Removing Barriers to Vaccines for Kids Should be Top Priority

As the COVID-19 vaccine has been approved for adults, then teens and school-aged children, researchers are monitoring the vaccination trends for different groups. About a year after vaccines were approved for adults, almost 72% of the US adult population is fully vaccinated according to the most recent CDC data. Vaccines for teens ages 12 and up were approved in May 2021, and as of September 2021, nearly half of teens ages 12-17 had received at least one dose. School-aged children just gained access to COVID-19 vaccines in November 2021, and so far, an estimated 16.7% of children ages 5-11 have received at least one dose.

The lower vaccination rates for children and teens reflect not only the shorter time frame since approval, but also barriers to vaccine access and concerns parents have about vaccinating their children. Some of the most commonly cited barriers to vaccination, especially among Latino and Black parents, are not being able to get the vaccine from a trusted place, believing they may have to pay out-of-pocket for the vaccine, difficulty traveling to a vaccination site, and concerns about being able to take time off to get their children vaccinated and/or to care for them if they experience any side effects. In addition to access issues, parents are cautious about vaccinating their children. Even among vaccinated parents, nearly a quarter say they would take a wait-and-see approach to vaccinating their children.

Thankfully, CMS recently announced that vaccine counseling services are mandatory under Medicaid’s EPSDT benefit for children. This is important for many reasons.

First, Medicaid/CHIP cover about a third of all children in the US, even larger shares of children with low to moderate family income, and a disproportionate share of children of color. Thus, Medicaid policies can have a big impact on reaching children who face bigger barriers to vaccine access. (Note that EPSDT is not a requirement for separate CHIP programs, but about 58% of children whose coverage is funded by CHIP are actually enrolled in Medicaid with EPSDT and of those in enrolled in separate CHIP programs, some are eligible for EPSDT under the state’s program rules.)

Second, parents may have lots of questions about the COVID-19 vaccines before deciding whether to vaccinate their children, as shown by the “wait and see” numbers. Pediatricians, family physicians and trusted community providers are the best source of information for parents, but until now, providers may not have been compensated for time spent answering parent questions. My hunch is that these providers would answer vaccine-related questions anyway, but by actually compensating them for this time, providers can do so without jeopardizing the financial viability of their practices or cutting the conversation too short because of time constraints.

Third, by requiring compensation for vaccine counseling separate from vaccine administration, parents can learn about the COVID-19 vaccine over several office visits before making a final decision. Parents can also have these conversations with their child’s primary care provider, even if the COVID-19 vaccine would be administered later at a local pharmacy or other vaccination site.

CMS’ announcement is broadly applicable to all vaccines for kids and teens, but for the COVID-19 vaccines specifically, vaccine counseling services will be 100% federally funded thanks to the American Rescue Plan Act. Under ARPA, certain COVID-related Medicaid expenditures (now including COVID-19 vaccine counseling under EPSDT) are 100% federally funded through the last day of the first quarter that begins one year after the end of the COVID-19 public health emergency. We anticipate more guidance from CMS soon outlining how vaccine counseling services should be implemented and billed.

As people in your community consider whether to vaccinate their children, it’s important to remind them that the vaccines are safe, effective, and specifically tailored to children. The short and long-term risks of COVID infection greatly outweigh the risks associated with vaccination. Having your children vaccinated will help protect family members, friends, and those around you who may be at higher risk. Plus, once fully vaccinated, kids can be kids again – safely returning to all their favorite activities. Direct people with questions to reliable sources, such as the American Academy of Pediatrics, HHS, and the CDC.

Kelly Whitener is an Associate Professor of the Practice at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.