Sponsors (14)
The bill boosts provider reimbursement and clarifies vaccine eligibility for Medicaid and CHIP children to improve access in the short term, at the cost of higher Medicaid spending, some administrative constraints on states, and uncertainty once the temporary payment guarantees expire.
Medicaid- and CHIP-enrolled children will have vaccine administration and counseling paid at no less than 100% of Medicare Part B rates through 12/31/2028, improving provider reimbursement and likely increasing access and provider participation for low-income children.
CHIP-enrolled children are explicitly designated as 'federally vaccine-eligible,' ensuring Vaccines for Children (VFC)-related protections and coverage parity between Medicaid and CHIP programs.
States that include the required vaccine outreach messaging can receive a small (1 percentage point) FMAP increase starting Q1 2027, providing modest additional federal funding to support vaccine outreach and delivery.
Reimbursing vaccine administration and counseling at Medicare Part B rates through 2028 raises federal and state Medicaid spending, potentially increasing budgetary pressure or crowding out other services.
The payment guarantee is time-limited (through 12/31/2028), creating uncertainty for states and providers about reimbursement levels after expiration and complicating long‑term planning for vaccine delivery programs.
States must include specified vaccine outreach messaging to qualify for the FMAP bump, which may constrain state messaging flexibility and impose administrative implementation costs.
Based on analysis of 2 sections of legislative text.
Adds CHIP children to federally vaccine-eligible definition and requires Medicaid/CHIP to pay vaccine administration and counseling at no less than 100% of Medicare Part B through 12/31/2028.
Official title: To amend title XIX of the Social Security Act to ensure access to immunizations under the Medicaid program and the Vaccines for Children program, and for other purposes.
Introduced April 21, 2026 by Kim Schrier · Last progress April 21, 2026
Expands which children are treated as federally vaccine-eligible and requires Medicaid and CHIP to pay for pediatric vaccine administration and counseling at no less than 100% of the Medicare Part B rate through December 31, 2028. Also aligns Medicaid managed care payment rules and clarifies allowable provider fees under the Vaccines for Children program to ensure coverage and payment parity for pediatric vaccine services. The changes extend certain VFC/CHIP coverage, add CHIP-enrolled children to the federally vaccine-eligible definition, and update statutory cross-references so Medicaid fee-for-service and managed-care plans must apply the new payment floor for vaccine administration and counseling during the covered period.