Vaccinations have proven to be one of the most effective public health strategies to control and prevent the onset of illness. However, with the current COVID-19 pandemic, immunization services have decreased at an alarming rate, causing concern for smaller outbreaks to occur. Doctors and public health experts have worried that a vast number of preventive care interventions – including vaccinations — have gone unmet in the past few months. This concern is further increased when considering the disparities vulnerable populations already face. 

Disparities in vaccination coverage are significantly greater for pregnant women and children on Medicaid compared to those with private insur­ance, with rates 2.5% to 15% lower among children covered by Medicaid, depending on the vaccine. To address these gaps, AcademyHealth, Immunize Colorado (IC), and the National Academy for State Health Policy (NASHP) coordinated efforts for a three-year CDC funded cooperative agreement to implement new state-based strategies and policies to address immunization gaps among low-income pregnant women and children.

Partnerships between Medicaid and immunization programs are critical to improving immunization rates for children and pregnant women with Medicaid coverage. This initiative specifically engaged Medicaid program leadership and enhanced collaborative efforts across Medicaid and Public Health departments and the CDC to identify shared priorities, best practices and strategies to make progress towards national immunization program goals. To facilitate this, the project team solicited state participation in a Community of Practice (CoP) comprised of Medicaid agency, Immunization Program, and Immunization Information System (IIS) staff. Participating states included Colorado, Hawaii, Kentucky, Montana and New Mexico.

The project’s objectives were to support states in their Medicaid policies or outreach procedures to facilitate vaccination of children living in poverty, implement policies that include providers caring for pregnant women and/or adults as covered vaccinators, and increase utilization of Medicaid resources for IIS sustainability. AcademyHealth developed a blog mid-way through the project to provide updates on the challenges CoP states were facing around education, data infrastructure, and access to care. Over the course of three years, the CoP states made improvements, outlined below, in key sectors: public health collaboration, IIS funding and sustainability, provider and community engagement, and data collection.

 Overall Project Successes:

  • All five states added immunization measures to state Medicaid value-based programs in order to record and incentivize quality improvement initiatives.
  • The CoP states focused on improving their data capacity and quality in the following ways:
    • Hawaii and New Mexico strengthened their IIS infrastructure by applying for and receiving a 90% match rate through federal HITECH administrative funding.
    • Kentucky and Montana added pharmacies and non-pediatric immunizing health care practices to participate in their IIS. This helped increase data collection and made immunization services easier to access for Medicaid beneficiaries.
    • Colorado, Hawaii, Kentucky, and New Mexico improved data sharing and data analysis capabilities, creating documented Memorandum of Understanding (MOUs), data dashboards, and data matching between IIS and Medicaid data systems.
  • All CoP states focused on increasing patient and provider education and outreach through targeted campaigns, roundtables, school webinars, and immunization curriculums.
    • They also improved partnerships between Medicaid and public health agencies, which encouraged mutual working relationships with hospital systems, provider groups, and private clinics.
  • Leveraging the work of state immunization programs, Montana and Hawaii enacted legislation to require vaccination uptake (e.g. HPV, Flu).

More information on CoP state’s successes can be found in their state snapshots. As these states continue to build on their work in the CoP, AcademyHealth, NASHP, and Immunize Colorado are pleased to announce a new funding cycle from the CDC to support and facilitate a second community of practice that will work with five new states aimed at improving immunization rates. The goal of this second CoP is to  guide state’s project teams  to increase immunization rates among lower-income children and pregnant women utilizing the  strategies from the first CoP.

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