Medicaid and CHIP Mandatory Adult Vaccine Coverage Beginning October 1, 2023


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The Centers for Medicare & Medicaid Services (CMS) wants to remind states that with the passage of the Inflation Reduction Act (IRA), Medicaid and Children’s Health Insurance Program (CHIP) programs will be required to provide coverage for approved adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) without cost sharing for certain enrollees beginning October 1, 2023.  This requirement can be found in section 11405 of the IRA.

The enrollees that must be provided with adult vaccines are:

  • Most Medicaid Categorically Needy enrollees;
  • All Medicaid Medically Needy enrollees; and
  • CHIP enrollees 19 years of age or older (i.e., pregnant and postpartum individuals covered by CHIP).

The IRA also provides certain states that covered such vaccines without cost sharing as of the date of enactment with an additional eight-quarters of the one percentage point federal medical assistance percentage increase. CMS plans to issue guidance to states on this subject and other IRA related topics in the future.