Vaccines For Children (VFC)

How It Works

VFC is an entitlement to free vaccines for children who meet eligibility criteria. The VFC program allows children to receive their vaccines by their primary care provider, unless the child is underinsured, which requires a visit to a federally qualified health center (FQHC) or rural health center (RHC). Eligibility categories for VFC include the following:

Uninsured
Medicaid enrollees
SCHIP enrollees within a Medicaid expansion program
American Indians
Underinsured children who receive their vaccines at a federally qualified health center (FQHC) or rural health center (RHC).

Some states have expanded eligibility for VFC vaccines by supplementing VFC purchases with funding from a combination of Section 317 and state revenues. In general, there are six categories of expansion of VFC, which fit into the following six schemas:

Universal. All immunizations are provided to all children in both public and private locations.
Universal select. All but a few immunizations are provided to all children in both public and private locations.
VFC and underinsured. All immunizations are provided to VFC eligible and underinsured children in both public and private locations.
VFC and underinsured select. All but a few immunizations are provided to VFC eligible and underinsured children in both public and private locations.
VFC only. Only children meeting VFC eligibility receive VFC vaccines.
Other. VFC program does not fit into one of the five schemas listed above.

To see if your state has an expanded VFC program, click here.

While VFC provides the vaccine free for the provider, it does not pay the vaccine administration fee. The pediatrician providing VFC purchased vaccines is able to charge an administration fee, except in cases of inability to pay. For children with insurance (including private, Medicaid, or SCHIP), the insurance company may be charged the administration fee. For children in Medicaid and SCHIP, the maximum administration fee is established by the Centers for Medicaid and Medicare Services (CMS) and is based on region of the country. Private insurance plans determine the administration fee for their enrollees.

History

The dramatic rise in cost of vaccines in the 1980s and early 1990s resulted in the enactment of VFC in 1993.

Policy Update

VFC has been lauded as a successful program that has resulted in greater vaccine access for children. Despite its successes, there are two major areas in which advocates continue to work.

Eliminating access barriers for underinsured children. Currently, underinsured children are entitled to vaccines from the VFC program only in FQHC or RHC. For many children a FQHC or RHC is not readily accessible. Many advocates feel that this group of children would benefit if they could receive their vaccines in the 12,000 public health clinics, in addition to the 4,000 FQHC and RHC. Legislation proposed by Henry Waxman, H.R. 4702, during the 110th Congress would achieve this goal if passed.
Improving administration fees for vaccines under the VFC program. Many pediatricians view the allowed administration fees for vaccines delivered under the VFC program as insufficient. Advocates have been working with CMS and state Medicaid offices to increase allowable fees.

Links

AAP’s Childhood Immunization Support Program

References

Gerbeding, Julie. Centers for Disease Control: Report to Congress on 317 Immunization Program, April 2007.

Institute of Medicine. Financing Vaccines in the 21st Century. Washington, DC: National Academies Press, 2004

Lee, Grace. Gaps in Financing for Underinsured Children in the United States. Journal of the American Medical Association, Volume 298, No. 6, August 8, 2007

U.S. Department of Health and Human Services . Office of Disease Prevention and Health Promotion. VFC: Eligibility Criteria, October 3, 2007. Accessed on March 20, 2008 at: http://www.cdc.gov/vaccines/programs/vfc/providers/elig-scrn-rec-doc-req.htm