Patient Eligibility

The Childhood Vaccine Program is a universal vaccine purchase program financed by a combination of federal and state dollars. All children less than 19 years of age in Washington State are eligible to receive vaccine through the program. To ensure the appropriate source of funding is used for purchasing vaccines, providers are required to screen and document each patient's eligibility status at each immunization visit prior to vaccine administration. For a full description of eligibility categories refer to the Eligibility for Publicly Funded Vaccines – A Guide for Providers (PDF).

Patient Eligibility Status Screening

All providers participating in the Childhood Vaccine Program are required to confirm the patient's age and to screen and document each patient's eligibility status. Status screening consists of asking and documenting the child's eligibility status at every immunization visit prior to vaccine administration. The patient, parent, or legal guardian may be asked the screening questions or be asked to fill out a form to collect the information.

Eligibility screening documentation must be standardized at the provider site regardless of the method (paper or electronic) used. Screening and documentation may be completed using:

Provider records will be reviewed during routine quality assurance site visits to determine compliance with meeting the screening requirement.

Children Qualifying for Multiple Eligibility Categories

A child may be identified for multiple eligibility categories. In those cases, the provider must select and document the eligibility category that will require the least amount of out-of-pocket expenses to the parent/guardian for the child to receive necessary immunizations.

Example: If a child is covered under both Medicaid and AI/AN, Medicaid should be used as it is the least out of pocket expense for the child. This would also apply if the AI/AN child was also covered under CHIP or private insurance.

Health Care Sharing Plans

Health Care Sharing Plans are non-profit alternatives to purchasing health insurance from private, for-profit insurers. Generally these plans consist of members who share a common belief system and collectively share the cost of their members' medical care. Members select a plan and pay a monthly share amount. Members may also be responsible for an unshared amount, similar to an insurance deductible

In Washington State, Health Care Sharing Plans are not regulated by the Washington State Office of the Insurance Commissioner and therefore are not considered health insurance. Subsequently, the provider may select and document the uninsured eligibility category for children covered under these plans.

Out of State Residents

State of resident is not a criteria used when determining a patient's eligibility status for childhood vaccines. Providers may utilize CVP supplied vaccine for out of state patients and bill the patient or health insurance plan accordingly. If a provider administers CVP vaccine to a Medicaid child from a neighboring state, the provider must be Medicaid-enrolled with the patient's state Medicaid program in order to receive reimbursement for a vaccine administration fee.