From Alabama to Utah, efforts to vaccinate Medicaid enrollees against covid run into obstacles

Medicaid enrollees continue to get vaccinated against covid at far lower rates than the general population despite vigorous outreach efforts by government officials and private organizations to get low-income people inoculated, according to data from several states.

That leaves many Medicaid enrollees — who tend to be sicker than those with private insurance — at higher risk for severe illness, hospitalization, or death from the virus.

Nationally, more than 215 million Americans — including 75% of adults and 57% of children ages 12 to 17 — are fully vaccinated, according to the Centers for Disease Control and Prevention. Among children 5 to 11 years old, who have only been eligible for a shot since early November, about 25% have been fully vaccinated. A vaccine has not yet been authorized for children younger than 5.

There is no nationwide compilation of how many Medicaid enrollees have been vaccinated.

But in Utah — one of a handful of states that publish that data — fewer than half of adult Medicaid enrollees are fully vaccinated.

Disparities exist in every age and racial/ethnic group that the state publishes data on. For example, about 40% of Black Medicaid enrollees are vaccinated, compared with 56% of Black people overall. Among Hispanics, 38% of Medicaid enrollees are vaccinated, compared with 51% of the overall Hispanic population. (Hispanic people can be of any race or combination of races.) Among children 12 to 18, about 35% of Medicaid enrollees are vaccinated, compared with 57% overall.

Officials at Molina Healthcare, which is one of Utah's four Medicaid managed-care plans and has about 90,000 members, said overcoming resistance to the covid vaccine has been difficult. One of the biggest hurdles is getting in touch with members. Molina officials told a Utah Medicaid advisory board in January that they can't reach 40% of their members because they don't have correct addresses or phone numbers.

"It's worrying," said Brian Roach, division services manager at the Utah Department of Health, which oversees the federal-state health insurance program for low-income residents. "We still see little increases every month, but it is not enough to close the gap," he added. "There has been no silver bullet to solve this issue."

Roach said he is not surprised Medicaid health plans have difficulty reaching members. "The Medicaid population is pretty transient, and people change jobs and move," he said.

Under federal rules implemented for the covid public health emergency, states can't remove people from the Medicaid rolls if their income changes, so enrollees have generally not had to check in with the state to renew their eligibility. As a result, states might not have updated contact information.

Personal contact with someone trusted by the enrollee is crucial to persuading members to get vaccinated. Harley Jones, a senior manager at Project Hope, a global humanitarian relief group, said unvaccinated people often need to hear from someone they know, such as a clinic nurse, to persuade them to get the shots. Since last summer, the nonprofit has been using a federal grant to help free health clinics in Texas boost vaccination rates.

"It's been a year since the mass vaccination clinics, and this is a slow slog," he said. "What works is finding the trusted voice for people who is from their community, knows the culture, and that one-on-one can take hours or a month to pay off."

The federal government has authorized nearly $400 million for vaccination outreach efforts to underserved communities.

Utah's difficulty getting Medicaid enrollees vaccinated is mirrored in other states.

In Ohio, 54% of adult Medicaid enrollees are at least partly vaccinated, compared with 73% of adults in the general state population.

Washington state has vaccinated 43% of its Medicaid enrollees 5 and older, compared with 76% of all state residents in that age group.

In Virginia, 41% of Medicaid enrollees 5 and older are vaccinated, compared with 76% of state residents in that age group.

In California, about 54% of Medicaid members 5 and older are at least partly vaccinated, compared with 81% of state residents in that age group.

Dr. Christopher Chen, medical director for the Washington Medicaid program, said that since Medicaid enrollees are more likely to be in poorer health, they are more likely to benefit from the vaccine to prevent complications from covid. "It's definitely something to be concerned about," he said.

Washington, he noted, increased pay to doctors and pharmacists to vaccinate Medicaid enrollees and agreed to pay doctors to counsel patients about the vaccine. The state also gave its Medicaid health plans access to data showing which of their members had not been immunized so they could reach out to those people.

The University of Alabama received a $1 million federal grant last July to increase vaccination rates in an 18-county rural region in the southern part of the state where African Americans make up the majority of the population. Under the plan, community health workers canvass the region to inform residents about the benefit of the vaccine. The initiative also provides a $15 incentive payment for getting a shot.

Since last summer, many of the counties have seen vaccination rates double. But because the rates were so low to begin with, most of the area still has fewer than half of residents vaccinated.

Dr. Hee Yun Lee, who oversees the grant and is associate dean for research at the University of Alabama School of Social Work, said many people lack easy access to shots because they don't have cars and mistrust of vaccines runs strong.

Another obstacle has been skepticism from some pastors, who told congregations not to fear covid, Lee said. They also incorrectly told congregants that the disease can't afflict them while they attend church, she said. A gathering of more than 300 people in a church recently led to an outbreak.

"There are a lot of misconceptions about the virus here," she said.