Feb, 23, 2021

MCO Strategies to Promote COVID-19 Vaccine Uptake

Alex Morin, Emily Carrier, and Patricia Boozang, Manatt Health

The United States is in the midst of an unprecedented national effort to manufacture, distribute, and ultimately administer COVID-19 vaccines to all Americans. The introduction of new virus strains with increasing transmissibility and virulence and the pressure to “re-open” the economy more fully has intensified the pressure to vaccinate quickly, as has the imperative to address disparities in vaccine uptake affecting communities of color already hardest hit by the virus.[1] While the federal government is coordinating distribution of vaccines from manufacturers to states, individual states (and certain municipalities) are responsible for coordinating the various components of infrastructure and operational logistics needed to take the vaccine from federal distribution channels to the arms of Americans.

Most state COVID-19 vaccine strategies focus on the following four critical elements:

  • Rapidly identifying “priority cohorts” of residents to receive the vaccine based on COVID-19 exposure risk and mortality risk as defined by state distribution frameworks;
  • Developing and executing a coordinated education and outreach campaign with consistent information about the vaccine and the logistics of distribution and administration to promote broad uptake of the vaccine;
  • Creating and coordinating a network of distribution sites (including providers, pharmacies, and other sites) based on storage requirements of different vaccines and vaccine candidates; and
  • Monitoring uptake and augmenting the state’s strategies on a real time basis to ensure success.

Each of these individual elements is complex and requires the alignment of multiple stakeholders, including local government agencies, local health departments, providers (hospitals, physician practices, pharmacies, clinics, etc.), non-government entities, and payers. Further, efforts to address disparities in vaccine uptake require additional planning and intensity of effort to connect communities of color to the vaccine.

States have significant power both to convene stakeholders and to require stakeholder action. One specific area where states can exercise authority in coordinating vaccine administration is through their Medicaid managed care organizations (MCOs) that serve Medicaid enrollees. In this expert perspective, we outline four recommendations for states to engage their managed care plans to assist in efforts to successfully and rapidly vaccinate the Medicaid population.

Summary of Recommendations

Recommendation #1: Require MCOs to analyze claims data and administrative datasets to identify priority cohorts for outreach as defined by the state vaccine strategy.

Most state vaccine administration plans call for the allocation of the vaccine in phases that target population cohorts from high-risk to low-risk of COVID-19 infection and morbidity. The phased approach also considers expectations regarding the available supply of vaccine and associated supply-chain and distribution requirements (e.g., ultra-cold chain) linked to the criteria outlined by the National Academies “Committee on Equitable Allocation of Vaccine for the Novel Coronavirus,” which was developed at the request of the National Institutes of Health (NIH) and the CDC. Most states have incorporated this overall framework in some way, though implementation challenges are affecting how states are progressing through the phases. [2]

The criteria for each phase may be clinically determined (i.e., people with certain co-morbidities), or be determined by age and other nonmedical characteristics such as occupation. Based on the data that MCOs collect on enrollees, plans can build lists of enrollees within each state-defined “cohort” and conduct outreach to those enrollees in preparation for when they become eligible for the vaccine. By proactively building these lists, the plans will be ready to contact enrollees and assist with vaccine appointment registration, transportation as necessary, and all associated follow-up. MCOs are also positioned to identify enrollees in under-resourced communities that are experiencing disparities in COVID-19 case rates and vaccine uptake to date, for example based on race and ethnicity data, language preference, administrative codes that record issues such as homelessness, or address. States and MCOs can work collaboratively to identify these cohorts.

Authority: Most state model contracts require that plans participate in local and state immunization initiatives/programs and have contract requirements in place to report to the state certain data elements.

Recommendation #2: Require MCOs to undertake outreach and education efforts for enrollees utilizing consistent information and messaging provided by the state or other central body to promote vaccine uptake. 

Each state will be deploying a coordinated and broad outreach and education effort to its residents about receiving the vaccine, and to providers about enrollment as vaccine providers. In most cases, states are seeking to coordinate the information that is shared with the public to ensure consistency as the vaccine is rolled out to specific cohorts over time. MCOs are in a strong position to assist state efforts to conduct outreach and education efforts to enrollees. Utilizing lists of enrollees developed in recommendation #1, MCOs can initiate outreach to enrollees to: 1) inform enrollees that they are eligible to sign up for a vaccine appointment and assist with scheduling; 2) help coordinate transportation to vaccine appointments as necessary; 3) answer questions about the vaccine to address any reservations about receiving the vaccine; 4) send reminders to enrollees about vaccine appointments, including second appointments for vaccines with two-dose protocols; and 5) monitor for post-vaccine effects and answer questions during any follow-ups.

States should work with the MCOs to ensure that standardized and culturally/linguistically appropriate materials, information and outreach strategies are utilized in all education and outreach efforts. This should include leveraging community health workers (CHWs) and partnering with community-based organizations (CBOs) to provide MCO members with information and resources, including transportation to vaccine appointments. The visual below contains an illustrative engagement roadmap for states to deploy with their MCOs for outreach and education efforts.

Illustrative MCO Outreach Strategy

Authority: Most state model contracts require that plans participate in local and state immunization initiatives/programs and have contract requirements in place to report to the state certain data elements.

Recommendation #3: Increase Medicaid COVID-19 vaccine administration fees to 100 percent of Medicare for current and next fiscal year.

Given the scale of the vaccine distribution effort and the need for maximum participation by providers, raising the vaccine administration fee to align with Medicare may motivate providers to enroll and serve as sites for vaccine distribution. It may also motivate providers in communities at higher risk of COVID-19 related morbidity and mortality to register as vaccine providers and motivate their own outreach efforts for their Medicaid populations. A number of states have already made this change or are considering it.

Authority: Step 1: Model contracts may require vaccine administration rates to be set at a certain level, i.e., the Medicare or Medicaid fee-for-service (FFS) rate. Step 2: In some states, changes to the administration fee for the COVID-19 vaccine may require a state plan amendment (SPA) or a Disaster Relief SPA. Under a Disaster Relief SPA, the increase would be effective immediately and would extend for the duration of the national public health emergency (PHE).

Recommendation #4: Require MCOs to track and report extended presentations and long-term health and financial impacts from COVID-19-positive and COVID-19-recovered patients. 

Little is known about long-term implications of delayed or extended presentations of COVID-19 or reinfection. Given the substantial number of infected individuals and the reported disability caused by extended presentations, these syndromes could have significant effects on utilization and cost. In addition to states’ own interests in monitoring these public health and cost impacts, the CDC is monitoring long-haul presentations of COVID-19 and may work with state Medicaid programs to understand how Medicaid enrollees (and budgets) will be affected by COVID. The CDC can set the parameters to analyze data as well as best practices for managing extended presentations as they emerge.

Authority: Most state model contracts require that plans participate in local and state immunization initiatives/programs and have contract requirements in place to report to the state certain data elements.


In 2018, nearly 55 million Medicaid enrollees in the country were enrolled in Medicaid managed care, and at least some of these enrollees are at high risk for COVID-19 infection, morbidity, and mortality.[3] MCOs are critical partners in ensuring rapid, effective immunization of Medicaid enrollees. States have the tools in place today to require plans to unleash their resources in identifying vaccine priority cohorts, launching outreach and education campaigns, and enhancing network provider rates to immunize, track, and report long-haul cases. Further, managed care plans have aligned incentives related to ensuring that their members access the vaccine and avoid COVID-19 infection, illness, and possible long-term health impacts.

[1] The COVID-19 related death rate for Black, Latino(a), and American Indian is over twice as high as the rate for white Americans, and these groups are significantly more likely to be hospitalized as a result of the virus. The Centers for Disease Control and Prevention (CDC), COVID-19 Hospitalization and Death by Race/Ethnicity.

[2] Institute of Medicine (IOM), Framework for Equitable Allocation of COVID-19 Vaccine.

[3] Kaiser Family Foundation, Total Medicaid MCO Enrollment.