CMS Released a State Health Official Letter on Medicaid and CHIP Coverage of Stand-Alone Vaccine Counseling

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Today, the Centers for Medicare & Medicaid Services (CMS) released a State Health Official Letter to provide guidance to states on coverage and payment for stand-alone vaccine counseling in Medicaid and the Children’s Health Insurance Program (CHIP). CMS is interpreting the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit in the Social Security Act to require the provision of stand-alone vaccine counseling to eligible beneficiaries. This mandatorily applies to both Medicaid and Medicaid-expansion CHIP beneficiaries eligible for EPSDT. States have the option to cover stand-alone vaccine counseling for adult Medicaid beneficiaries and beneficiaries in separate CHIPs. This guidance links the mandatory COVID-19 vaccine and vaccine administration coverage and reimbursement under the American Rescue Plan (ARP) with the “health education” requirement under Medicaid’s EPSDT benefit. The health education requirement under EPSDT mandates states to provide coverage of stand-alone vaccine counseling related to all vaccines for Medicaid beneficiaries under the age of 21 who are eligible for EPSDT. Learn more here: https://www.medicaid.gov/federal-policy-guidance/downloads/sho22002.pdf