Vaccines Covered by Medicaid: Adults, Children, and CHIP

Medicaid covers the vaccines the Advisory Committee on Immunization Practices (ACIP) recommends for your age and health situation, and for most enrollees there is no copay or other cost. That includes the full childhood schedule, adolescent shots like HPV and meningococcal, and the adult lineup from the annual flu shot to shingles, RSV, COVID-19, Tdap, pneumococcal, hepatitis A and B, and more. A short list of narrow eligibility categories sits outside this guarantee, which is worth knowing before a visit.

How Medicaid Decides Which Vaccines Are Covered

Medicaid does not maintain its own vaccine list. Coverage tracks whatever ACIP, the panel that advises the CDC, recommends. When ACIP adds a vaccine or changes a recommendation, state Medicaid programs are required to cover it.¹

That means you don’t have to memorize a fixed schedule. If your doctor or pharmacist says a vaccine is recommended for someone in your situation, Medicaid almost certainly pays for it. The obligation covers every category of ACIP recommendation, not only the routine immunization schedules.²

Vaccines Covered for Adults

Since October 1, 2023, the Inflation Reduction Act has required every state Medicaid program to cover all FDA-approved vaccines that ACIP recommends for adults 19 and older, including the cost of administering them, with no copays or other cost-sharing.³ The underlying statute treats this as a mandatory benefit.⁴

The adult immunization schedule includes more than two dozen vaccines. The ones most adults will encounter:

Annual flu shot, including high-dose formulations for older adults.
COVID-19 vaccines from multiple manufacturers.
Tdap and Td boosters for tetanus, diphtheria, and pertussis.
Shingles (Shingrix) for adults 50 and older.
Pneumococcal vaccines for adults 65 and older, and for younger adults with certain health conditions.
HPV (Gardasil 9) through age 26, with shared clinical decision-making for ages 27 to 45.
Hepatitis A and B for adults who haven’t been vaccinated.
MMR and chickenpox for adults who lack evidence of immunity.
RSV vaccine for all adults 75 and older, and for adults 50 to 74 with conditions that raise their risk of severe RSV illness, such as chronic lung disease, heart disease, diabetes with complications, or severe obesity.⁵
Meningococcal vaccines for adults with certain risk factors or who were not vaccinated as adolescents.
Mpox (Jynneos) for adults at risk of monkeypox exposure.

All of these appear on the 2025 ACIP adult immunization schedule, and states must cover them.⁶ When ACIP updates its recommendations, states must implement coverage for the changes.²

Vaccines During Pregnancy

Pregnant enrollees are covered for all ACIP-recommended vaccines on the same terms as other adults. The ones most often recommended during pregnancy are the Tdap booster (typically in the third trimester, to pass protective antibodies to the newborn), the flu shot, the COVID-19 vaccine, and the RSV vaccine Abrysvo, given between weeks 32 and 36 during RSV season to protect the infant after birth. Federal law also specifically exempts pregnancy-related services from Medicaid cost-sharing, which adds a second layer of protection against out-of-pocket charges.²

Vaccines Covered for Children Under 21

Children on Medicaid have the broadest vaccine coverage of any group. Under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, every Medicaid-eligible child under 21 must receive all age-appropriate immunizations recommended by ACIP.⁷ That covers the full childhood schedule: MMR; DTaP; polio; hepatitis A and B; chickenpox; rotavirus; pneumococcal; and, as children grow, adolescent shots like HPV and meningococcal. There is no cost-sharing.

EPSDT also reaches vaccines that fall outside the routine schedule when a provider determines the immunization is medically necessary for that child.²

The Vaccines for Children Program

The Vaccines for Children (VFC) program supplies the actual vaccine product at no charge to children 18 and younger who are Medicaid-eligible, uninsured, underinsured, or American Indian or Alaska Native.⁸ It covers every vaccine on the ACIP pediatric schedule, and kids who are behind can catch up through VFC.⁹ For Medicaid-enrolled kids, the state Medicaid program pays the administration fee, and a provider cannot turn away a VFC-eligible child because a parent can’t pay that fee.

Children in Separate CHIP Programs

Kids in a separate Children’s Health Insurance Program (CHIP) are not VFC-eligible because they’re treated as fully insured, and the state CHIP program pays for their vaccines instead.¹⁰ CHIP still has to cover ACIP-recommended vaccines and their administration without cost-sharing.² For a parent, the practical result is the same: the shots are covered.

Travel and Non-Routine Vaccines

A common assumption is that Medicaid only pays for routine immunizations. The federal mandate is broader than that. CMS has stated that the coverage requirement extends to every category of ACIP recommendation, including vaccines advised because of travel, occupational exposure, or medical conditions, and is not limited to the routine schedules.²

Hepatitis A vaccination for travel to countries with high rates of the disease is a good example: it carries an ACIP recommendation, so Medicaid must cover it for eligible adults without cost-sharing. Vaccines that lack ACIP endorsement, such as Japanese encephalitis where ACIP guidance is limited, may require a medical necessity determination, particularly for children covered under EPSDT. State Medicaid agencies must cover ACIP-recommended vaccinations even when they are not on the standard adult immunization schedule.¹

Who Might Not Have Full Vaccine Coverage

A few groups of Medicaid enrollees fall outside the IRA’s mandatory adult vaccine coverage:

People in limited-benefit eligibility categories, such as those enrolled only for family planning services or emergency medical care, generally do not receive vaccine coverage through that enrollment.
Some adults in alternative benefit plans through Medicaid expansion still receive coverage for routine ACIP-recommended vaccines, but the exact scope of the IRA-required coverage can depend on how the state structured its plan.

Most full-benefit enrollees, in both traditional Medicaid and the expansion population, are covered. If you have full Medicaid benefits and a provider says a recommended vaccine isn’t covered, that’s worth questioning.¹¹

Where to Get Vaccinated

Covered vaccines are available at primary care offices, local health departments, community health centers including federally qualified health centers, urgent care, hospitals, and many pharmacies. Pharmacies have become a common access point, especially for flu and COVID-19 shots.¹¹

A few things to do before the visit:

Call ahead to confirm the pharmacy or clinic accepts Medicaid for vaccine services. Not every location does.
Bring your Medicaid card and ID so the provider can bill correctly.
Bring any immunization records you have. If you don’t have them, your state’s immunization registry may.
Ask about cost before the shot. Full-benefit enrollees should owe nothing for an ACIP-recommended vaccine. If someone quotes a copay, ask them to verify it with your plan.

If a Vaccine Claim Is Denied

Denials happen, often from billing errors or confusion about eligibility category, and you can challenge them. In a Medicaid managed care plan, file an internal appeal with the plan within 60 days of the denial notice, in writing or by phone. The plan must decide within 30 days, or within 72 hours if the case is urgent. If the plan upholds the denial, you can request a state fair hearing, generally within at least 90 days of the plan’s decision, and a final decision must come within 90 days from when you first appealed to the plan.¹²

If you’re in fee-for-service Medicaid rather than managed care, you skip the plan-level appeal and go directly to the state fair hearing after the denial notice. Your state Medicaid agency can walk you through the steps; the contact information is on your Medicaid card or the state agency’s website. Because the federal coverage mandate is clear, vaccine denials that reach the appeal stage are usually resolved in the beneficiary’s favor.

1
Medicaid.gov. Quality of Care Vaccines
2
Medicaid.gov. SHO 23-003 Mandatory Medicaid and CHIP Coverage of Adult Vaccinations Under the Inflation Reduction Act
3
Medicaid.gov. Fact Sheet – Inflation Reduction Act Changes to Medicaid and CHIP Adult Vaccine Coverage
4
Office of the Law Revision Counsel. 42 USC 1396d – Definitions
5
Centers for Disease Control and Prevention. RSV Vaccine Guidance for Adults
6
Centers for Disease Control and Prevention. Recommended Adult Immunization Schedule 2025
7
Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment
8
Office of the Law Revision Counsel. 42 USC 1396s – Program for Distribution of Pediatric Vaccines
9
Centers for Disease Control and Prevention. Vaccines for Children Program Information for Parents
10
CDC. Vaccines for Children Program Operations Guide
11
Medicaid.gov. Coverage and Payment of Vaccines and Vaccine Administration Under Medicaid, CHIP, and Basic Health Program
12
eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries