VFC providers must screen and document VFC eligibility at each vaccine encounter. Providers administering VFC vaccine should review age and whether the child meets the definition of at least one of the categories below.

VFC and Section 317 stock must be clearly differentiated in the storage units. VFC providers may utilize VFC stickers, use labels, or maintain separate storage units to complete the differentiation requirement. Staff administering VFC, Section 317 and private stock must have a clear clinic process that ensures staff knows which vaccine stock to select from prior to preparing the vaccine for administration.

VFC Eligibility Categories

Children from birth through eighteen (18) years of age (under nineteen (19) years) and meet at least one of the following criteria are eligible to receive VFC vaccine:

1. Medicaid eligible – Any MO HealthNet eligible child or any child under a Managed Care MO HealthNet plan. Children covered by private insurance who have MO HealthNet as a secondary insurer ARE eligible for VFC vaccine (see Insured Exceptions). Note: A child is VFC-eligible in Missouri if they are insured by Medicaid in any state.
2. Uninsured – A child who has no health insurance coverage. Children covered by health sharing plans or cost savings plans are considered uninsured in Missouri. These plans are non-profit alternatives to purchasing health insurance and are not recognized as insurance by the Missouri Department of Insurance.
3. American Indian or Alaska Native
4. Underinsured
   1. A child who has health insurance, but the coverage does not include vaccines.
   2. A child whose insurance does not cover all ACIP recommended vaccines. The child is eligible to receive from VFC only those vaccines not covered by the insurance.
   3. A child whose insurance caps vaccine cost at a certain limit. The child is eligible to receive VFC vaccine after the insurance cap has been reached.
   4. This category does not include children with a high or unmet deductible or those unable to pay the deductible.

Underinsurance, limited coverage and “caps” are increasingly uncommon coverage options and may only occur in insurance plans that are not compliant with the Affordable Care Act (ACA). ACA-compliant plans must cover all ACIP-recommended vaccines with no deductible or co-pay when administered by an in-network provider.

Note: Underinsured children may only receive VFC vaccine at a Federally Qualified Health Center (FQHC), Rural Health Center (RHC), or a Local Public Health Agency (LPHA).

Children who are ineligible for VFC vaccines include children whose health insurance covers vaccinations as a benefit.

Insured exceptions include:

American Indian/Alaska Native with health insurance that covers immunizations: American Indian and Alaska Native children are always VFC-eligible. For American Indian and Alaska Native children that have full immunization benefits through a primary private insurer, the decision to participate in the VFC program should be made based on what is most cost-beneficial to the child and family.

Insured, with Medicaid as secondary insurance: A child may have private health insurance and Medicaid as secondary insurance. The child is VFC-eligible as long as they are enrolled in Medicaid. However, the parent is not required to participate in the VFC Program. There are two options:

1. Administer VFC vaccine and bill Medicaid for the administration fee.
2. Administer private stock and bill the primary insurance for both the cost of the vaccine and the administration fee.

CHIP Vaccine

CHIP is a nationwide program for parents who are over the income guidelines to qualify for Medicaid but cannot afford insurance on the open market. Parents are charged a monthly premium and the child will have a Medicaid card; however, they are not considered Medicaid eligible VFC patients.

In order to accurately report and document the number of CHIP patients seen within our state, VFC providers are required to do the following:

• Verify eligibility (2 options):
  • Check EMOMed (Preferred) through the MO HealthNet Web Portal or by calling 573-751-2896.
    • You will be provided with an ‘ME’ or ‘Plan’ code. If the patient is a CHIP patient, the code will be either 73, 74, or 75.
  • Ask the parent: If the parent provides a Medicaid card ask the parent: “Do you pay a monthly premium for your coverage?” If no, they are Medicaid. If yes, the patient meets CHIP qualifications.
• Document patient eligibility in your electronic medical record (EMR) or ShowMeVax as CHIP.
• When documenting the immunization given, choose ‘CHIP’ as the funding source. If this is not an option within your EMR, you will need to contact your EMR to add this option.
• Inventory documentation:
  • Select CHIP as the funding source for the patient in your inventory documentation method.
  • If there are no ‘CHIP’ doses in your inventory, you will:
    • Document as a VFC dose.
    • Complete a borrowing report and keep onsite for review.
• Do not open another box of vaccines before using all doses.
  • For example: If you have given all of your VFC doses to VFC patients and another VFC patient at your clinic needs a vaccine, you would administer a CHIP dose and complete a borrowing report.
  • REMINDER: You do not have to pay back VFC doses or CHIP doses that were borrowed for VFC or CHIP patients.

See example below for how to complete the borrowing form.

For assistance, you may reach out to the Vaccine Support Team at vfc-smvsupport@health.mo.gov or 866-256-3166 or your VFC Consultant.

If you are certain that you do not see CHIP participants, you may send an email to the Vaccine Support Team at VFC-SMVsupport@health.mo.gov.

Section 317 Vaccine

Local Public Health Agencies (LPHAs), some Rural Health Clinics (RHCs), and Federally Qualified Health Centers (FQHCs) are able to offer select vaccines to uninsured and underinsured adults. Section 317 funded vaccines must be separated from VFC and private stock. Funding is provided by the CDC and is limited; 317 providers must screen adults at each immunization contact for eligibility. All 317 vaccine orders must be submitted to ShowMeVax separately and not included with pediatric orders. To ensure equitable distribution of 317 vaccines, all orders will be reviewed by program staff. Providers administering 317 vaccines must enter vaccine administration per patient in ShowMeVax and offer walk-in appointments. If all vaccine appointments are scheduled, a provider may make a follow-up appointment for a walk-in 317 patient.

All 317 vaccine fall under the Vaccine Replacement Policy. Providers must attempt to transfer 317 vaccines to at least three (3) other 317 providers at least ninety (90) days prior to the expiration. FQHCs participating in the 317 program may be contacted for transfers of short-dated 317 stock. For a list of participating FQHCs, you may contact the Vaccine Support Team or your VFC Consultant.

Documentation of Eligibility Screening

VFC providers must screen and document for VFC eligibility at each immunization contact. The screening information must be maintained on file at the clinic for at least three (3) years and must be made available for review by the VFC Consultant. Patient eligibility may change from one encounter to the next; this is why screening must be completed at each contact. Screening for VFC and documenting the eligibility can be done on paper or by electronic format. VFC eligibility can be documented in paper form on the Immunization Consent and History Form or in electronic formatting in the VFC provider’s Electronic Health Record or Electronic Medical Record. All VFC providers must enter all vaccines administered in ShowMeVax. VFC providers can enter the administered vaccinations manually or by electronic feed from an Electronic Health Record.

Vaccine Administration Fees

VFC vaccines are purchased using federal contracts at a significantly discounted rate. VFC providers may not bill for the cost of the VFC vaccine. VFC providers may bill for an administration fee of up to $21.53 per vaccine administered to the non-Medicaid eligible VFC patients. If a parent/caregiver cannot afford to pay the administration fee, the fee must be waived, and the vaccine(s) must be given to the VFC patient. Administration fees may only be billed one time within ninety (90) days of the date of administration. No one who receives VFC vaccine may be sent to collections for failure to pay the administration fee. VFC providers may charge an office visit fee, in addition to the administration fee.

If a VFC provider chooses to use a billing company for billing patients, the vaccine administration fee information must be provided to ensure the billing company does not overcharge patients for the administration fee and complies with billing program requirements. If a VFC clinic changes ownership, the new business entity must be made aware of the billing practices as well.

All billing departments or billing companies must also have access to the eligibility screening information to ensure that proper billing practices are maintained for each patient.

Vaccine Administration Documentation

All VFC providers must maintain immunization records for ANY administered vaccine that include ALL of the following:

1. Name of vaccine administered
2. Date vaccine was administered
3. Date VIS was given
4. Publication date of VIS
5. Name of vaccine manufacturer
6. Lot number
7. Name and title of person who administered the vaccine
8. Address of the clinic where the vaccine was administered

Note: Best practice is to also include site and route of administration.

Note: VFC providers must enter all vaccines administered in ShowMeVax.

Vaccine Information Statements (VIS)

The National Childhood Vaccine Injury Act (NCVIA) requires all immunization providers to give the appropriate VIS to the patient (or parent or legal representative). The appropriate VIS must be given prior to vaccination and prior to each dose of a multi-dose series. The VIS must be given regardless of the age of the patient.

Ways to give a VIS:

In the past, healthcare providers and public health entities interpreted federal law as a requirement that a paper copy of each VIS is handed to the patient prior to vaccination, and that the patient must take this copy away with him or her following vaccination.

The evolution of electronic media has resulted in broadening this interpretation. For example, now:

1. A provider may produce permanent, laminated, office copies of each VIS, which may be read by patients prior to vaccination.
2. VIS may be reviewed on a computer monitor (or any video display).
3. VIS may be downloaded by the patient to a smartphone or other electronic device to read at his or her convenience. (VIS have been specially formatted for this purpose, such as a QR code)
4. VIS may be made available to read before the immunization visit (e.g., by giving the patient or parent a copy to take home during a prior visit or telling them how to download or view a copy from the Internet). Patients must still be offered VIS in one of the formats described previously to read during the immunization visit, as a reminder.
5. Provider must still offer a copy (which can be an electronic copy) of each appropriate VIS to take away following vaccination. However, the patient may decline.

It is recommended that you sign up for email updates to receive notification when a VIS has been updated.

Updated VIS or VIS in other languages can be found here:

1. Immunize.org VIS
2. CDC VIS

Vaccine Adverse Event Reporting System (VAERS)

VFC providers must maintain records in accordance with NCVIA, which includes reporting clinically significant adverse events online to the Vaccine Adverse Event Reporting System (VAERS). Deaths or severe reactions possibly associated with immunization should also be reported to the Bureau of Immunizations at 800-219-3224.