VFC Program Frequently Asked Questions

Questions 1-10 are listed on page 1. Questions 11-19 are listed on page 2.

1. Is the VFC Program "going away?"
2. Who is eligible to receive VFC vaccine?
3. Who is considered under-insured?
4. Are under-insured children still eligible for VFC-supplied vaccine?
5. Are un-insured children (those with no health insurance) still eligible for VFC-supplied vaccine?
6. Can under-insured children be considered un-insured due to their insurance plan's lack of vaccine benefits?
7. Why are under-insured children only eligible to receive VFC-supplied vaccine at Federally Qualified Health Centers or Certified Rursal Health Centers (FQHC/RHC)?
8. Can I send under-insured patients to a local health department for VFC-supplied vaccine?
9. Where can under-insured patients obtain VFC-supplied vaccine?
10. If my practice resides in Utah, but I vaccinate children from another state, from which state should I receive VFC vaccine?

1) Is the VFC Program "going away?"
No, the Utah VFC Program still exists. However, there is a change in where under-insured patients may receive VFC-supplied vaccine. Beginning January 1, 2012 under-insured patients are only eligible to obtain VFC-supplied vaccine in a Federally Qualified Health Center or Certified Rural Health Center FQHC/RHC). This change is due to a loss of funding that in the past allowed the VFC Program to provide vaccine/access for under-insured patients in ALL VFC provider offices.

2) Who is eligible to receive VFC vaccine?
All children birth through 18 years of age who are: enrolled in Medicaid; enrolled in CHIP; have no health insurance (un-insured); American Indian/Alaskan Native; and under-insured who are served in a Federally Qualified Health Center or Certified Rural Health Center (FQHC/RHC). Click here for more information regarding VFC eligibility.

3) Who is considered under-insured?
Children whose health insurance plan does not include vaccine as a covered medical service, provides coverage for only selected vaccines, or caps vaccine coverage at an annual limit after which there is no vaccine coverage for the remainder of the year. Under-insured children are only eligible to receive VFC-supplied vaccine in a Federally Qualified Health Center or Rural Health Center (FQHC/RHC). 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. Click here for more information regarding VFC eligibility.

4) Are under-insured children still eligible for VFC-supplied vaccine?
Yes, under-insured children are still eligible for VFC-supplied vaccine, but only in a Federally Qualified Health Center or Certified Rural Health Center (FQHC/RHC).

5) Are un-insured children (those with no health insurance) still eligible for VFC-supplied vaccine?
Yes, children with no health insurance remain eligible for VFC vaccine in ALL VFC provider offices.

6) Can under-insured children be considered un-insured due to their insurance plan's lack of vaccine benefits?
Children who are covered by a health insurance plan, regardless of vaccine coverage, are considered insured or under-insured. They cannot be considered un-insured for the purpose of obtaining VFC-supplied vaccine. There are not enough doses of vaccine in the VFC program to allow for this practice, and, more importantly, it is considered fraud and abuse of the program. Facilities suspected of this practice may be referred to Medicaid Program Integrity.

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7) Why are under-insured children only eligible to receive VFC-supplied vaccine at Federally Qualified Health Centers or Certified Rural Health Centers (FQHC/RHC)?
These sites are authorized under federal VFC statute (42 U.S.C. § 1396s) to serve the under-insured with VFC-supplied vaccine through the VFC Program.

8) Can I send under-insured patients to a local health department for VFC-supplied vaccine?
No, a local public health department is not an FQHC/RHC. They follow the same VFC eligibility guidelines as private healthcare providers. Local public health departments cannot be a referral source for your under-insured patients to receive VFC-supplied vaccine.

9) Where can under-insured patients obtain VFC-supplied vaccine?
Under-insured patients are eligible to receive VFC-supplied vaccine only at Federally Qualified Health Centers (FQHC) or Certified Rural Health Centers (RHC). Under-insured children may not receive VFC-supplied vaccines at local public health departments or private healthcare provider offices. Click here for a list of FQHC/RHC in Utah.

10) If my practice resides in Utah, but I vaccinate children from another state, from which state should I receive VFC vaccine?
VFC is a federal program and healthcare providers whose facility/practice is located in Utah should enroll with the Utah VFC Program and receive vaccine from Utah. Providers may serve any child who is eligible for VFC vaccine, under Utah VFC guidelines, in their practice regardless of the patient's state of residence. Providers are encouraged to enroll in each state's Medicaid program in order to bill the patient's Medicaid state for the administration fee. Each state establishes their administration fee reimbursable amount.

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