State health officials are advised to plan and prepare for the needs of Medicaid and Children's Health Insurance Programs (CHIP) enrollees and the healthcare workforce by preparing an inoculation program for individuals in these groups. Priority should be given to vaccination of eligible individuals as follows: (1) pregnant women; (2) individuals caring for or living with infants under the age of six months; (3) healthcare workers; (4) children between the ages of six months and 18 years; (4) adults between the ages of 19 and 24; and (5) adults between 25 and 64 with health conditions associated with increased complications of influenza.
Agencies are encouraged to offer immunizations through providers whose services are mandatory benefits, such as physicians and federally qualified health centers/rural health clinics, at nontraditional locations such as schools or retail establishments, to coordinate with other state and local agencies and to allow eligible entities to make presumptive eligibility determinations for uninsured pregnant women and children so that as many people as possible may be immunized.
State officials are reminded that copayments and deductibles may not be required for services to individuals under 18 or pregnant women. The federal government will make the H1N1 vaccine available to states at no charge. Providers will be permitted to charge, and Medicaid and CHIP must pay, for only the administration of the vaccine to enrollees as the vaccine itself is free.
Because of the need for prompt treatment, states are urged not to require prior authorization for medications used to treat influenza. Aliens who are eligible only for emergency services under Soc. Sec. Act §1903(v) may be entitled to treatment of H1N1 as emergency services. In order to assure that an adequate healthcare workforce is available, states are encouraged to streamline the provider application process and increase provider enrollment. Federal financial participation is available for outreach to and education of providers and enrollees.
CMS Letter to State Health Officials, No. SHO 09-11, Sept. 24, 2009, ¶53,152
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
Visit our News Library to read more news stories.
