If you’re headed to the county health department for a vaccine, there’s one thing you’ll need to bring if you have it: your insurance card.
For uninsured Oklahomans, county health departments will continue to serve as a place where low-income children and adults can receive vaccines for free or at reduced cost.
But for insured Oklahomans, the game has changed.
In the past, even those with insurance, often could get free or low-cost vaccines from county health departments.
But federal and state budget cuts, along with changes under the Affordable Care Act, have left the state Health Department reassessing what services it can provide and how they will be paid for.
Starting last summer, county health departments across Oklahoma started billing those with insurance for vaccines that physicians often don’t stock in their offices because of their high cost. The change came in response to high demand for some of the most expensive vaccines, especially in rural Oklahoma.
“That is a big shift from public health because it’s always been ‘Please come to the county health department — you will be served,’ but we’re not there any more,” said Lori Linstead, director of the Immunization Service at the Health Department.
Instead, people with insurance will be served by county health departments similar to how they’re served at their physician’s offices. Instead of receiving a free or low-cost vaccine, their insurance will be billed, Linstead said.
Since last July, the state Health Department has filed 30,000 insurance claims for vaccincations with about 200 insurance companies for almost $2 million worth of care delivered by county health departments across Oklahoma. So far, the agency has been reimbursed only $270,000. Several claims are pending, so the agency anticipates more money coming in.
Angry parents
Today, most health departments can’t afford to keep the more costly childhood vaccines on hand. This does not include Tulsa City-County Health Department and Oklahoma City-County Health Department, which operate independently of the state Health Department.
Linstead refers to these vaccines as “The Big Four” — Prevnar, a vaccine that helps prevent pneumonia; the Human papillomavirus, or HPV, vaccine, which helps prevent the most common sexually transmitted infection; the rotavirus vaccine, which prevents a common illness in children that causes diarrhea; and the meningococcal vaccine, that prevents a disease that can result in meningitis, or inflammation in the brain.
These vaccines often cost more than $100 each and require multiple doses.
Because of that, the Health Department cannot afford to stock these vaccines for residents with private insurance. Instead, most county health departments tend to carry these vaccines only for children without insurance through a federal program called Vaccines for Children. The program provides immunizations for American Indian children and those who are on Medicaid, uninsured or underinsured. An underinsured child includes a child who has health insurance that doesn’t cover vaccines.
But the two-tier system creates problems in rural Oklahoma. A doctor who may not carry the more expensive vaccines might refer a patient to a county health department only to find the health department may have vaccines for those without insurance, but not those with insurance.
The state Health Department tried unsuccessfully to address the issue by requesting $2.7 million this year from the Legislature to start a vaccine stock for insured residents.
Susan Mendus, education director for the immunizations unit at the Health Department, said county public health workers regularly deal with understandably angry parents.
“So then the parents get mad and say ‘I can pay for it,’ and we have to say ‘I’m sorry — we still don’t have it,’ so then the parents get even more mad and say ‘You’re giving it to these (Vaccines for Children) kids,’ ” Mendus said.
Toni Frioux, deputy commissioner for prevention and preparedness at the state Health Department, said that years ago, public health nurses and physicians would go to schools across Oklahoma, providing vaccines without asking whether a child was insured.
But the state Health Department no longer has money available to do that on a wide scale, Frioux said.
This means that when they hold those types of vaccination events, public health nurses must find out whether the children are covered under the state’s Medicaid program, SoonerCare, have private insurance, or lack coverage.
“When we go out and do clinics, it starts becoming much more complex and complicated in trying to determine which children qualify for Vaccines for Children, which children are insured, and — have their parents given us a copy of their insurance card?” Frioux said. “It’s just not as easy as going out and immunizing.”
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