Are Medicaid’s low reimbursements keeping poor kids from getting flu shots?

Would more poor children receive flu shots if Medicaid reimbursed the doctors closer to the real cost of the shots?

Researchers at the University of Rochester Medical Center (URMC) believe the number would increase if doctors were not losing money each time they immunized a child on Medicaid against the flu.

The researchers looked at flu immunization rates for children 6 to 23 months during 2005 to 2006, 2006 to 2007, and 2007 to 2008 flu seasons and found those paid by Medicaid had a much lower vaccination rate.

Healthday reports:

“Reimbursement rates ranged from $2 in Colorado, Connecticut and Hawaii to almost $18 in New York, with the average reimbursement rate $9. In a previous study, the researchers had calculated that the actual cost to doctors’ offices for administering a vaccine was $20.”

” ‘In most states the reimbursement from Medicaid is far below the actual cost. This may create an obvious disincentive when physicians’ offices lose money every time they give a flu shot, even though vaccines are provided for free,” lead author Dr. Byung-Kwang Yoo, an assistant professor in the Department of Community and Preventive Medicine, said in a URMC news release.”

“Using mathematical models, Yoo and colleagues calculated that for every extra dollar paid by Medicaid, flu vaccination rates among poor children would increase by 0.6 to 0.9 percent. That means a $10 reimbursement increase would raise vaccination rates among children in low-income families by up to 10 percent.”

The idea is that by paying a higher reimbursement rate on the front end, more children would be immunized against the flu and less children would need more expensive medical care later to treat the actual flu.

Do you think more poor children would get immunizations if the Medicaid reimbursements were higher?  Do you think the doctors think about losing money on each of those shots and don’t advertise to those patients they could get the shot there? Do you think the parents just don’t bring them in and it has nothing to do with what is being reimbursed? Does it make sense to pay more on the front-end to save on the back end?

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bunch of yentas

October 21st, 2010
6:32 am

I guess you answered your own question by pointing us to a study that has data suggesting that increasing reimbursements would increase use of flu shots.

My son received a flu shot or two in those first few years of life. How hard those days are when it seems the Doctor shoots your child up with viruses and narcotics seemingly every few months.

I have never had a flu shot. I have had the flu, twice actually.

I live by the theory that if you can beat something using your own immune system, you will come out stronger in the long run.

My 7 year old child has never had an antibiotic. If he ever gets a real infection and needs an antibiotic, I want it to work and not be watered down due to overuse.

mom of 3

October 21st, 2010
6:37 am

The sad truth is we help other countries but fail our own children.

One part of the story

October 21st, 2010
6:42 am

Interesting that the researchers do not seem to have looked @ private insurance reimbursement of vaccinations, which is also well below cost to the provider. The article you referenced makes it sound like the researchers also didn’t consider other contributing factors, such as perception of vaccines in low income communities or overall state flu vaccination rates. Of course none of that matters because now child health advocates will be able to wave this article in front of legislators as they lobby for increased reimbursement.


October 21st, 2010
7:01 am

All I know is that my personal MD, a solo practioner internal medicine specialist, sent out an email blast to us patients suggesting that we get flu shots. He said that the cost for anybody who did not have insurance would be no more than what Medicare would pay –

My insurance co-pay was $15 (and I got a tetanus shot (once eveery ten years) at the same time, and I had blood work drawn too, so basically I got a 3 for 1 for $15); I know my insurance company paid an additional $22 for the flu shot, an additional $35 for the tetanus shot, and $35 for the blood work). All of this is hardly enough for the MD to keep his doors open, but that is his business.

So, something about this story does not add up, at least from my perspective.


October 21st, 2010
7:05 am

Also, I guess I should have added that I could have gotten a free flu shot at my place of employment, though I opted for my personal MD since I needed other stuff for the one co-pay, so why not do it all at once.

My point is that my employer is CHEAP, so giving this free flu preventive care cannot cost too terribly much from the outset.


October 21st, 2010
7:14 am

If the “poor” parents didn’t spend their money on beer, cigarettes and lottery tickets they could easily afford the cost of a flu shot.


October 21st, 2010
7:36 am

In a way I agree with Devildog. If I need something for my children, I did without something else. Period. Many poor parents can afford other luxuries, but they expect the children to be provided for by the government. Doctors could advertise as Medicaid plus $10, couldn’t they?

I see a great deal of misrepresentation and poor values in a school with 70% free lunch, yet the money is found for kids to dress well, have computers, etc. We do have some truly poor kids, but if they can buy junk from the school snack store, they DON”T need Free Lunch!


October 21st, 2010
7:47 am

Devildog, you must have a nice view sitting up there on your high horse. I can tell you, when you’re broke, $22 might as well be a million, and $22 might be your entire food budget for the week, so “affording” the cost of the flu vaccine isn’t the problem – it’s that most people will choose to eat over getting vaccinated when faced with such an awful choice. I was in this unenviable position right after college when I got my first post-graduation job that offered no health coverage whatsoever, so I’ve been there, eating just once a day and downing cup after cup of coffee at work to stave off hunger, and I tell you, $22 was a hell of a lot of money.


October 21st, 2010
7:48 am

As much as you can point the finger at cost, what about the time it takes to get into the doctor to get the shot in the first place? Thankfully my little one’s birthday is in Nov, so she has always gotten it during the a checkup visit. I think most adults have it offered at the office and just get it then unless you wanted to have other issues reviewed as well with the one co-pay.

I know many people who have money to go out and do what they want to do, but when it comes to other things, they just don’t have the money. It’s the same as anything else in life. If it’s important to you, you can always figure out a way to get things done. I try not to judge as that is not the Christian way, but I stilll struggle with frustration all the same.


October 21st, 2010
7:54 am

@Bunch – I’ve never had a flu shot either, and I’ve only had the flu two or three times during my entire life.

I very rarely get “sick”. I do get the occassional cold, stuffy nose, etc. but nothing that has laid me out of work for more than a day, except lower back issues…..


October 21st, 2010
8:06 am

If you have beer in the fridge or cigarettes in your purse or a smart phone (with its $30/mo data plan) then you’ve got $25 to go to Publix, Target, Walgreen’s or where ever and get a flu shot. The shot is cheaper than fighting the flu.

Then again, if anyone cared about spending a couple of dollars now instead of a bunch of dollars later, you wouldn’t hear cars going by with grinding brakes or squealing belts.


October 21st, 2010
8:14 am

It’s also ignorance and education. Yes, Doctors do not promote things they don’t make money on. The poor have not been educated and exposed to proper health – many do not brush their teeth two times a day. Their lack of education and simple ignorance due to their conditions contribute the most.

And I don’t like posts from high and mighty who look down there nose at the poor, judgemental, when they obviously do not have any idea what poverty is like or the causes of it. Poverty is the cruelist thing. Rather than criticize and judge, get off the couch and actually do something to help those in need.

On topic?

October 21st, 2010
8:18 am

For those of you on the “poor people care more about clothes, drugs, etc than their kids path…The article doesn’t say people with Medicaid won’t pay for their shots. It says Medicaid as an insurer pays so little that docs don’t push patients to get them.

@catlady…Seems like Medicaid would be like most insurance companies and prohibit “balance billing” above a contracted rates. I know my insurance says that if the contracted rate for a services is $50, then most me and insurance combined pays is $50. Not $50 + $X to a offset crappy reimbursement rate.


October 21st, 2010
8:22 am

there are tons of places that offer free flu shots. CVS down the street from me is one of them.

I have been in healthcare reimbursement for 20 years now and I can tell you without a doubt that government programs pay the least of any insurance company. Hospitals and doctors cannot pay the bills with the money the govenrment pays for services. Period, end of story. Make excuses, make pleas, cry about the children, “those without”, dress it up how ever you want. The facts are the facts.


October 21st, 2010
8:25 am

The problem is the whole system of med costs. I called the doctor last year to see if they had flu shots available yet so I could make an appointment for my son. Their first question (before they would answer mine) was “What kind of insurance do you have”. I asked if it mattered. And she said “yes, only people with private/employer health insurance could get shots right now”. Medicaid folks or self pay folks did not have access to the shots right then. The whole system is so stupid. It’s the same stinking shot, so why should it matter how you pay for it!!!!

That's OK, Jeff...

October 21st, 2010
8:27 am

….Obama the chosen one is gonna take care of us…


October 21st, 2010
8:53 am

Could it also be that a lot of medicaid patients only go to the doctor when they are already sick? They do not have the means for preventitive care so aren’t there to get “encouraged” by the doctor to get a flu shot. Many don’t have doctors anyway and have to use the emergency rooms when they do get sick. To somehow imply that the doctors don’t push the shots because they lose money is misleading at best.


October 21st, 2010
9:01 am

I just googled this and it appears that MANY local health departments are offering FREE flu shots.
Some have free transporation too!

As some of you may remember, I had a terrible time finding the 2nd chicken pox vaccine this summer, for my daughter. She needed it ( to get into UGA) and our MD did not carry it. Her enrollment was flagged for the fall.

I spent days ( driving in my car and using my time/ gas ) trying to locate a place to have it administered. I went to the Health Department and they told me it was FREE…do you have insurance? I was honest and said YES…OH then it is $109. We pay our part for the premium level insurance offered through work. It would be covered at a Medical Facility if I could find one that carried it and took our insurance. I called Michelle, on this blog, and she solved the problem for me by locating a facility. You go girl!

I just got my vaccine last week at Walgreen’s. It was covered by our insurance this year. Last year it was $25.

I went years without one but have a dear friend who got
SO sick a while back and still has respiratory issues that will be with her forever. I no longer take any chances.,

Seems to me that private Medical facilities may need to be able to make a profit, in order to stay in business. It is just a fact. They decide what works for them. Our MD is a general practice and I was told that they do not administer enough of the chicken pox immunization to make it worth while, as the shelf life is shorter and they have to toss them.

You can usually find out the reduced rate that your insurance is paying to your doctor for services and realize that many already take reduced rates from the bulk of their clients to stay on their insurance plan. Can you stay in business and lose money…I cannot. Perhaps only the government can.

After my experience, I am not too sympathetic if you cannot get your immunization at a reduced rate at my FOR PROFIT office…as I cannot get anything (at a reduced rate) at the Health Department ( due to my income and the fact that I have purchased insurance) and you perhaps can. Is Medicaid government sponsored? HMMM they do not need to make a profit nor due they need to understand overhead, as a small business would.

Does anyone know how this might change with the new healthcare reform…I do not.

Is Medicaid government sponsored?...

October 21st, 2010
9:17 am

…Well, yeah – it is the government insurance program for people who are under-privileged with debilitating medical conditions and are pre-medicare(age 65) eligibility. Just another of the long time existing government programs serving the poor and disabled who cannot afford medical care…


October 21st, 2010
9:19 am

I’ve never had the flu shot and figure I’m likely at a low risk (no young children & I work from home). My husband’s employer offered it for free to him so he got the vaccine. My employer/insurance does not cover it. I have no issue paying the $25 at a pharmacy to get it; I’m just not sure I really want it. I’ve heard plenty of people who have had the flu say that all it takes is getting the flu once and then I’d change my mind.


October 21st, 2010
9:24 am

re: medicaid ….I asked the question to make a point…thanks for the answer though…some can figure out that perhaps those on medicare can qualify for FREE vaccines at their health department,,,ya think? Am I missing something here?


October 21st, 2010
9:26 am

Oh forgot to answer the actual questions! I do think Medicaid, especially in states where the flu is much more prevalent should cover more of the cost. If it costs me $25 retail, the actual cost is probably $10-12?? It is crazy that in some states they only pay $2. What if there was a ‘co-pay’ option for Medicaid recipients to help make up the difference for these optional vaccines (so that maybe it’s only $5 instead of $25)? If access/transportation is the issue, I wonder why county health departments haven’t teamed up with schools in high-poverty areas to offer the vaccine at the schools. Not enough publicity about the effects of flu maybe?? I’m really not about gov’t handouts but if the net cost to the Medicaid program for the kids who are getting the flu can be prevented by giving the vaccine to more kids, then it only makes sense to me that they would push the vaccine more.

Is Medicaid government sponsored?...

October 21st, 2010
9:39 am

…my bad – I am somewhat slow when it comes to recognizing rhetorical questions…


October 21st, 2010
9:49 am

Why should the doctors have to “push” the vaccine more anyway. I don’t need a doctor to tell me what my child does and does not need. With all the ads on the radio and tv from the gov’t about getting vaccinated, how can anyone say they didn’t know they needed it? I get so sick of the excuses people have blaming everyone else for their problems. If you don’t get your kid vaccinated and he/she gets sick, it really is no one’s fault but your own.


October 21st, 2010
9:55 am

People who use benefits through private or publicly funded health insurance plans generally don’t care about what their physician is being reimbursed for the procedure or shot–just that the physician takes the insurance plan. (People who have to pay cash WILL shop around. But not people on insurance; there’s generally no incentive to do that.)

There are still a lot of misconceptions about the flu vaccine (it causes the flu, it will make you sick, it will paralyze you) that are floating around. That’s what keeping people from getting the flu shot. If you ask 10 people you know if they got the flu shot (or plan to get it), at least 5 of them will say “no” because they don’t want to get sick.


October 21st, 2010
9:55 am

@ Lori…

I get so sick of the excuses people have blaming everyone else for their problems.

Me too…in all aspects of life. Personal repsonsibility is a thing of the past IMHO.


October 21st, 2010
10:03 am

@ Suwanee Mommy….you are so right!

My husband had a refill prescription . His MD wrote it and he took it in to be filled. Did not even notice that the GENERIC option was not checked this time. Our portion ( with our premium insurance) was over $200 with a one month scrip of brand name. He filled in the drive through and when he realized it, he drove around and walked inside. He had not even opened the envelope. The generic option is $10 per month, on our end and much less for the total price. We both said that if someone had medicaid to approve this, they would not have given it another thought as to using the generic….this comes from many discussions with our son…in the Pharmacy.

We have had to pay our own way and tend to be a bit more watchful about things.


October 21st, 2010
10:45 am

Am I the only one who thinks it might be a big conspiracy for us all to get a flu shot that may/may not be necessary- regardless of cost? I am finding that it is in my face every day to get one- whether its’s now my son’s preschool who are now mandated by the DCF to show in their files that they gave us info on the flu and that we have to sign that we got it, to marquee signs in front of every Walgreens and CVS advertising to get your flu shots there, etc?? Where is the research showing that the shot really works? My children did not get one last season, and neither of them got sick, I’m just a skeptic I guess. As far as the questions on the article, there aren’t simple “yes or no” answers. Too many factors involved- shouldn’t the motivation for doctors is to make sure people don’t get sick, not to make money off of them, and shouldn’t parents be bringing in their children for this shot (that I still don’t really feel is needed) whether they are rich or poor? Is anyone asking what companies are making this shot, how do they get transported, who is making money where because of this? Is this really about keeping America healthy???


October 21st, 2010
11:16 am

Regina….The CDC has pleanty of studies/data showing that vaccines do indeed work. It is not a conspiracy at the CDC.


October 21st, 2010
11:52 am

OK…you cannot get the flu from the flu shot. It is NOT a live vaccine, therefor, there is nothing to transmit. Now, can you get some chills, etc. from making antibodies? Yes, but nowhere near what you would experience with the actual flu.

For those folks who have great immune systems and are exposed/have been exposed to a variety of germs on a daily basis, you may want to risk no shot. If you get the flu, you picked the wrong odds.

Now, for those who are elderly, immune suppressed (HIV, cancer, lupus, etc.), very young (under developed immune systems), or live with someone in those categories, you should STRONGLY consider the flu shot. This could be the difference between getting severely ill and/or death. These folks are considered high risk because they have less ability to actually “fight it off.”

If you are sick for 24 hours with a fever, vomiting, diarrhea and you get better the next day…this is NOT the flu!! The flu is pretty distinctive! It usually has a sudden onset and the feeling of “I feel like I’ve been hit by a Mack truck.” High fevers (> 102F), headache, stiff neck, usually a dry cough (not the wet productive kind), and EXTREME lethargy (tireness). Not everyone experiences these symptoms, but these are the “typical” symptoms. Oh…and they usually last several days to a couple of weeks with the lethargy and dry cough lasting up to a month! OHHH…and guess what? You don’t start exhibiting symptoms until about 48 hours AFTER you are contagious! That means even though you weren’t feeling sick, you were exposing others! Nice huh?

I say if your company offers it for free or low cost…do it! Especially if they come on-site! You’ve lost nothing. If you get a little sick, you were either exposed before the shot or you are building the antibodies!

If you choose NOT to get the flu shot, might I recommend frequent hand washing, good rest, stay hydrated, eat healthy, and for goodness sake, if you feel bad, do NOT go to work or in public places!

I know I did not answer the question…sorry!


October 21st, 2010
11:53 am

Holy cow MJG…I rivaled you today! ;o) tee hee!!


October 21st, 2010
12:03 pm

Michelle – I agree with most of your post. I don’t get the flu shot, and I very rarely get sick. I am a constant hand washer…..every time I get home from shopping, work, etc, the first thing I do is wash my hands. I have no fingerprints anymore…LOL. I eat VERY healthy and very little junk food, and drink a TON of water, no sodas for me thank you. I do drink alcohol, so I figure it’s killing germs so there’s no harm. LOL again….

If I’m sick, I stay home, work won’t close down without me….

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October 21st, 2010
12:33 pm

To answer the question, it really depends on the parents. I don’t think the parents of the kids I teach would bother. However, I’ve never gotten one either. My parents swear by them. Since my mom is 60 I guess it’s a good idea to get one at her age. I’ve never made my kids get one either. I don’t know if it’s really necessary.


October 21st, 2010
1:01 pm

I honestly don’t get some of the arguments against getting a flu shot. Even if you work from – as I do – your spouse and/or child(ren) can bring home the germs and transmit them to you (even if they were immunized). Just because you’ve never gotten it before doesn’t mean you won’t this year. And unless you only touch surfaces that you know for a fact have been sanitized or not touched by others, you are at risk. That includes the keypad on the checkout at Publix, the shopping carts, apples in the fruit bin, door handles…Just do it already!


October 21st, 2010
1:26 pm

I’ve had one flu shot in my adult life. I once went 4 years without so much as a cold, so it is not always necessary for everyone.


October 21st, 2010
1:33 pm

I’m with you RJ, I’m a little skeptical of the necessity of flu shots myself. There were a few years there where I was petrified of one of my kids coming down with the flu. Even with health insurance, I couldn’t find a single flu shot for them for a couple of years no matter where I went (plenty for adults, just not kids). Since, year after year, my kids didn’t get the flu (and even the one time my son did catch it he didn’t get that sick with it) I just gave up.

Frankly, it seems to me the very people whom programs like Medicaid are designed to help are the least likely to benefit from them. I realize there are a lot of people who are genuinely in need, but there are also a lot of folks out there who know how to “work the system” and get the government to support virtually their entire, relatively comfortable, lifestyles. My MIL has neighbors who live in a comfortable home, drive newer cars and smoke like chimneys (a very expensive habit these days) although neither one of them has held down a job in decades. Not only do they live off of disability payments, unemployment and food stamps, they raised a family on them. They, and their single mom daughter, have been proud Medicaid recipients for years. They could write a book on how to get free stuff from the government, but they probably won’t since that might actually qualify as a legitimate job. It’s amazing what a lack of shame can get you in this country.


October 21st, 2010
4:45 pm

Michelle…yes, you get the crown today! You have more knowledge than many of the rest of us, on this subject.

Since I am typing on a hotel computer keyboard, I am happy I got my flu vaccine last week.

I went years without one and having observed how sick my dear friend got…never again.
I have worked with thousands of children and have built up quite an immunity but do not want to take a risk anymore. I also have felt a little off, after the shot itself but not this year nor last. I would rather feel puny for one day than risk the long term implications but that is just me.


October 21st, 2010
4:47 pm

Kate…many of us, on this blog, have witnessed the same things regarding life time dependence and the continuous cycle. Others here think we are nuts!


October 21st, 2010
6:20 pm

I agree with Photius today- there are a few too many of you high and mighty folks on this blog! Some of you seem to enjoy looking down your nose at the less fortunate.
About the flu shots…please get yours because it is people like you who are out spreading disease everywhere because of your paranoia. No folks- it is not a conspiracy. Be a good parent and get your kids immunized too.


October 21st, 2010
6:56 pm

I have to disagree with Michelle-I might not have gotten the flu from the flu shot, but I was definitely the sickest I have been in years after receiving it. Maybe it was a coincidence. I don’t know, but I’ll just take my chances. Since I teach school, I am exposed to just about every germ and get a little cold about every year but nothing big. Then last year I decided to get a flu shot because everybody said I should. I was so sick-and it lingered for several weeks. I’ll never do that again.


October 21st, 2010
8:04 pm

Thanks for this great discussion!

Do you know someone whose child was denied health insurance coverage due to a pre-existing condition or had a pre-existing condition excluded from coverage? Give them the link to this survey being conducted by The Georgetown University Center for Children and Families. Their answers will help lawmakers figure out how to improve access to healthcare for kids.


October 21st, 2010
11:38 pm

i got the flu several years ago and thought i was going to die…seriously…i was sick for 3 months!,so now i always get a flu shot and so does my youngest daughter. i have paid as much as $50 for each of us for the shot…and that was close to a months worth of groceries when i was laid off. this year her insurance covered ours….thank goodness! i work in a place where every mother who has to pick their sick kids up from school go immediately. kids snotting and coghing and sneezing..adults too. i wash my hands all the time..use sanitizer etc…i still have been sick more often at this job than ever before in my life. i will get any vaccine offered for anything!!