ACCESS recognized a need for healthy food access due to the lack of grocery stores and partnered with local organizations to create a Farmers Market so that community members could access fruits and vegetables and even created a cookbook to help with preparing healthy meals with these ingredients.
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Bailey Spates is a Program Specialist with NACHC’s Regulatory Affairs department.
Vaccines are one of our greatest tools to combat serious illnesses, hospitalizations, and even death. The CDC estimates that Americans born between 1994 and 2013 will avoid a staggering 322 million illnesses, 21 million hospitalizations, and 732,000 deaths thanks to vaccines over their lifetimes. That’s a public health victory worth celebrating! But the reality is, not everyone has equal access to this lifesaving protection. That’s where Community Health Centers step in as champions for health equity. Health centers understand that underserved communities often face barriers to healthcare, including access to vaccinations, and therefore strive to provide their patients with vital immunizations.
In February, CMS released a helpful new toolkit outlining State flexibilities to empower providers like Community Health Centers to better understand vaccine coverage and cost-sharing for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, ultimately helping move towards more equitable vaccine access and coverage.
For a quick summary, review this NACHC infographic. The following analysis looks at the impact of recent policy changes within the new toolkit and its potential to improve vaccine access for health center patients.
The CDC, along with the Advisory Committee on Immunization Practices (ACIP)— a committee of experts that work to provide recommendations for best vaccine administrations for preventable diseases—has a list of approved vaccines that are now covered for Medicaid and CHIP beneficiaries, thanks to the Inflation Reduction Act. The expanded list, which includes the COVID-19 vaccine, ensures continued equitable access to critical vaccines for both children and adults. To understand the importance of this further, let’s explore the current landscape of vaccine coverage in children.
States must cover Medicaid and CHIP beneficiaries under age 21 eligible for the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. This means beneficiaries have coverage for all immunizations recommended by the CDC and ACIP pediatric immunization schedule. For CHIP programs that choose to offer EPSDT coverage, the same rules apply; they must also follow EPSDT requirements for immunizations. Additionally, children under age 18 (or 21 at some states’ discretion) are exempt from Medicaid cost-sharing, including for vaccinations.
For our youngest patients who are enrolled in Medicaid (up to age 18) or are uninsured, underinsured, or American Indian/Alaska Native, there’s no change! The Vaccines for Children (VFC) program, established in 1994, plays a critical role in ensuring equitable access to essential childhood immunizations. By promoting widespread vaccination coverage, the VFC program contributes significantly to the overall health and well-being of families and communities.
Thanks to the Inflation Reduction Act, as of October 1st, 2023, adults 19 and over with traditional Medicaid and certain medically needy benefits have coverage on ALL the recommended adult vaccines covered by Medicaid, with no out-of-pocket costs. This includes both the vaccine itself and the administration fee. Unfortunately, if beneficiaries are on an alternative Medicaid benefit plan, the IRA coverage doesn’t apply. However, coverage will still apply for the standard, routine vaccinations recommended by ACIP, also with no cost-sharing.
As healthcare homes for their patients, Community Health Centers can help provide access to these vaccines for their communities, helping patients achieve better health outcomes. Health centers see 1 in 5 Medicaid patients, and these changes now mean over 15 million patients have access to routine and essential vaccines.
Across the country, states implement a wide range of reimbursement models to cover costs associated with administering vaccines. For Medicaid and CHIP enrollees, the cost of administering a vaccine might be bundled into the existing prospective payment system (PPS) rate Health centers receive for the entire visit. Other states might use a different payment method such as the Alternative Payment Methodology, but the idea is similar: there is coverage of the vaccine and vaccine administration within the overall visit cost. States can also choose to set higher PPS rates to recognize the extra costs of giving certain vaccines.
To streamline reimbursement for vaccinations, states could implement separate payments for vaccines at approved per-dose rates, independent of the standard health center PPS rate. This approach mirrors Medicare’s established rates for vaccine administration costs, potentially simplifying the process for Health centers. Additionally, CMS recommends states review their requirements for CHC/Rural Health Clinic encounters to ensure clear guidance for providers to accurately bill for vaccines. The bottom line is that no matter how they get paid, Health centers are committed to providing vital vaccinations. If you have questions about your state’s specific reimbursement model, contact your state Medicaid agency.
Despite the positive impact of the IRA, broader policy barriers continue to hinder health centers’ ability to provide essential vaccines to our patients. We recently addressed these issues in our white paper, “Strategies to Address Policy Barriers to Adult Immunizations in Federally Qualified Health Centers (2024).“ As the cornerstones of healthy communities, health centers strive to ensure everyone has access to affordable vaccines. However, persistent barriers threaten this equitable access, making advocacy a crucial tool in securing the resources we need to fulfill this vital role.
1. Earmark Resources to Address the Financial Burden of Upfront Vaccine Purchases for Health Centers: To ensure health centers can offer the full range of vaccines communities need, we must address the financial burden of upfront vaccine purchases. Allocating resources and advocating for higher reimbursement rates that reflect vaccine administration costs are crucial steps to being able to expanding vaccine access for the health center community.
2. Streamline Reimbursement with Simplified Billing Codes and Expand the Workforce: Confusing billing codes create roadblocks for CHC reimbursement of essential vaccinations. Advocating for clear definitions of CHC encounters ensures proper payment, keeping these vital programs sustainable. The HHS COVID-19 Public Readiness and Emergency Preparedness Act (PREP Act) continues to offer liability protection for pharmacies, pharmacists, pharmacy interns, and pharmacy technicians administering COVID-19 vaccines, seasonal influenza vaccines, and COVID-19 tests until December 31st, 2024. However, these flexibilities will end at the end of 2024, going back to pre-COVID times where only certain providers could bill for vaccine administration. To improve vaccine accessibility and address workforce limitations, expanding the pool of billable, authorized vaccine providers is a key advocacy message.
By understanding the new vaccine coverage options and advocating for further improvements, Community Health Centers can continue to be true champions for affordable vaccines. Regardless of their patients’ ability to pay, Health centers can provide important vaccinations for their patients to stay healthy. Remember, this is just the beginning. Stay tuned for more information on how health centers are working to keep your community healthy.
PHOTO CREDIT: Mary’s Center, Washington, DC
Jessica Hinshaw, MPH, is the Director of Environmental Health in NACHC’s Population Health Department.
As summer temperatures rise, Community Health Centers face the critical challenge of protecting their patients from the adverse health effects of heat. Heat-related illnesses and deaths are preventable. Yet, heat causes the most climate-related deaths each year– even more than hurricanes and wildfires. Furthermore, due to a changing climate, the heat now stretches as early as April to as late as October in certain areas of the continental US. The patients that receive care at health centers can be especially affected by heat because of health and life conditions, social drivers of health, and occupation.
Fortunately, there are many resources that can help health centers prepare clinicians, patients, and facilities for heat.
Heat can cause a range of health issues, from heat exhaustion to heat stroke, and can exacerbate chronic conditions such as cardiovascular and respiratory diseases. Populations that face negative impacts from heat include:
These populations often have limited access to cooling resources, making it imperative for health centers to talk with patients and prepare their staff and facilities during the heat season.
The NACHC Environmental Health team hopes health center staff and patients can stay safe throughout the heat season. Please reach out if you have additional resources or stories, suggestions, or questions to share at envhealth@nachc.org.
June is Pride month, a time to celebrate and bring attention to issues facing the lesbian, gay, bisexual, transgender, and questioning (LGBTQ+) community. We’re spotlighting a Community Health Center that has responded to this call by sharing with us ways that they engage with their state lawmakers on policy issues related to LGBTQ+ health. We talked with Rhea Debussy, Ph.D. (She/Her), Director of External Affairs, of Equitas Health.
Q: Will you tell us about Equitas Health and the community you serve?
Rhea Debussy, PhD (RD): Equitas Health is a nonprofit community healthcare system founded in 1984. We’re one of the nation’s largest LGBTQ+ and HIV/AIDS-serving organizations, and we serve tens of thousands of patients in Ohio, Texas, Kentucky, and West Virginia. Our services include general primary care, pharmacy, gender affirming care, mental health and counseling, HIV-focused case management, HIV/STI prevention and treatment, and much more.
Q: Building relationships with state lawmakers is a meaningful way for them to learn about the work that Community Health Centers do. Can you share with me some of the ways you engage with your state lawmakers and what you’ve found to be some of the more useful tips and tricks for building those relationships?
RD: Building governmental and community-based relationships is definitely an important part of an effective legislative advocacy strategy. While coordinating with our partner organizations, we engage our state lawmakers by providing public comment during committee meetings, holding policy-focused meetings with key officials, sharing stories from our community, and so much more. For folks working to build an effective strategy and new relationships, I’d definitely recommend being both genuine and communicative. But also, staying even-tempered is also very helpful in today’s political environment.
View NACHC’s LGTBQ+ resources
Q: Why is it important for health centers to share the stories of the community they serve?
RD: Sharing stories from the community is such an effective advocacy tool, and it’s important because it shows that the government – for better or worse – has real effects on real people. Even if your social values or political ideas don’t align with an individual elected official, that person is likely just trying to do the same thing as you – help. By sharing stories from our communities, we can make sure that elected officials have a clearer picture of who a policy affects, why, and how.
Q: Can you share with me any stories of success you’ve had?
RD: Absolutely, and I’ll share a recent one. Like many states, Ohio has outdated laws that criminalize HIV. For the past several years, we’ve worked with partner organizations and state lawmakers alike in an effort to repeal these outdated and discriminatory laws, which disproportionately impact women and Black Ohioans living with HIV. And just last month, a state lawmaker, Rep. Sara Carruthers (R-47), introduced two bills that would modernize some of these laws. While there’s still plenty of work to be done, moments like this are definitely successes.
Policies enacted by state legislatures often have a greater impact on our lives than we realize. According to Bloomberg Government, in 2023, state legislatures introduced more than 107,000 bills and enacted 19,003, compared to Congress which simply passed 27 bills.
State legislatures deal with issues ranging from high school graduation requirements, business times of operation, all the way to laws governing the access and availability of health center care through state level funding and mandates. State legislatures do more because they tend to have more frequent legislative sessions, there is greater flexibility to be innovative with their approach to policy, and the main advantage is that they generally represent a smaller number of constituents which allows them to address issues more localized to their communities. The biggest takeaway from this interview is that state-level advocacy is critical to sustaining the Community Health Center movement.
Visit NACHC’s advocacy website, Health Center Advocacy Network, for advocacy tools, templates, resources and information.
Proposals to sustain and protect the federal 340B Drug Pricing Program are gathering momentum on Capitol Hill. The House Energy & Commerce Oversight and Investigations Subcommittee held a hearing yesterday about the program, with lawmakers focusing on a range of issues that included affordability, patient care, and transparency.
Sue Veer, President and CEO of Carolina Health Centers, Inc., and NACHC Board Member, was among the experts called to testify. Veer described how her rural South Carolina health center serves as the primary medical home for over 26,000 patients, operating 16 sites and a wide range of services that include childhood services, behavioral health, and two community pharmacies. Like many Community Health Centers across the country, Carolina Health Centers has experienced devastating financial losses from conditions and restrictions imposed by drug manufacturers, a practice that has flourished due to a lack of clarity in the federal 340B statute.
“Health centers across the country are reducing services and closing practices because of losses to their operating margins and the increased burden of responding to conditions of participation in the program”
Sue Veer, President and CEO of Carolina Health Centers, Inc.
“The 340B Program is at risk and it is our patients who will suffer,” Veer told lawmakers, estimating that their operating margins have been reduced by nearly $700,000 annually. Veer said the 340B contribution supports services such as delivery of medicines to patients who live in remote locations, Early Childhood Services and parenting education for families, behavioral health and substance use disorder services, and oral health.
“Health centers across the country are reducing services and closing practices because of losses to their operating margins and the increased burden of responding to conditions of participation in the program,” said Veer. She also described how 340B covered entities and pharmaceutical manufacturers are treating each other as “adversaries rather than partners” and that the path back to stabilizing the 340B program must not only “include guardrails to protect against arbitrary restrictions and abusive business models, but also provide points of access to accommodate the scope of care provided by each of the 340B covered entity types in the healthcare system.”
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The subcommittee hearing comes on the heels of last week’s introduction of the 340B Affording Care for Communities and Ensuring a Strong Safety-Net (340B ACCESS) Act, sponsored by Reps. Larry Bucshon (IN-8), Earl L. “Buddy” Carter (GA-01), and Diana Harshbarger (TN-01). The measure represents input from diverse stakeholders, led by NACHC, who formed the Alliance to Save America’s 340B Program (ASAP 340B) and provides a path to sustain the federal 340B program for all stakeholders. The introduction of House bill (a bipartisan group of Senators have also introduced a discussion draft of legislation earlier), is only the beginning of a long and deliberative process to ensure a comprehensive bill crosses the finish line.
“The legislative process is lengthy and allows for refinement and improvement of proposed laws through debate, discussion, and amendment. It is essential that stakeholders who may have questions about ‘The 340B Access Act’ continue to share their perspectives and support the process. This helps create effective, fair, and comprehensive legislation that can stabilize the program for the long-term,” said Joe Dunn, SVP for Policy and Advocacy at NACHC.
The full subcommittee hearing titled “Oversight of 340B Drug Pricing Program” can be viewed at this link.
Learn more about the 340B ACCESS bill that NACHC supports.
NACHC is pleased to support landmark legislation introduced in the US House of Representatives that includes key reforms needed to protect the federal drug discount program known as 340B. The introduction of the 340B ACCESS Act is just the start, however, of the process to find a legislative solution to stabilize the 340B program. This is the first comprehensive legislation of its kind to be introduced and it will evolve as it goes through the legislative process – like all bills do. It will be refined by members of Congress and their staff as they try to perfect it — and their will be multiple opportunities for health center advocates to give input.
The legislation, 340B ACCESS Act, sponsored by U.S. Rep. Larry Bucshon, MD (R-IN), Rep. Buddy Carter (R-GA), and Rep. Diana Harshbarger (R-TN), takes a comprehensive approach to 340B reform that addresses issues of the most concern to Community Health Centers — including those related to contract pharmacies, defining the intent of the program, and PBMs (pharmacy benefit managers).
This legislation also marks an important milestone in NACHC’s longstanding efforts to protect 340B and bring together diverse stakeholders to align around a comprehensive solution with the launch last year of the Alliance to Save America’s 340B Program (ASAP 340B). NACHC tried litigation, the alternative dispute resolution process, until it became abundantly clear the only path forward was federal legislation.
Here are a few key highlights. This legislative solution:
For many health centers, reinvested 340B savings fuels innovation, allowing them to provide essential services not reimbursed by insurance. Learn more about what 340B means for health centers. If Congress does not protect the 340B program, more safety net providers will continue to suffer under the current restrictions.
Please let us know your thoughts about the bill. Fill out the NACHC Feedback Form
