Several state Medicaid programs have begun reimbursing for vaccine counseling services amid efforts across the country to increase COVID-19 vaccination rates. Vaccine counseling services can provide reassurance, education, and clarity to those experiencing vaccine hesitancy.
Washington‘s Medicaid program, Apple Health, offers provider reimbursement for COVID-19 vaccine counseling visits. The program defines counseling visits as a conversation between a patient and a provider or qualified health professional, nurse, or medical assistant about the COVID-19 vaccine. Eligible providers are those who have established a relationship with the patient at least one time in the last three years. Reimbursable conversations may include:
- a patient’s reasons for not being vaccinated;
- addressing patient-identified concerns related to vaccination;
- providing tailored and individualized medical advice regarding COVID-19 vaccine for that patient; and
- providing resources about how to get a COVID-19 vaccine, if applicable.
North Carolina‘s Department of Health and Human Services also reimburses Medicaid providers for providing counseling on the benefits of COVID-19 vaccination to help Medicaid beneficiaries get accurate information to make an informed decision about getting the vaccine. Medicaid providers can be reimbursed up to 15 minutes for preventive medicine counseling or risk factor reduction intervention related to COVID-19. Further, parents or guardians of children receiving Medicaid – even if the adult is uninsured – can receive counseling from their child’s doctor.
- Massachusetts‘ Medicaid program, MassHealth, reimburses physicians and acute outpatient hospitals for providing clinically appropriate, medically necessary COVID-19 counseling services; and
- New York‘s COVID-19 vaccination CPT codes include all necessary counseling provided to patients and caregivers.
Visit the America’s Essential Hospitals coronavirus resource page for more information about the pandemic.
Contact Senior Director of Policy Erin O’Malley at firstname.lastname@example.org or 202.585.0127 with questions.