Vaccine Financing Maria E. Volk, MPA Chief, Vaccine Management and Field Services California Department of Public Health Immunization Branch April 27-28, 2011

Section 317 Immunization Program Vaccine Funding: National 317: Discretionary funding through Section 317 grant funds. This funding allows the State to expand eligibility for vaccines. 317 vaccine funds are made available to states to use according to local needs. The use of 317 varies from state to state, but is generally used for non-VFC eligible children in public clinics and limited vaccines for adults.

Section 317 Immunization Program Vaccine Funding: National Vaccine targets varied over years: polio, measles, rubella, back to measles … Section 317 changed dramatically when VFC started in 1994 with the program emphasis squarely on children Primary use for Section 317 vaccine since 1994 has been to fill structural gap in VFC program: underinsured children outside of FQHC/RHCs

10-Year Vaccine Purchase Contrast: VFC and Section 317 Programs Changes between 2001 and 2010 Section 317 VFC Vaccine purchase budget $48 M $2,594 M Percent increase in vaccine purchase budget 24% 423% Average annual growth in vaccine purchase budget $5 M $288 M % Change in cost to fully vaccinate a child from 0 through 19 years old during same time: 362%

Section 317 Cannot Fill the Underinsured Childhood Gap: National 10-year pace of need has been 10 times the growth of Section 317 vaccine funding Size of underinsured population did not shrink in past 10 years VFC-induced new vaccines have created ever widening need for discretionary funding State/local vaccine funding has not increased with increased need, either Implications Need to abandon thinking that discretionary funding will ever fill the VFC gap More realistic strategy is needed – one that uses the Affordable Care Act’s immunization requirements

Section 317 IZ Program Vaccine Funding: CA CA law requires that all health plans (with the exception of ERISA plans) cover all ACIP recommended vaccines for children. Therefore, underinsured children is not as much of a problem in CA as in some states.

Section 317 IZ Program Vaccine Funding: CA California’s 317 funding is not an entitlement program, and the budget is limited. While there is now increased focus on providing adult vaccines and 317 funds can be used for adult vaccines, vaccines administered to adults cannot be provided at the expense of the childhood vaccine program. Currently, the State’s budget only allows for the limited provision to adults of Tdap, Td, MMR, Hepatitis A (for post-exposure prophylaxis), and Hepatitis B (for adults in household and sexual contacts of HbsAg+ pregnant women).

CA Budget Figures: FY 2011 VFC Budget: $400 million Note: Adult Flu was previously purchased with state general fund vaccine funds. For FY 2011: The state’s discretionary budget (317/state) was cut by 1/3 from $40 million to $27 million.

LHD Vaccine Supplies Refer to the California State Eligibility Table (available on the IZ Coordinator’s website). At the State level, vaccine purchases for LHDs are split between the VFC and 317 funds. At least 85% of vaccines are purchased with VFC funds and 10-15% with 317 funds. LHDs do not need to keep supplies separate, but VFC screening is required. LHDs cannot charge for the cost of vaccines they receive from the State Program. While an administration fee of up to $17.55 per vaccine provided is allowable for patients that are uninsured, this fee must be waived if the patient cannot afford to pay it. LHDs may also bill Medi-Cal or CHDP under existing programs. Because the vaccine received from the State comes from a variety of funding sources, the LHD should provide immunizations to anyone who meets the eligibility criteria and presents requesting them at a LHD clinic.(Insured at LHD Policy)

317 Allocations Tdap 317 Allocations for April-Sept. First time this has been done. Increasing focus on accountability at national level. May be new direction from CDC in the next year or so.