July 23, 2017

Eligibility Policy Changes for Texas Vaccines for Children Administered by the Health Department

The Texas Department of State Health Services has developed policy changes to the TVFC (Texas Vaccine for Children) Program in response to reductions in state and federal immunization funds, increased federal accountability for publicly-funded vaccines, as well as increases in prices for some vaccines.

The following changes to TVFC patient eligibility are effective beginning January 1, 2012.

1. Children who have private insurance that covers vaccines will no longer be eligible to receive TVFC vaccines in public health department clinics, but instead will be referred to their medical home for immunization services.  In some cases, local health departments may serve as the medical home that provides healthcare services.  In those cases, private insurance is accepted.

2. Insured children with vaccine coverage who have high co-pays or deductibles are no longer considered underinsured and are therefore no longer eligible to receive TVFC vaccines.  However, children that qualify under the new definition of underinsured will continue to be eligible to receive vaccines in any TVFC-enrolled provider office.

3. Children, birth through 18 years of age, who meet at least one of the following criteria, are eligible to receive TVFC from any TVFC-enrolled provider:  

· Medicaid eligible:  A child who is eligible for the Medicaid program

· Enrolled in CHIPs

· American Indian or Alaskan Native

· Uninsured:  A child who has no health insurance coverage

· Underinsured:  A child who has commercial (private) health insurance, but coverage does not include vaccines; a child whose insurance covers only selected vaccines (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.

For more information you can contact the San Angelo Health Department at 657-4214 or go to www.dshs.state.tx.us/immunize/default.shtm.