On January 27, 2023, the Centers for Medicare & Medicaid Services released a State Health Official (SHO) letter, “Medicaid Continuous Enrollment Condition Changes, Conditions for Receiving the FFCRA Temporary FMAP Increase, Reporting Requirements, and Enforcement Provisions in the Consolidated Appropriations Act, 2023.” The SHO letter is the second in a series of guidance related to section 5131 of the Consolidated Appropriations Act, 2023 (CAA), which established a fixed end date for the Medicaid continuous coverage requirement, a gradual phase-down for the enhanced federal match, and new guardrails for mitigating coverage loss for individuals who continue to be eligible. This expert perspective reviews the additional detail and operational expectations of states during the unwinding of Medicaid continuous coverage as laid out in the SHO letter.
Borrowing Proven Policy Strategies to Vaccinate Kids Against COVID-19: Lessons from Past Successes can Provide a Roadmap for Ensuring Equity in Immunization Efforts
With authorization of the first COVID-19 vaccine for children ages five and older, most kids in the United States are now eligible to be immunized. Recent experience with other vaccines shows the country is capable of immunizing kids widely, with vaccination rates of more than 90 percent for diseases such as measles and chickenpox. Explicit efforts to enhance equity also have paid dividends, with longtime racial and ethnic vaccination disparities being narrowed dramatically for certain diseases. But the U.S. experience with other controversial immunizations, such as the vaccine against human papillomavirus (HPV), demonstrate that success is not inevitable, as HPV vaccination rates have underperformed and displayed clear disparities more than a decade after being approved and recommended.
The objective of this brief is to highlight the strategies and tools that have contributed to prior successful U.S. efforts to widely vaccinate children against contagious diseases and reduce vaccination disparities, so that they may be applied to initiatives to immunize kids against COVID-19. Examples include leveraging children’s higher rates of health insurance to make it easy to access vaccines; employing trusted health care providers enrolled in the Vaccines for Children program to administer shots to uninsured and under-insured kids; using state Medicaid policies to set vaccination targets for Medicaid Managed Care Organizations and health care providers; and adding COVID-19 vaccines to lists of immunizations required to enroll in school, which are already used in all 50 states.