vFC program - information for Parents
The Vaccines for Children (VFC) Program offers vaccines at no cost for eligible children through VFC-enrolled healthcare providers.
Children through 18 years of age who meet at least one of the following criteria are eligible to receive VFC vaccine:
- Enrolled in Medicaid
- Enrolled in the Utah Children's Health Insurance Program
- Not insured: A child who has no health insurance coverage
- American Indian or Alaska Native: As defined by the Indian Health Care Improvement Act (25 U.S.C. 1603)
- Under-insured: A child who has commercial (private) health insurance but the coverage does not include vaccines, a child whose insurance covers only selected vaccines (VFC-eligible for non-covered vaccines only), or a child whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the child is categorized as under-insured. Under-insured children are eligible to receive VFC vaccine only through a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC).
NOTE: VFC providers (local health departments and private providers) can vaccinate under-insured patients with their own privately-purchased vaccine and follow their clinic policies for collection of payment. Please check with your provider to determine if this option is available.
Children whose health insurance covers the cost of vaccinations are not eligible for VFC vaccines, even when a claim for the cost of the vaccine and its administration would be denied for payment by the insurance carrier because the plan's deductible had not been met.
An FQHC is a health center that is designated by the Bureau of Primary Health Care (BPHC) of the Health Services and Resources Administration (HRSA) to provide healthcare to a medically underserved population. FQHCs include community and migrant health centers, special health facilities such as those for the homeless and persons with acquired immunodeficiency syndrome (AIDS) that receive grants under the Public Health Service (PHS) Act, and "look-alikes," which meet the qualifications but do not actually receive grant funds. They also include health centers within public housing and Indian health centers.
An RHC is a clinic located in a Health Professional Shortage Area, a Medically Underserved Area, or a Governor-Designated Shortage Area. RHCs are required to be staffed by physician assistants, nurse practitioners, or certified nurse midwives at least half of the time that the clinic is open.
If your child meets one of the VFC eligibility criteria listed above, the vaccine must always be provided free of charge. The vaccines have already been paid for with federal tax dollars. This means that no one can charge a fee for the vaccine itself.
However, each state immunization provider has been granted (by law) the ability to charge what is called an "administrative fee." An administrative fee is similar to a patient's co-pay, in that it helps providers offset their costs of doing business.
The amount of the administrative fee differs from state to state, based on a regional scale determined by the Centers for Medicare and Medicaid Services (CMS). In Utah, the maximum amount a provider can charge is $20.72 per vaccine.
These regional administrative charges are maximum fees that providers may ask patients to pay. That means that a provider may charge a patient any amount up to, but not exceeding that charge, for each vaccine administered. There is no lower limit, so providers have the option to charge what they feel is fair, including no charge at all.
There are many single and combination vaccines that are licensed in the U.S. and that protect children against 16 preventable diseases. The vaccines available through the VFC are determined by the Advisory Committee on Immunization Practices (ACIP). CDC, as the administrator of VFC, purchases and distributes the vaccines. VFC covers the following vaccines: Diphtheria, Tetanus, Pertussis, Haemophilus influenzae type b, Polio, Measles, Mumps, Rubella, Hepatitis A, Hepatitis B, Varicella, Pneumococcal Conjugate, Influenza, Rotavirus, Meningococcal and Human Papillomavirus.
Click here to get the most current information on childhood immunization schedules.