The Centers for Medicare and Medicaid Services (CMS) is now requiring states to cover COVID-19 vaccine counseling visits in which health care providers talk to families about the importance of kids’ vaccination. Medicaid (Medi-Cal in California) provides health insurance coverage to over 40% of all children in the United States.

The California Medical Association (CMA) has been advocating for such coverage, as it will help expand access to individualized medical advice in all communities and give families the support they need to engage with trusted community providers about the importance of pediatric vaccination.

“By supporting conversations between families and health care providers and answering parents’ questions, we can connect more children to effective vaccines,” said CMS Administrator Chiquita Brooks-LaSure. “The Biden-Harris Administration is requiring states to cover vaccine counseling through Medicaid to create the space for children and parents to ask questions, get answers, and receive the information they need from trusted partners.”

CMS will now consider certain COVID-19 vaccine counseling visits for children and youth to be COVID-19 vaccine administration, for which state expenditures can be federally matched at 100%. CMS will match COVID-19 vaccine counseling-only visits at the 100% federal match rate only when they are provided to children and youth under age 21 as part of the Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.  

Additionally, moving forward, CMS will require that states cover stand-alone vaccine counseling visits related to all pediatric vaccines (not just COVID-19) under the EPSDT benefit. These state expenditures will be matched at the state’s regular federal medical assistance percentage.

This new mandate underscores the importance of vaccination education, but is also a critical step towards protecting families by increasing their access to information from trusted health care providers as they make informed decisions concerning vaccinations for their children.

CMA continues to advocate for similar coverage for ALL Medi-call enrollees, not just children.