Will Medicaid Cover the Flu Shot, Shingles Vaccines, and Other Vaccinations?
Key takeaways:
Your location dictates how many adult vaccines Medicaid will cover.
Medicaid is required to fully cover the COVID-19 vaccine as well as testing and treatment.
Adults who live in states that haven’t expanded Medicaid aren’t particularly worse off for vaccine coverage.
If you want to stay current on your vaccines and you have Medicaid, where you live matters. For example, most state Medicaid agencies cover at least some adult immunizations, but some may not cover any. In effect, coverage for vaccinations is a patchwork because of differences in state laws and standards around preventive care. That can leave many Medicaid enrollees in a tough situation, especially since Medicaid is meant to help uninsured people with low income.
To help remedy this, the federal Affordable Care Act (ACA) aimed to make Medicaid more uniform and generous in its benefits across states. But a 2012 Supreme Court decision gave each state the choice of expanding its Medicaid program (to up to 138% of the federal poverty level), instead of making expansion mandatory.
So far, 38 states and the District of Columbia have expanded their Medicaid coverage. But what does that mean for vaccine coverage? And what can you expect if your state hasn’t expanded Medicaid coverage?
Below, we look at how state Medicaid programs cover vaccines and what you can do if your state doesn’t cover the ones you need.
Does Medicaid cover vaccines for adults?
In addition to the COVID-19 vaccine, the CDC recommends 13 vaccines for adults:
Flu (Influenza inactivated [IIV], Influenza recombinant [RIV4], or Influenza live attenuated [LAIV4])
Tetanus, diphtheria, pertussis (Tdap or Td)
Measles, mumps, rubella (MMR)
Varicella (VAR)
Human papillomavirus (HPV)
Pneumococcal conjugate (PCV13)
Pneumococcal polysaccharide (PPSV23)
Hepatitis A
Hepatitis B
Meningococcal A, C, W, Y
Meningococcal B
Haemophilus influenzae type B (Hib)
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Under Medicaid, coverage for these vaccines, and others, depends on the policies of the state you live in. A recent study found that 22 out of 51 state Medicaid programs (about 43%) covered all 13 recommended vaccines.
For those who live outside of those states, there may be free and low-cost vaccine options that can help. Or, if you have coverage but the cost is still too high, a coupon, like those available from GoodRx, may help you save money.
What about Medicaid vaccine coverage for children?
Coverage is more substantial for children: Medicaid covers all recommended vaccines for enrollees younger than 21 years old, under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. The federally funded Vaccines for Children (VFC) program also provides free vaccines for those who might otherwise skip vaccination because of an inability to pay. These coverage options are especially important because up through the age of 18, there are 13 separate vaccines the CDC recommends for most in that age group, many of which require more than one dose.
Does Medicaid cover the COVID-19 vaccine?
Yes. Thanks to a provision in the American Rescue Plan Act, state Medicaid programs are required to cover COVID-19 vaccines and any administration fee that may apply. Medicaid must also cover testing and treatment for COVID-19.
Find a free COVID-19 vaccine near you.
How much regional difference is there between states as to whether Medicaid covers adult vaccines?
It varies, but most states cover at least one of the recommended adult vaccines. Some only cover flu vaccines for adults.
Coverage varies widely depending where you live. Among the majority of states that offer at least some coverage, it can range from coverage for both kids and adults to an age limit that caps out at 19 or 20 years old.
So, in some areas, older Americans looking for a shingles vaccine might find it difficult to get coverage. That can be problematic given that Shingrix, the CDC-recommended shingles vaccine, costs about $200 a dose out of pocket and requires two doses. It’s now also approved for use in immunocompromised adults.
Is vaccine coverage worse in the 12 states that haven't expanded their Medicaid programs than in those that have?
Although it may seem that there could be less adult vaccine coverage in states that haven’t expanded Medicaid, that isn’t the case. In fact, all of these states offer some vaccine coverage. Compared to the states that have expanded Medicaid, they don’t fall behind due to the variation that still exists in those states.
For context, here are the 12 states that haven’t expanded Medicaid:
Alabama
Florida
Georgia
Kansas
Mississippi
North Carolina
South Carolina
South Dakota
Tennessee
Texas
Wisconsin
Wyoming
To give you a better idea of the variation among these non-expanded states, here are a few examples of the vaccine coverage they offer for adults:
Alabama Medicaid covers five of the recommended adult vaccines (influenza, pneumococcal, Tdap, hepatitis A, and shingles).
Mississippi Medicaid covers all 13 recommended vaccines.
Wyoming Medicaid provides flu shots for all adult members, but other vaccine coverage will depend on the plan you have.
Are there different vaccines for Medicaid?
No. Medicaid vaccines are the same as you’d receive through any other program or form of insurance. And Medicaid-covered vaccines are always administered by qualified professionals such as pharmacists and healthcare workers. This also applies to COVID-19 vaccines. At the height of the pandemic, some mass vaccination sites also brought in active-duty troops from the National Guard to give shots, and they were also qualified to do so.
The bottom line
If you have Medicaid, the vaccines that are covered under your plan will depend on where you live. While states have been given the option to provide coverage to more low-income individuals, whether or not your state has expanded Medicaid likely won’t impact your odds of getting vaccine coverage. If Medicaid won’t cover your needed vaccines, there are free and low-cost alternatives, as well as coupons, that may provide a way to cut costs.
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References
Centers for Disease Control and Prevention. (2016). Vaccines for children program (VFC).
Centers for Disease Control and Prevention. (2022). Adult immunization schedule.
Centers for Disease Control and Prevention. (2022). Child and adolescent immunization schedule.
Centers for Medicare & Medicaid Services. (2021). Medicaid, children’s health insurance program (CHIP), and basic health program (BHP) related provisions in the American Rescue Plan Act of 2021.
Granade, C. J., et al. (2020). State policies on access to vaccination services for low-income adults. Journal of the American Medical Association Network Open.
GSK. (2021). Shingrix approved in the US for prevention of shingles in immunocompromised adults.
Health Resources and Services Administration. (n.d.). Early periodic screening, diagnosis, and treatment.
Kaiser Family Foundation. (2022). Status of state Medicaid expansion decisions: Interactive map.
Medicaid.gov. (n.d.). Medicaid & CHIP in District of Columbia.
Medicaid.gov. (n.d.). State overviews.
Reuters. (2020). Fact check: Vaccines do not differ based on insurance.
Steinhauer, J. (2021). Overwhelmed, more states turn to National Guard for vaccine help. The New York Times.
Vaccines.gov. (n.d.). Find COVID-19 vaccines.
