Promoting COVID-19 Booster Vaccinations Among Dually Eligible Individuals

COVID-19 has disproportionately impacted individuals dually eligible for Medicare and Medicaid.[1] Further, this population may experience additional challenges accessing or completing their primary COVID-19 vaccine series (e.g., both doses of a two-dose vaccine or one dose of a single dose vaccine), and these challenges may persist related to booster vaccination. Protection against COVID-19  for vaccinated individuals may decrease over time, and the Delta variant is more  infectious, even for vaccinated individuals.[2] COVID-19 booster vaccinations provide further protection for fully vaccinated individuals and those closest to them .[3],[4],[5] To facilitate access to booster doses, the Center for Medicare & Medicaid Services (CMS) will cover booster doses to Medicare beneficiaries without cost sharing.[6]

Health plans are encouraged to continue outreach to members to coordinate their primary vaccination(s) against COVID-19 and follow up with fully vaccinated members to facilitate booster vaccinations after completion of their primary series. Coordinating primary or booster COVID-19 and influenza (“flu”) vaccinations is an opportunity for plans to support the overall health of their members by offering protection against infectious diseases.[7] More information about flu vaccines for the dually eligible population is available from a recent RIC webinar.

How can health plans promote booster vaccinations for dually eligible members?[8]

  • Provide up-to-date information to members that answers common questions through your health plan’s typical communications channels. Information on booster vaccinations is developing rapidly and members may have questions. One health plan uses a “Q&A” section on their website to answer member questions about boosters and COVID-19 more generally.[9]
  • Identify members eligible for boosters by using vaccination data. The available vaccines have different waiting periods between the primary series and the booster dose. Many health plans track members' vaccination status to ensure eligible members completed a two-dose series (if applicable). This information may also be available through a state vaccination registry or Immunization Information System (IIS).[10]
  • Contact members eligible for booster vaccinations. As noted in an earlier blog post, health plans have used phone calls and campaigns, text messages, Interactive Voice Response (IVR), or emails to communicate with members about completing their primary series. These methods can be employed to promote booster vaccinations as well.
  • Provide information to members who may be hesitant or express concerns about receiving the vaccine. Members may have concerns about side effects of booster vaccinations, similar to concerns expressed about the primary series, and health plans should provide information to members to address their concerns. One health plan noted in a July 2021 New England Journal of Medicine article that vaccine hesitant members’ primary reason for remaining unvaccinated was “lack of confidence” in the safety of the COVID-19 vaccine. As a result, the health plan uses a proactive multimedia outreach approach that provides information to members about the safety of vaccinations and connects members to a clinician to discuss vaccine safety. They tailor messaging to members based on various characteristics and historical vaccination experiences with them, and work with a diverse group of internal and external communication partners on messaging to better resonate with members.[11]
  • Partner with known and trusted community entities. Federally Qualified Health Centers (FQHCs), Rural Health Clinics, local pharmacies, and the community-based workforce can serve as “trusted sources of information” or “messengers” for underserved populations. These partners can also facilitate primary or booster vaccination by addressing structural or attitudinal barriers, such as limited access to vaccination sites or lack of trust in vaccines, respectively.[12] Equitable COVID-19 vaccination is imperative, and the Centers for Disease Control and Prevention (CDC) provides a number of resources for health plans to leverage in addressing barriers by connecting with community partners.[13] In particular, the CDC developed a guide for community partners aimed to increase vaccination among racial or ethnic minorities. Additionally, many resources are available to support outreach and vaccination efforts including the CDC COVID-19 Toolkits.[14]
  • Eliminate barriers for members to access booster vaccinations due to transportation needs. As noted in an earlier blog post, plans may leverage transportation benefits to provide rides to vaccinations clinics to all members, regardless of previously identified transportation needs. Plans may also collaborate with organizations that provide transportation services to people who have difficulty leaving their homes or provide in-home vaccinations for these members.
  • Support member booster vaccinations by helping members navigate the process of registering for a booster vaccination appointment, especially those members who may experience challenges using technology.

[1] Centers for Medicare & Medicaid Services. (2021). Preliminary Medicare COVID-19 Data Snapshot. Retrieved from https://www.cms.gov/files/document/medicare-covid-19-data-snapshot-fact-sheet.pdf.

[2] Oliver, S. (2021). Evidence to Recommendation Framework: Pfizer-BioNTech COVID019 Booster Dose. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-9-23/03-COVID-Oliver.pdf.

[3] Centers for Disease Control and Prevention. (2021). COVID-19 Vaccines Work. Retrieved from  https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/work.html.

[4] Centers for Disease Control and Prevention. (2021). Benefits of Getting a COVID-19 Vaccine. Retrieved from  https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-benefits.html.

[5] Centers for Disease Control and Prevention. (2021). The Possibility of COVID-19 after Vaccination: Breakthrough Infections. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html.

[6] Centers for Medicare & Medicaid Services. (2021). CMS Will Pay for COVID-19 Booster Shots, Eligible Consumers Can Receive at No Cost. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-will-pay-covid-19-booster-shots-eligible-consumers-can-receive-no-cost.

[7] Centers for Disease Control and Prevention. (n.d.). Frequently Asked Influenza (Flu) Questions: 2021-2022 Season. Retrieved from https://www.cdc.gov/flu/season/faq-flu-season-2021-2022.htm#coadmin.

[8] This information is current as of the date of posting (11/11/2021). Up-to-date information on COVID-19 booster vaccinations is available from the Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html.

[9] SCAN Health Plan. (2021). Coronavirus Benefit Information. Retrieved from https://www.scanhealthplan.com/members/coronavirus-information?scan_state=CA.

[10] Centers for Disease Control and Prevention. (2016). Keeping Your Vaccine Records Up to Date. Retrieved from https://www.cdc.gov/vaccines/adults/vaccination-records.html.

[11] Overhage, J.M. & Agrawal, S. (2021). COVID-19 Vaccination Perceptions Among Socially Vulnerable Medicare and Medicaid Members: Experience from a National Health Plan Outreach Program. NEJM Catalyst. https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0162.

[12] Gonzales, A., Lee, E.C., Grigorescu, V., Smith, S.R., De Lew, N., & Sommers, B.D. (2021). Overview of Barriers and Facilitators in COVID-19 Vaccine Outreach. Office of Health Policy, Assistant Secretary for Planning and Evaluation. Retrieved from https://aspe.hhs.gov/sites/default/files/2021-08/Vaccine%20Outreach%20Research%20Report%208-27-2021%20FINAL.pdf.

[13] Centers for Disease Control and Prevention. (2021). COVID-19 Vaccine Equity for Racial and Ethnic Minority Groups. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/vaccine-equity.html.

[14] Gonzales, A., Lee, E.C., Grigorescu, V., Smith, S.R., De Lew, N., & Sommers, B.D. (2021).