entitlement program to be a required part of each state’s Medicaid plan. The program began in October 1994. The Office of Management and Budget approves funding for the VFC program. Funding is through the Centers for Medicare and Medicaid Services to CDC, and awards are made to eligible grantees. The VFC program provides a vaccination entitlement for Medicaid-eligible, uninsured, American Indian and Alaska Native, and underinsured children who receive vaccines at federally qualified health centers (FQHCs). The VFC program negotiates vaccine prices at the federal level and allocates credits to states to distribute vaccines free of charge. The program does not cover any of the practice-based costs associated with the administration of the vaccines. Payment for vaccine administration is generally sought from specific insurance programs, such as Medicaid, or from parents of VFC-eligible, non-Medicaid children (CDC, 2003).

Section 317 Immunization Grant program. The Section 317 Immunization Grant Program is a federal discretionary grants program for states and other US jurisdictions (CDC, 2009d). It was established by the 1962 Vaccination Assistance Act and was the primary source of federal funds for vaccine purchase until it was supplanted by the VFC program in 1993. Unlike the VFC program, Section 317 provides federal funds for both vaccine purchase and vaccine-related infrastructure, such as population needs assessments, surveillance, compliance monitoring, training, and school-based delivery systems. The program targets immunization coverage for underinsured children and youths not eligible for the VFC program and to a small degree uninsured and underinsured adults. In 2007, CDC created the Adult Hepatitis B Vaccine Initiative by using savings from Section 317 funds to provide free vaccine for high-risk adults in various community settings. Funding for vaccine costs totaled $36 million in the first 2 years; this resulted in the delivery of over 581,000 doses, 343,000 of which reportedly were administered. The initiative involves 56 grantees that enroll 2,437 sites, of which 38% are local health departments, 20% STD clinics, 13% primary-care loci, 11% jails or prisons, and 18% other sites, including substance-abuse and HIV centers (personal communication, J. Ward, CDC, July 30, 2009). However, Section 317 funding for adult vaccination initiatives does not support the infrastructure and medical-supply costs to deliver vaccines to people at highest risk.

Children’s Health Insurance Program. The federal CHIP was established in 1997 under Title IX of the Social Security Act and was expanded in the Children’s Health Insurance Program Reauthorization Act of 2009 (CMS, 2009). It is a federal block-grant program that requires state matching funds to expand health-care coverage to children under 18 years old and pregnant women who do not meet income eligibility requirements for

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