A Look at How Medicaid Agencies Are Assisting with the COVID-19 Vaccine Roll-Out

As of February 2021, three emergency COVID-19 vaccines will be approved in the US, and states will play a key role in the timely distribution and prioritization of eligible populations. With Medicaid covering more than 77 million participants, including groups at disproportionately high risk of COVID-19 infection as well as hard-to-reach groups, Medicaid agencies can be key partners for public health officials, who typically support the state's COVID -19 Vaccination guide efforts. In mid-February 2021, the Kaiser Family Foundation (KFF) and Health Management Associates (HMA) conducted a two-part quick mini-survey of Medicaid directors in all 50 states and the District of Columbia. Of the 32 states that responded to Part II of the survey, 29 indicated that Medicaid agencies were involved in at least one vaccine rollout activity (Figure 1). This report provides insights into helping government Medicaid agencies introduce the COVID-19 vaccine, including specific actions. (Find the results from Part I of the Mini-Survey on Medicaid Enrollment and Spending Trends in a separate report.)

Figure 1: States reported having taken specific measures related to the introduction of vaccines in the state

Three quarters of the responding states (24 out of 32) said they were working with public health or other agencies to plan and implement the introduction of the vaccine. Several states indicated close coordination with their state health departments, who take the lead in the distribution and introduction of vaccines. For example, one state indicated that it is increasing health department messaging and communications, but is also regularly reporting concerns from key Medicaid stakeholders (e.g. behavioral providers not included in the Phase 1a priority group for health care workers). Fewer states, however, indicated that they were involved in setting state vaccination priority lists (11 out of 32).

Over three-quarters of the responding states said their state Medicaid agencies provide technical assistance to providers (25 out of 32). States said they were communicating directly with Medicaid providers about the introduction of COVID-19 vaccinations, for example through provider bulletins and dedicated websites that provide information on COVID-19 vaccination coverage, reimbursement and billing, and a dedicated email Address / inbox for the provider contain questions. One state also reported that it has been working to ensure there is an expedited process for vaccines to register with Medicaid (if not already enrolled).

Over half of the responding states said they contacted Medicaid participants to encourage uptake of COVID vaccinations (19 out of 32). Several states discussed working with Medicaid managed care plans to introduce vaccines, including: messaging to address member reluctance to use vaccines; Clarify the availability of MCO coordination and transport services for care, which could lower barriers to access to vaccines; Coordination of COVID vaccine appointments; Calling high risk members and setting reminders for a vaccination appointment. Over half of the responding states (17 out of 32) are expanding their services to support the introduction of vaccines. For example, some states have specifically mentioned approving non-emergency medical transportation (NEMT) services for vaccine appointments. A number of states (12 out of 32) also reported that they had planned or approved new or expanded administrative grants from Medicaid. For example, one state said its existing nurse counseling center would provide general information about vaccine administration to callers.

The majority of responding states reported that the Medicaid agency is involved in specific activities to support the introduction of vaccines for groups that are disproportionately covered by Medicaid. About two-thirds of the responding states (22 out of 32) said their state Medicaid agencies are involved in specific activities to support the introduction of vaccines to HCBS recipients. About half of the responding states said they were helping introduce vaccines to residents of non-nursing home facilities, color communities, and people in rural areas (Figure 2). Several states commented on a number of specific activities including:

• Exchange data with the public health authority on seniors receiving HCBS who are not in a care facility or alternative housing facility. The health department has compared the data with its vaccine register and is now making contact with the people who have not yet been vaccinated.
• Develop quality measures aimed at closing the vaccination differences between whites and color communities.
• Proactive contact with NEMT drivers to get vaccinated and drive to vaccination events.
• Applying for federal approval to provide COVID-19 vaccines to populations participating in programs with limited benefits (e.g. family planning program, uninsured COVID-19 group, and limited scope programs that offer only emergency and pregnancy services ).
• Partnership with Rite Aid to provide vaccinations to long-term care facilities not covered by the federal pharmacy's partnership program.
• Encourage MCOs to use community health workers to contact people who are temporary or difficult to reach, including those who are homeless, people with disabilities, or people with substance use disorders.

Figure 2: States said they had specific measures in place to support the adoption of vaccines for groups disproportionately covered by Medicaid

More than three-quarters of states (26 out of 32) said at least one way that public health partnerships and Medicaid were or could be developed to support vaccine adoption efforts. The most frequently reported areas were coordinating contacts, exchanging data and holding daily or weekly meetings between agencies. States described other activities that might be helpful in introducing vaccines, including: creating opportunities for staff to work across agencies; Coordinate to assist those without internet access and those whose first language is not English with planning vaccination appointments and assisting in ensuring and promoting equity in the introduction of vaccines.