Health Department budget uncertain as agency adjusts to federal vaccine cuts

Tuesday, August 7, 2012

McCOOK, Nebraska -- Writing the Red Willow County health department's 2012-13 budget will be "a shot in the dark" -- commissioner Earl McNutt's words -- until commissioners and the health department director have a year or two under their belts after changes in national laws regarding immunizations for children whose parents' insurance covers vaccinations.

Starting Oct. 1, 2012, a new national policy goes into effect stating that public vaccine clinics can no longer supply government-purchased vaccines to children whose insurance covers vaccinations.

According to the Nebraska "Vaccines for Children" program (VFC), if a child is enrolled in Medicaid, is uninsured or if the insurance does not cover vaccines (underinsured), he/she will continue to qualify for government-purchased VFC vaccines.


If a public vaccine clinic elects to continue to provide vaccines to fully-insured children, which it can do, it must purchase the vaccines through private vendors.

Darcey Hansen, the director of Red Willow County's health department, told commissioners Monday morning that if Red Willow County opts to continue to vaccinate fully-insured children, her office will bill the parents' insurance and then collect from the parents what is not covered by insurance.

Hansen emphasized that her department's immunization program should pay for itself.

Hansen said that her department has done some private stock immunizations (for Flumist and Gardasil that were not allowed to be given to children who had insurance, as per VFC regulation in 2011-12) for the past year, and has found that insurance companies pay for the immunizations. "It's not out of the realm of possibilities," she said.

Hansen is afraid that if her clinic does not continue to offer immunizations as it has in the past, "immunization rates will go down." She said her office is within just a point or two of achieving its goal of 90 percent full-immunization of children 0-2 years old. "It's all about immunization rates," Hansen said. "It's not to make a profit. It's to break even, to get children immunized and to increase vaccination rates."

"There's no reason why it won't pay for itself," commissioner Vesta Dack said. "We have to do it," fellow commissioner Steve Downer said.


The cost of vaccines to the county will increase as it buys private stock vaccines, but that is the only significant increase in the budget that Hansen is writing for 2012-2013, Dan Miller, the county's new budget assistant, told commissioners. Hansen's budget is preliminary as the commissioners work to write the county's 2012-2013 budget.

Vaccines vary in price from $12.50 per pose to $130 per dose. Hansen estimates that, in 2012-2013, her office will administer 1,610 doses at a total cost of $90,545. She is preliminarily budgeting $100,000.

Using 2011-2012 immunization records, Hansen told commissioners that 423 children (ages 0 through 18 years old) were enrolled in Medicaid, were uninsured or their insurance did not cover vaccines. A total of 319 children would have needed private stock vaccines because their insurance covers vaccinations.


Commissioners agreed Monday that the county's immunization program should continue as it has, but are puzzled by how to determine a number for the revenue side of the budget when they have little idea how many children with insurance will be immunized, how well and how much insurance companies will reimburse the county and how well parents will pay the outstanding balance (if any).

"It's just a shot-in-the-dark (as to how to figure a revenue number) without a couple year's experience," McNutt said.

Hansen and Miller will work together on the health department's budget to determine its revenue.


Hansen said that Red Willow County's health department started its immunization program with a flu outbreak in 1975.


Hansen said parents will now be asked to verify whether their insurance covers vaccinations. She said that some insurance companies cover 100 percent of vaccines, while others require a co-pay.

Health department personnel will need to know this information prior to a visit so that they can ensure adequate supplies of private stock vaccines. Personnel will also ask for a copy of insurance and/or Medicaid cards at each visit.

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