1. Vaccinations in Kansas What Exactly is Going On? Dennis Kriesel, Kansas Association of Counties

2. At The State Level There are 3 categories that a child can fall under, which determines what vaccine supply can be used: –V–VFC Program –3–317/SGF Program –P–Private Vaccinations

3. The Vaccines for Children (VFC) Program VFC children get public vaccine Eligible groups (at LHDs): –M–Medicaid –N–No Health Insurance –H–HealthWave –N–Native American/Alaska Native

4. The 317/SGF Program 317 children get public vaccine Eligible groups (317 vaccine is only available from health departments): –U–Underinsured Those who have insurance but it doesn’t cover immunizations –U–Underserved Those who have insurance that covers immunizations, but the copay/deductible is seen as “too high”

5. Private Vaccinations Children who do not fall under VFC or 317/SGF programs are considered “fully insured” Fully insured children cannot receive state vaccines for free from LHDs Their vaccinations must come from “private stock”

6. At the Local Level There are (potentially) two supplies of vaccine LHDs carry: –P–Public Vaccine Stock For VFC kids For 317 kids –P–Private Vaccine Stock (Optional) For fully insured kids

7. LHD Vaccine Supplies Public Vaccine SupplyPrivate Vaccine Supply VFC HealthWave Medicaid Uninsured Am. Indian / AK Native 317/SGF Underinsured Underserved “Fully insured” kids Anything Else (e.g., adult travel vaccinations)

8. What LHDs “Have” to Buy LHDs only have to purchase private vaccines if they want to service fully insured children “HDs can no longer provide free immunization services for private providers’ insured clients using state vaccines. They must either contract with those physicians to provide the services using private stock vaccine, or encourage physicians to provide immunizations using their own private stock vaccine.” –Sue Bowden, KIP Director

9. VFC Versus 317/SGF In terms of vaccine supplied to LHDs, there is no difference (i.e., both groups are vaccinated from the same stock) However, 317 program funding has not kept pace with costs The end result is, those kids in the 317/SGF program do not get the same level of vaccination as VFC kids

10. 317/VFC Program Differences Varicella (Chickenpox) –V–VFC kids can receive 12 months through 18 years –3–317 kids can receive 12 months through 23 months (through 18 yrs if close contact with immunocompromised) Prevnar (Pneumococcal Diseases) –V–VFC kids can receive 6 weeks through 59 months –3–317 kids cannot receive

11. The “Underinsured” Loophole The VFC program does cover underinsured kids, but the child must go to one of the following entities: –F–Federally Qualified Health Center (FQHC) –R–Rural Health Clinic (RHC) –A–A VFC provider with a delegation/deputization agreement with an FQHC/RHC

12. Given that all LHDs are VFC providers in KS, delegation arrangements would give them the ability to provide underinsured kids with VFC vaccine The practice is already done by the State of Michigan The agreements are short and simple KIP has all the necessary materials

13. The “Underinsured” Loophole Advantages of letting LHDs serve underinsured kids through VFC –T–They qualify for all the VFC vaccines –I–It frees up more money for the 317 program 317 still would serve the underserved kids If enough fiscal resources were liberated, the 317 program could expand its vaccination program for those that remained (e.g., Prevnar for underserved kids)

14. Public Vaccine SupplyPrivate Vaccine Supply VFC HealthWave Medicaid Uninsured Am. Indian / AK Native 317/SGF Underinsured Underserved “Fully insured” kids Anything Else (e.g., adult travel vaccinations)

15. What Is “Underserved”? KS does not operate with a formal figure that defines “underserved” (i.e., just what makes someone underserved?) KIP wants to have a guideline that can be applied across the state KIP is asking LHDs for recommendations as to what would be a reasonable guideline (through KALHD seen as ideal)

16. Conclusions Fully insured kids cannot get public vaccine –L–LHDs wanting to serve fully insured kids must obtain private vaccines 317 kids do not qualify for the same vaccines as VFC kids Underinsured kids can be moved to VFC KIP wants a recommendation for defining “underserved”