These requirements apply to all VFC providers including hospitals, pharmacies and large healthcare systems.
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.
Determine Which VFC Eligibility Criterion Is Met
Children must be from birth through 18 years and meet one of these criteria. If multiple 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: 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.
Document VFC Eligibility
Document eligibility in child’s permanent medical record. Documentation must include these elements:
- Date of screening
- Whether patient is VFC-eligible (Y/N)
- VFC eligibility criterion (or critera) that is met (if any)
Ensure Vaccinators Only Use VFC Vaccines for VFC Patients
Update practice protocols so vaccinators know when to pull from VFC or private stock. Organize storage units (PDF) to prevent administration errors.
Reminder: By California law, providers must report doses administered (including eligibility and funding source) to a local immunization registry (CAIR or CAIR/Healthy Futures) within 72 hours—for both private and publicly supplied vaccines. Save all program-related documentation for three years.