Medicaid Managed Care: Unanswered Impact on School-Located Immunization Services

Managed care coordination for Medicaid beneficiaries is being implemented in states across the country. Recently, 1.5 million Medicaid beneficiaries in five regions of Illinois began this transition. This article presents the findings of a study to learn if immunizations would continue to be a reimbursable service if provided to beneficiaries outside of the designated primary care setting. The findings revealed a lack of clarity among health plan representatives and billing personnel in how to obtain coverage information. Five contacted plans (25%) stated they were unable to verify coverage and unclear where to acquire this information. Similarly, six (30%) representatives could not answer the question and recommended calling the Illinois Department of Healthcare and Family Services hot line. Despite the potential benefit of improved coordination of care gained by transitioning to managed care entity model, this infrastructure change may inadvertently introduce barriers to services obtained outside the medical home, like school-located immunization.