As public health officials nationwide sound the alarm on a “tripledemic”—the emergence of the respiratory syncytial virus (RSV), the influenza virus and the COVID-19 virus simultaneously—pregnant women should take steps to protect themselves and their infants against infection.
While cases of RSV in particular continue to climb, a new prenatal vaccine can reduce the risk of RSV-caused hospitalization by 60% if taken during the third trimester of pregnancy. However, during the 2022 flu season, only one out of four pregnant women received the prenatal vaccines recommended by the Centers for Disease Control and Prevention.
There are also troubling disparities in vaccination rates. Pregnant women with private health insurance are 74% more likely to receive recommended prenatal vaccines than pregnant women covered by Medicaid and the Children’s Health Insurance Program (CHIP), which provide healthcare coverage for low- and middle-income populations.
This is a significant health equity issue: Medicaid and CHIP cover more than four out of 10 of all births in America (PDF), and approximately seven out of 10 births for pregnant women who are Black, American Indian, or Alaska Native—groups that experience severe and persistent disparities in maternal and infant outcomes. Improving vaccination rates in Medicaid will help improve vaccination rates for historically underrepresented groups.
Making it easier for pregnant women to access vaccines—such as during a regular prenatal visit or at a community pharmacy—is one way to enhance vaccine uptake. Below, we recommend changes states can make to their Medicaid and CHIP policies to support access to prenatal vaccines in these settings.
Our recommendations are informed by a recent study of Medicaid and CHIP policies in all 50 states, plus Washington, D.C., and Puerto Rico. The study was conducted by Manatt Health and supported by Pfizer, which manufactures prenatal and other vaccines (Editor’s note: Pfister and Polaris are co-authors of the white paper study.)
Ensure adequate reimbursement for administering prenatal vaccines
First, states should ensure that physicians and other providers who administer prenatal vaccines receive adequate reimbursement. Providers incur a range of costs to acquire, store and administer vaccines, but state Medicaid programs don’t always adequately reimburse for these costs. The Manatt study found that many state Medicaid programs pay physicians less for the vaccines themselves than Medicare does. In addition, most state Medicaid programs pay less than half the Medicare rate for adult vaccine administration, including nine that don’t pay a vaccine administration fee at all.
As a result, in some states, Medicaid providers lose money (PDF) with every shot they administer. Evidence (PDF) shows that vaccine access for Medicaid beneficiaries improves when states close the reimbursement gap between Medicaid and other payers.
Ensure pharmacies are properly incentivized to offer prenatal vaccines
Second, states should ensure that their Medicaid policies encourage pharmacies to offer prenatal vaccines. As compared to physician offices, community pharmacies are located in more places and are more likely to be open outside regular business hours. In addition, unlike most physician offices, community pharmacies generally offer vaccines on a walk-in basis. Unfortunately, the Manatt study found that in some states, pharmacists aren’t eligible to bill Medicaid for certain vaccines. And even when they are, states vary widely in their payment rates for pharmacist vaccinations.
Ensuring that pharmacists are eligible to bill Medicaid for vaccines and that they are adequately reimbursed for doing so would help increase vaccine access.
Ensure that the Vaccines for Children (VFC) program does not create barriers to vaccinations for pregnant youth
Third, states should make it easier to access vaccines through the federal VFC program. The VFC program distributes vaccines free of charge to state-certified providers for administration to youth enrolled in Medicaid (among others). In some states, only VFC providers are eligible to bill Medicaid for administering pediatric vaccines. However, compared to pediatricians, OB-GYNs and pharmacies are less likely to participate in VFC because of the administrative costs of participation, their relatively low volume of pediatric vaccines and states’ relatively low reimbursement for vaccinations.
Given that four out of five (PDF) pregnant adolescents are covered by Medicaid, states should consider allowing OB-GYNs and pharmacies to bill for prenatal vaccines without enrolling in the VFC program, thereby enabling pregnant adolescents convenient access to those vaccines during their prenatal visits or at a pharmacy.
Leverage managed care organizations
Fourth, states should consider opportunities to leverage managed care organizations—private health plans that contract with states to administer coverage and that now cover the vast majority of non-elderly Medicaid and CHIP enrollees. States can direct managed care plans to provide appropriate reimbursement for both vaccines and vaccine administration, as described above. In addition, states can require managed care plans to conduct member outreach and education on prenatal vaccines as part of care coordination for pregnant enrollees and can also define quality measures and financial incentives for their plans related to prenatal vaccination outreach and uptake.
Address vaccine hesitancy
Finally, although we focus here on vaccine access, we should also be mindful that some individuals have concerns or uncertainty about receiving vaccines (prenatal or otherwise). Research shows that prenatal vaccine hesitancy reflects a combination of factors such as lack of healthcare access, cultural attitudes and beliefs, health literacy, trust in healthcare providers and racial discrimination. Thus, states should pair the access-focused strategies above with strategies to support public awareness and education regarding prenatal vaccinations, including local public service announcements as well as targeted and culturally competent outreach.
Prenatal vaccines play a vital role in promoting healthy pregnancies and healthy babies. Given that Medicaid and CHIP cover a significant portion of all pregnancies in America—especially for historically disadvantaged groups—the policy actions described above could play a key role in supporting vaccine access and health equity.
Elizabeth Cherot, M.D. is president and CEO of March of Dimes. Helen Pfister and Julian Polaris are partners in Manatt Health, the legal and consulting healthcare group of professional services firm Manatt, Phelps & Phillips, LLP.