability,” she said.

Howell added that during the 10 years she has been working with immunizations in the Yuma area, change is a constant, especially when it comes to privately insured patients.

“The amount of money from the state and federal level to cover the cost of the vaccines given to privately insured patients has always been fragile. During this time, we have seen many restrictions on providing vaccine to this population. This time, the change is more drastic and vaccines purchased with federal dollars are no longer to be used on privately insured children, not just at the health department but at any facility that receives federally purchased vaccine.”

She noted that many people at the state level are currently working to resolve the issue but one has yet to be found.

“For parents, it is a matter of knowing your insurance policy, working with your provider, knowing your options and planning ahead.”

Shirley Rodriguez, coordinator of Health Services at Yuma Elementary School District 1, said she is also no longer allowed to immunize students across Yuma County as she had been because of the change.

Rodriguez said her concern is that some family doctors or pediatricians do not carry vaccines or keep them on hand.

“It's kind of a catch-22: Children have to have, by law, the immunizations to remain in school, but it's going to be difficult for them to all get immunized.

“I had a parent that came in this week and said that they just moved here and they didn't even have a doctor to go to yet. They had insurance but hadn't been in to see a doctor ... We don't want kids not to be immunized because we want them in school and we want them to be protected from these diseases that are preventable.”

For more information, contact the Arizona Department of Health Services VFC Program at 1-602-364-3630 or at www.azdhs.gov, click on the “Arizona Immunization Program” link on the left side of the page and then click on "Vaccines for Children." Individuals can also visit www.whyimmunize.org for more information about immunizations and places that insured children can be immunized.