Medicaid Slated to Cover Coronavirus Vaccine Counseling for Children

December 8, 2021

According to Centers for Medicare & Medicaid Services (CMS), State Medicaid programs must cover vaccine counseling for all pediatric vaccines for eligible beneficiaries as well as coronavirus counseling for children.

Vaccine counseling for children will be covered under Medicaid as part of vaccination administration and beneficiaries eligible for Medicaid-covered vaccine. Beneficiaries eligible for counseling must be under 21 years of age and covered through the Medicaid Early and Periodic Screening, Diagnostic Treatment (EPSDT) benefit, according to CMS.

CMS also shared that Medicaid provides health insurance coverage to more than 40% of all children in the United States and is a significant source of coverage for Black and brown children.

"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.

According to CMS, they will now consider certain COVID-19 vaccine counseling visits for children and youth to be billed as COVID-19 vaccine administration, for which state expenditures can be federally matched at 100% through the last day of the first quarter that begins one year after the end of the COVID-19 public health emergency, under the American Rescue Plan (ARP).

CMS states this "action will help expand access to individualized medical advice in all communities and give families the support they need to engage with trusted community providers."

Furthermore, CMS announced that it will require states to cover stand-alone vaccine counseling visits related to all pediatric vaccines under the EPSDT benefit and the state expenditures will be matched at the state's regular federal medical assistance percentage.

"This action not only underscores the importance of vaccination education, but is also a critical step towards protecting families by increasing their access to information from providers as they make informed decisions concerning vaccinations for their children," stated CMS in the press release.

Biden-Harris Administration Makes 100% Federal Medicaid Matching Funds Available for State Expenditures on Certain COVID-19 Vaccine Counseling Visits for Children and Youth. Centers for Medicare & Medicaid Services. December 02, 2021. Accessed December 8, 2021.


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