NEW POLICY BY THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES REGARDING ADMINISTRATION OF IMMUNIZATIONS
Some very significant policy changes have recently been made by the Texas Department of State Health Services. It is thought the primary factor influencing these changes is the economy, and more specifically, legislative cuts to spending for vaccines in Texas. Regardless of the rationale, DSHS is facing some substantial changes in their vaccine policy. For years public health has vaccinated children, both the uninsured and those insured that chose to come to the health department for immunizations. Most insurance policies do not cover all of the cost of immunizations; so many children legitimately fell into an underinsured category. Parents would gladly pay a small co-pay for required vaccines rather than incur the cost of an office visit from their physician. All of that is about to change.
DSHS has redefined underinsured such that local health departments will no longer be able to vaccinate most children who are covered by a private insurance policy. All of the vaccines that are administered for the prevention of childhood diseases are provided by DSHS, so they will be required to follow this policy.
In accordance with the new DSHS policy, the Denton County Health Department will continue to provide immunizations to children who meet at least one of the following criteria:
- CHIP: A child who is enrolled in the CHIP program
- Medicaid: A child who is enrolled in the Medicaid program
- Uninsured: A child who has no health insurance coverage
- American Indian or Alaskan Native
- Underinsured (*New Definition*): A child whose health insurance does not include vaccines; a child whose insurance covers only selected vaccines (Texas Vaccines for Children (TVFC)-eligible for non-covered vaccines only); or a child whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the child is categorized as underinsured.
In accordance with DSHS policy, insured children with vaccine coverage who have high co-pays or deductibles are no longer considered underinsured. These children are now considered fully, privately insured and are no longer eligible for TVFC vaccines. Insured children will be required to receive vaccinations from their primary care providers. If you are not sure if vaccines are covered by your insurance, you will need to check with your insurance carrier.
These policy changes have been mandated, and the Health Department must comply.
This information has been provided by:
Bing Burton, Ph.D.
Denton County Health Department