Conducting Eligibility Screening
Eligibility screening requirements apply to all VFC providers, including hospitals, pharmacies, and large healthcare systems.
Screening Process
Providers agree to screen patients for VFC eligibility to ensure all eligible children have access to no-cost vaccines. If this step is skipped, parents or guardians could be billed for vaccines and higher administration fees or denied vaccinations if they can’t afford to pay.
1. Screen for VFC Eligibility at Every Patient Visit
Changes might impact eligibility. If this step is skipped, parents or guardians could be billed for vaccines and administration fees or denied vaccinations if they can’t afford to pay. To assist, see Patient Eligibility Screening Record (PDF) and Screening Record in Spanish (PDF).
2. Determine Which Eligibility Criterion Is Met
Children from birth through 18 years must meet at least one of these criteria. If multiple criteria apply, select criterion that requires the least out-of-pocket expense. Verification of parent/guardian/recipient response is not required.
- Medicaid-eligible (or enrolled): Has Medi-Cal as primary or secondary coverage
- American Indian (AI) or Alaska Native (AN): As defined by the Indian Health Care Improvement Act
- Uninsured: A child who has no health insurance coverage
- Underinsured: Health insurance doesn’t cover vaccines; doesn’t cover all ACIP-recommended vaccines; covers vaccines but with a fixed dollar limit (or cap); or does not provide first-dollar coverage for vaccines including copays, coinsurance, or deductibles*; underinsured patients are only eligible to receive VFC vaccines at FQHC or RHC facilities.
* Applies even when primary insurer would deny reimbursement for cost of vaccine and administration because family has not met plan’s deductible.
3. Document VFC Eligibility
Document eligibility in child’s permanent medical record, including
- Date of screening,
- Whether patient is VFC-eligible (Y/N), and
- VFC eligibility criterion (or criteria) that is met (if any).
Reminder: By California law, providers must report doses administered (including eligibility and funding source) to a regional immunization registry (CAIR or CAIR/Healthy Futures) for both private and publicly supplied vaccines. Save all program-related documentation for three years.
