Vaccine Provider Special Edition: Coverage Disparities

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Coverage Disparities for Minnesotans Enrolled in Minnesota Health Care Programs

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Minnesota Department of Health

April 15, 2022


Historical disparity and COVID-19

Minnesotans enrolled in Minnesota Health Care Programs (MHCP) experience historical and ongoing structural disadvantage that increases their risk for complications from COVID-19. As we continue to vaccinate Minnesotans against COVID-19 we strive to address disparities in vaccination coverage. Recognizing the barriers that exist and making vaccination more accessible can improve vaccination rates and health outcomes.

Understanding the disparity and the impact on Minnesota

Many people have enrolled in Medicaid programs during the pandemic. A Kaiser Family Foundation Analysis of Recent National Trends in Medicaid and CHIP Enrollment shows that there was 17% growth in enrollment in Medicaid programs in Minnesota from February 2020 to June 2021. Unfortunately, this large and growing group of Minnesotans are more vulnerable because of large disparities in vaccination coverage.

Minnesota Immunization Information Connection (MIIC) data shows there are disparities in COVID-19 vaccination rates across all age groups when comparing people enrolled in MHCP to statewide rates. Rates are also lower among pregnant people enrolled in MHCP compared with those who are privately insured. Pregnant people are at increased risk for severe illness from COVID-19 including risks for adverse pregnancy and neonatal outcomes, hospitalization, and death. The table below highlights the differences for vaccination rates among people with at least one dose. For a broader look at COVID-19 vaccination for Minnesotans enrolled in MHCP visit Minnesota Health Care Programs COVID-19 vaccination snapshot.

COVID-19 Vaccine Coverage by Age Group in Minnesota, April 12, 2022

Age group Difference between MHCP enrollees and non-MHCP enrollees
5-11 -15.0%
12-15 -20.2%
16-17 -19.6%
18-49 -21.8%
50-65 -16.3%
65+ -20.0%

The vaccine coverage difference for all pregnant people who gave birth in March 2022 between MHCP enrollees and non-MHCP enrollees was -20.6%.

Minnesota Health Care Programs cover vaccine counseling

Effective Jan. 1, MHCPs cover vaccine counseling that occurs during in-person or telehealth visits. Providers may counsel for COVID-19 vaccinations and standard vaccines. Providers billing for vaccine counseling services must have the ability to administer the vaccine for which they are counseling. Providers cannot bill for vaccine counseling separately if it is a required component of another service provided in the same visit. For full details refer to MHCP Provider Manual: Immunizations and Vaccinations.


Actions providers can take to increase COVID-19 vaccine uptake

Make a strong recommendation and explore hesitation

Health care professionals are the most trusted source for immunization information. Use a presumptive approach when recommending COVID-19 vaccination. Take time to explore concerns of those who are reluctant to get vaccinated. MDH has a wealth of information and resources that can help you share information with patients based on their concerns at About COVID-19 Vaccine.

Don’t miss an opportunity

  • Take advantage of every opportunity to assess and administer all recommended vaccinations for every family member present at the clinic visit, according to CDC’s adult, child and adolescent immunizations schedules. Taking off work and securing transportation means that some families may only have the ability to come in one time and may have to bring the whole family with them.
  • Use MIIC to help.

Providers can leverage several features in MIIC to assess, improve, and monitor immunization rates in their clients, including specifically looking at their patients enrolled in MHCP. Knowing the coverage at a clinic level is the first step to improving coverage. Providers can use the "List" feature and the "Single Vaccine COVID Assessment" report to get their MHCP rates and to monitor them over time. MIIC can also be used for reminder and/or recall notices which is an important evidenced-based strategy to improve coverage. For more guidance on how to use these resources in MIIC, providers can contact their MIIC Regional Coordinators or consult with the MIIC User Guidance. Contact the MIIC Help Desk with any questions you have!

Incorporate these other important strategies into COVID-19 vaccination whenever possible:

  • Hold evening and weekend clinics.
  • Accept walk-in appointments or host a walk-in vaccination clinic.
  • Collaborate with local partners (e.g., clinics, local public health, schools, community partners) to host vaccination clinics that reach a broader or underserved population.
  • Offer COVID-19 vaccine with other recommended childhood/adolescent vaccinations.
  • Use MIIC to see if patients are due for other recommended vaccines and encourage them to see their primary care provider if you can’t provide all vaccines needed.
  • Schedule a vaccines-only appointment for people with a temporary precaution to getting immunizations (e.g., current COVID-19 infection) before they leave so they have an opportunity to get vaccinated.
  • When administering vaccines to adults, ask if they have kids/grandkids and promote importance of getting up to date/staying current with vaccinations.
  • If you can’t give vaccine today or make an appointment for COVID-19 vaccine, help families find a convenient location at Vaccine Locations.

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