Guidance on Mandatory Coverage Requirements for Adult Vaccines

On June 27th, the Centers for Medicare & Medicaid Services (CMS) released guidance to states, outlining new mandatory coverage requirements for approved adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) and their administration, without cost sharing. Starting from October 1, 2023, as mandated by the Inflation Reduction Act (IRA), Medicaid and Children's Health Insurance Program (CHIP) must provide coverage and payment for these services. The guidance also specifies the requirements for states to claim a one percentage point increase in the federal medical assistance percentage (FMAP) for these services.