Part of the success of Utah Navajo Health System, Inc. has been its ability to partner with various state and federal agencies, and other organizations, like the University of Utah, for health care services.
One of the very important UNHS partnerships has been the Vaccines for Children (VFC) program, administered by the Centers for Disease Control. The VFC Program offers vaccines at no cost for eligible children through VFC-enrolled doctors. Children through 18 years of age, who meet at least one of the following criteria, are eligible to receive VFC vaccines:
Medicaid eligible: A child who is eligible for the Medicaid program.
Uninsured: A child who has no health insurance coverage
American Indian or Alaska Native: As defined by the Indian Health Care Improvement Act (25 U.S.C. 1603), (regardless of whether they have private insurance or not)
Underinsured which means the child has health insurance, but it:
Doesn't cover vaccines, or
Doesn't cover certain vaccines, or
Covers vaccines but has a fixed dollar limit or cap for vaccines. Once that fixed dollar amount is reached, a child is then eligible.
If your child meets one of the VFC eligibility criteria listed above, the vaccine must always be provided free of charge. Free of charge means just that. The vaccines have already been paid for with federal tax dollars and no one can charge a fee for the vaccine itself.
However, each state immunization provider has been granted (by law) the ability to charge what is called an "administrative fee." An administrative fee is similar to a patient's co-pay, in that it helps providers offset their costs of doing business.
The vaccines available through the VFC are determined by the Advisory Committee on Immunization Practices (ACIP). CDC, as the administrator of VFC, purchases and distributes the vaccines. VFC covers any vaccines included in the immunization schedules. Diseases that are preventable by recommended childhood vaccines, recommended by the Advisory Committee on Immunization Practices (ACIP), include the following.
- Diphtheria · Haemophilus influenzae type b (Hib)
- Hepatitis A· Hepatitis B · Influenza (flu) · Measles
- Human Papillomavirus (HPV) · Mumps
- Meningococcal · Pertussis (whooping cough)
- Pneumococcal · Polio · Rotavirus · Tetanus (lockjaw)
- Rubella (German Measles) · Varicella (chickenpox)
Unfortunately, under the rules of the VFC program, not all children are eligible to receive VFC vaccines. According to the VFC guidelines, which are strictly enforced and monitored by the federal government, children whose private health insurance covers the cost of vaccinations are not eligible for VFC vaccines. This is true, even when a claim for "If I could give Vaccines for Children to everyone I would give them to everyone," Fox said. "But the VFC comes in every six months to evaluate how we're doing, and if my waste record is too bad, they will pull the program. That means no vaccines for all of San Juan County pretty much. Or they can pull the program if I'm giving vaccines to people who don't qualify for the program. If I mess up once, that jeopardizes everybody as opposed to keeping it as it is and every once in a while having to have someone come up to Blanding for vaccinations."
Fox explained that the vaccines for both VFC and the privately insured come ten individual doses to a box and each box is for one vaccine only. If you look at the schedule for young children, there's one month, three month, six month, nine month, one year, eighteen months and two years. And you have to order one box for each one of those. If you don't have enough patients to use up all ten doses in a box, the unused doses are wasted. Right now there is virtually no waste with the VFC program because there are enough patients to use up the vaccines before the expiration dates hit; and usually that's one year. The VFC program is monitored to see how many vaccines each clinic has, how many are administered, to whom and more.
"Our hands are tied," Fox said. "We don't want anyone to feel like, 'I went to Utah Navajo Health, and I was a Caucasian, so they turned me down.' If you're from one of the areas where we don't offer private vaccines, and you have private insurance, we're more than happy to see your child for well child visits, but you may need to go to Blanding for the private vaccines and administration. Insurance still covers everything. We're more than happy to work with you."
the cost of the vaccine and its administration would be denied for payment by the insurance carrier because the plan's deductible had not been met.
"We have a lot of Caucasian patients who live down in Monument Valley and Montezuma Creek, who are teachers," explained UNHS Blanding Family Practice Clinic Manager Nick Fox. "They get PEHP from the school district and then they go into our clinics to get vaccines for their kids. We're having to turn them away because we only have the VFC vaccines at these clinics. The VFC program does not cover those with private insurance. Private insurance is covered by private vaccines and they're only offered in Blanding at this time. The reason behind that is the cost."
Fox explained further that the VFC program is a CDC program and UNHS has no choice but to follow the program's guidelines, which is difficult because it makes it look like the UNHS clinics in Monument Valley and Montezuma Creek are turning patients away. People in these areas work for the school district. They're being told they have to come to Blanding for their vaccines and they want to know why. They have health insurance, but with this program, all the vaccines the rural clinics stock are VFC vaccines because they have very few people who don't qualify for the VFC program.
"If we knew we would have a large number of private vaccines down there, like we do in Blanding, we'd stock them. But down there they would be outdated and we'd have to eat the cost," Fox added.
Fox said rural clinics like Navajo Mountain, Monument Valley and Montezuma Creek only stock the VFC vaccines. At Blanding Family Practice they stock the private vaccines because of the large population with private insurance. Down south patients with private insurance are told the well child checkups can be done, but they have to go to Blanding for the vaccines.
Fox said UNHS discussed the idea of taking private vaccines from the Blanding Family Practice office to Monument Valley and Montezuma Creek, but the problem is the vaccine life.
"Once you draw that vaccine up it's only good for 30 minutes. Once you pull it out of the fridge you can only have it out for 30 minutes," he explained. "It's pretty much like packing hazardous material. You have to have HAZMAT training to transport it and you treat it almost like a blood product. You have to have it on ice and you have to monitor the temperature every ten to fifteen minutes. It's just a huge hassle to go through just to get it to that location.
"And once you get it to that location, now you're pulling from an inventory that's an hour away and if you don't give that vaccination you waste it. If you have too many wastes for the VFC, they'll pull the program because they don't want you wasting their vaccines."
When asked how the VFC and private vaccines are shipped, Fox said the vaccines are sent from the VFC program, for VFC qualified patients, in the same manner that vaccines are sent for privately insured patients. However, private vaccines have to be ordered through the UNHS Pharmacy. The Pharmacy orders them and they are sent from the manufacturer, not from the VFC program.
"We tried to order individual vaccines, but they don't even offer them," Fox added. "So there's no way to order a specified amount of private vaccines for those living in rural areas, who have private insurance. It would be almost impossible to do because there's no way to tell how much to order."
According to Fox, these concerns over private vaccines vs. VFC vaccines are rare. There is no effort or intention to discriminate against anyone with private insurance, because of race or any other reason, he said. The guidelines mandate that all Native Americans, even if they have private insurance, qualify for the VFC program. But Caucasian patients with private insurance are not qualified, under the guidelines of the CDC, for the VFC program.