It has long been accepted practice that achieving high childhood vaccination rates is important to protect all children from serious illnesses, like polio and measles, and to protect immunocompromised people and newborns who cannot be vaccinated. However, starting last spring, the federal government has reversed course on longstanding vaccine guidance. First, the Secretary of the U.S. Department of Health and Human Services, Robert F. Kennedy Jr., bypassing the regular process, unilaterally announced that the COVID-19 vaccine would no longer be recommended for children. The Centers for Disease Control and Prevention (CDC) did not follow suit but did change its COVID-19 vaccine guidance for children from a universal recommendation to shared clinical decision-making. Next, in the fall of 2025, the Advisory Committee on Immunization Practices (ACIP) — a federal committee within the Centers for Disease Control and Prevention that provides advice on vaccines — reversed its longstanding recommendation for all newborns to receive the hepatitis B vaccine. This decision came after Secretary Kennedy removed all of the ACIP members and named replacements. Most recently, the CDC substantially revised the entire children’s vaccination schedule, rolling back numerous recommendations while bypassing the standard review process.
These changes threaten vaccine access, particularly for low-income children who receive vaccines through Medicaid and the Vaccines for Children (VFC) program. Access to vaccines through these programs is tied to ACIP’s recommendations (which are subsequently adopted by the CDC). Low-income children already have lower vaccination rates compared to higher-income children, a stark disparity highlighted in the Commonwealth Fund’s 2025 Scorecard on State Health System Performance. In this blog post, we outline how children receive vaccines through Medicaid and VFC, the impact of changes in federal vaccine recommendations, and the implications of disruptions in vaccine access.
Health Insurance Coverage of Vaccines for Low-Income Children
Medicaid covers all ACIP-recommended childhood vaccines, reaching nearly half of all children in the United States. Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit covers comprehensive health care services for children and adolescents up to age 21. Importantly, EPSDT ensures Medicaid coverage for all ACIP-recommended childhood vaccines without cost sharing. Other vaccines are covered under EPSDT only when they are necessary to correct or ameliorate a child’s health condition.
VFC automatically covers all ACIP-recommended childhood vaccines. The Vaccines for Children program was created in 1993 to address the measles epidemic and ensure cost was not a barrier to children receiving vaccinations. Over half of U.S. children are eligible for VFC, including those who are under age 18 and receiving Medicaid, uninsured, or American Indian and Alaska Native. Most children enrolled in Medicaid receive vaccines that their health care providers order through VFC, with Medicaid covering the vaccine administration fee. Over time, VFC has reduced disparities in vaccination rates for low-income children.
What’s Currently at Risk
Any changes in ACIP/CDC recommendations immediately affect whether Medicaid must cover and if VFC can supply a particular vaccine,with the potential to restrict access for millions of low-income children. The decisions to remove the universal newborn hepatitis B and COVID vaccine recommendations from the children’s schedule mean that Medicaid and VFC coverage is no longer automatic. Instead, the ACIP/CDC recommendation, and in turn Medicaid and VFC coverage, turns on “shared clinical decision-making,” meaning that parents must consult with providers about the benefit of that vaccine based on each child’s individual circumstances. This increases the likelihood of variability in recommendations from provider to provider and can create delays if providers or families are uncertain about how to proceed. When ACIP fails to universally recommend a vaccine, availability of that vaccine through VFC could be eliminated. Moreover, Medicaid coverage of such vaccines could become administratively more difficult because shared clinical decision-making requires additional documentation from providers. Those changes can create real-time uncertainty for families, providers, and health departments about what is available, when, and for whom.
Changes in ACIP/CDC recommendations that disrupt access to childhood vaccines will disproportionately harm the health of low-income children and children of color. Children enrolled in Medicaid are primarily low-income, disproportionately children of color, and more likely to have special health care needs and face increased risk of poor health outcomes. Low-income women and children face the greatest health risks as a result of eliminating the universal hepatitis B birth dose recommendation. Similarly, low-income people and people of color disproportionately experience adverse health outcomes from COVID, including increased rates of hospitalization and mortality.
Conclusion
Over the past nine months, ACIP has changed from a well-respected expert body guided by reputable evidence to one that has been riddled with controversy. The recent rollbacks in ACIP/CDC recommendations create uncertainty for families and providers and can result in delayed or restricted access to lifesaving vaccines. This increases the risk of lower vaccination rates and wider income, racial, and health disparities. In the short term, providers need clear guidance about how to use shared decision-making to document medical necessity and reduce coverage uncertainty. Over the longer term, it will be important to monitor and document the impact of these recent actions on children’s health and to assess the evidence base for potential future policy changes.
