Prenatal Vaccines in Medicaid and CHIP: Current State Policies and Proposals to Increase Access

Prenatal vaccines—those administered during a pregnancy—provide crucial protections to  pregnant women and/or newborns against communicable diseases such as whooping cough and influenza. Additional prenatal vaccines are in the pipeline, including a vaccine against infant respiratory syncytial virus (RSV).

Despite the demonstrated effectiveness of prenatal vaccines, fewer than one out of four pregnant women receives all federally recommended vaccines. Moreover, prenatal vaccination rates are lower among people covered by Medicaid and the Children’s Health Insurance Program (CHIP) than among people with private health insurance. These disparities may reflect differences in access to vaccine providers and inadequate provider reimbursement for the costs of acquiring and administering vaccines.

In “Prenatal Vaccines in Medicaid and CHIP: Coverage, Reimbursement, and State Policy Solutions to Increase Access,” Manatt Health examines the current landscape of Medicaid and CHIP coverage and reimbursement for prenatal vaccines, informed by a recent assessment of relevant policies in all 50 states, plus Washington, D.C. and Puerto Rico. We examine policies for both fee-for-service and managed care programs, as well as variation in coverage and reimbursement policies for physicians, advanced practice clinicians, pharmacists, and federally qualified health centers (FQHCs). We also propose actions that states can take to improve access to prenatal vaccines for the low- and middle-income people enrolled in Medicaid and CHIP.

To download the full white paper, click here.

To download the companion infographic, click here.

This analysis was conducted with support from Pfizer.



pursuant to New York DR 2-101(f)

© 2024 Manatt, Phelps & Phillips, LLP.

All rights reserved