The Epidemiology of U.S. Immunization Law:
The Model State Immunization Coverage Statute Program
Introduction and Background
The model state immunization coverage statute program is an outgrowth of our research into U.S. immunization law, entitled The Epidemiology of U.S. Immunization Law: Mandated Coverage of Immunizations Under State Health Insurance Laws. The review focused on state health insurance law mandates and found that 33 jurisdictions have immunization mandates but that the scope and structure of those mandates vary widely. The taxonomy created to describe these statutes consists of several basic elements, summarized below:
- Any mandate:Whether a state mandates the addressing of immunizations in insurance design, and if so, whether the mandate is for coverage or an offer of coverage. The study found that 33 jurisdictions had insurance laws that provided for some form of mandate (32 with mandated coverage and 1 with a mandated offer statute only).
- Age groups subject to mandate: A mandate can cover some or all ages of persons covered by an insurance policy. No state mandate covers all ages. Virtually all states confine their mandates to children.
- Scope of the mandate (coverage): Whether the mandate establishes the coverage requirements at evidence based standards (i.e., the ACIP approved immunization schedule). Six out of 33 mandate states require insurers to adhere to ACIP recommendations. The ACIP is the official advisory board whose charge is to provide the federal government with advice on immunization practice, and is widely accepted as the premier standard-setting organization for immunizations. The ACIP issues formal coverage recommendations as vaccine technology evolves, and vaccine-preventable threats arise, thus providing the most up-to-date information available on evidence-based practice.
- Scope of the mandate (access): Whether use of non-network providers is permitted. Because modern health insurance arrangements typically limit coverage either entirely or through the use of higher cost sharing to network providers, an element of mandate is whether state law addresses the use of out of network providers. None of the 33 mandates addressed coverage outside of any established provider network
- Cost sharing: Whether cost sharing (deductibles and coinsurance) is permitted. Thirteen out of the 33 state mandates prohibit insurers from levying copayments on immunization services. In addition, deductibles are prohibited in 21 out of 33 mandate jurisdictions.
Applying the criteria in their totality, the study found that no state met all elements of a comprehensive statute and that if age were confined to children, one state (HI) could be considered comprehensive with respect to its terms of coverage and its prohibition of cost sharing.
The table below summarizes the elements that each state statute addresses.
| State | Mandated Coverage | Covers all Ages | Covers all ACIP | Network/ Price |
No Copay | No Deductible |
|---|---|---|---|---|---|---|
| Gray Box = No Current Coverage | ||||||
| source: gwu/sphhs/chsrp Analysis of state immunization laws, Winter 2003 | ||||||
| Alabama | ||||||
| Alaska | ||||||
| Arizona | ||||||
| Arkansas | ||||||
| California | ||||||
| Colorado | ||||||
| Connecticut | ||||||
| Delaware | ||||||
| DC | ||||||
| Florida | ||||||
| Georgia | ||||||
| Hawaii | ||||||
| Idaho | ||||||
| Illinois | ||||||
| Indiana | ||||||
| Iowa | ||||||
| Kansas | ||||||
| Kentucky | ||||||
| Louisiana | ||||||
| Maine | ||||||
| Maryland | ||||||
| Massachusetts | ||||||
| Michigan | ||||||
| Minnesota | ||||||
| Mississippi | ||||||
| Missouri | ||||||
| Montana | ||||||
| Nebraska | ||||||
| Nevada | ||||||
| N. Hampshire | ||||||
| N. Jersey | ||||||
| N. Mexico | ||||||
| N. York | ||||||
| N. Carolina | ||||||
| N. Dakota | ||||||
| Ohio | ||||||
| Oklahoma | ||||||
| Oregon | ||||||
| Pennsylvania | ||||||
| Rhode Island | ||||||
| S. Carolina | ||||||
| S. Dakota | ||||||
| Tennessee | ||||||
| Texas | ||||||
| Utah | ||||||
| Vermont | ||||||
| Virginia | ||||||
| Washington | ||||||
| W. Virginia | ||||||
| Wisconsin | ||||||
| Wyoming | ||||||
| Total: 51 | 33 | 0 | 6 | 0 | 13 | 21 |
The Model Statute
Based on our analysis, we developed a model statute that addresses all elements of the study. In addition, for each state, we completed "customized drafting," i.e., developed suggested revisions for the state statute to bring the law into conformity with tests of comprehensiveness.
In addition to the model statute, we have provided a set of 7 illustrative tables for each of the 33 states with any statute. The first table of the series summarizes each state’s actual language compared to the model language for each element. The remaining tables, which conform to each of the model elements, analyzes each state element against the model and presents proposed language both from the model and from other state statutes.
Map of State Statutes and Recommended Language
Do you want to know how your state statute compares to the model statute? Click here to continue to the Map page.
