Updated: 3:08 p.m.
Democratic Illinois Gov. JB Pritzker’s administration has reversed a controversial state policy that made it harder for low-income children to get vaccinated, WBEZ has learned.
The change is likely to affect some of the roughly 130,000 Illinois kids who are in the Children’s Health Insurance Program, known as CHIP. WBEZ first reported in April that getting vaccines to those children got more difficult following a state rule change made by former Republican Gov. Bruce Rauner.
Pritzker’s administration quietly reversed the rule on Monday, according to a memo obtained by WBEZ. Physicians and pediatric organizations cheered the policy shift on Wednesday.
“We know that families want to get their shots at their medical home,” said Jennie Pinkwater, executive director of the Illinois chapter of the American Academy of Pediatrics. “They want to see their doctor, get those things taken care of in a place where they feel comfortable and have built a relationship with a physician or provider. We’re really excited to see this barrier removed to that.”
In a statement, Theresa Eagleson, director of the Illinois Department of Healthcare and Family Services, which oversees CHIP, echoed Pinkwater’s sentiment.
“It is crucial for children to receive their vaccinations at the time of their well or sick visits, without having to go places at a different date that may also be far away,” Eagleson said.
A spokesman for the CDC did not respond to a request for comment.
Before 2016, Illinois used free vaccines from the CDC for kids enrolled in CHIP. This was part of the CDC’s Vaccines for Children Program that aims to immunize kids who can’t afford to pay for the expensive shots.
Children who were eligible for free shots included those on Medicaid, the government health insurance program for people who are low-income or disabled. But kids on CHIP were not supposed to be getting the free vaccines, because their parents make too much money to qualify for Medicaid, though not enough to afford private insurance.
So the CDC called for Illinois and other states to pay for the doses it used on CHIP kids. Illinois’ debt to the feds climbed to around $24 million.
To stop the financial bleeding, Rauner’s administration shifted policy in 2016. He required doctors to pay for CHIP vaccines up front, then wait to get reimbursed by the state or by private insurers.
The problem was vaccines are expensive. Consider that shots can cost up to nearly $2,000 in a baby’s first year of life. And private insurers in particular sometimes took months to reimburse doctors, if they did at all. No one — insurers or physicians — was getting paid on time because this all happened during the state’s epic budget impasse.
Here’s the ripple effect of the 2016 policy: Some doctors stopped vaccinating their patients on CHIP because they told WBEZ they just couldn’t afford to front the money for expensive vaccines.
Parents struggled to find other doctors to immunize their kids. Even the Chicago Department of Public Health, a go-to referral for many doctors who had clinics outside the city, stopped vaccinating children on CHIP who did not live in Chicago because of the expense.
After Pritzker beat Rauner last fall, physicians sounded the alarm once again. They told Illinois public health officials that reducing vaccines for children “could lead to a public health crisis with disastrous consequences,” especially in light of measles outbreaks across the country.
There were around 130,000 children in Illinois on CHIP in 2018 — the biggest portion, around 44%, lived in Cook County, enrollment data shows.
The Pritzker administration hustled to change Rauner’s policy. Children would be getting back-to-school physicals this summer and would need to find doctors to give them shots required for school.
After a series of meetings between physicians and various Illinois agencies, the Illinois Department of Public Health issued a memo on Monday reversing Rauner’s 2016 policy.
Doctors whose patients have CHIP insurance no longer have to buy vaccines up front and wait to get reimbursed, according to Pinkwater, from the Illinois chapter of the American Academy of Pediatrics. Physicians can order vaccines at no cost from the Illinois Department of Healthcare and Family Services. HFS will then reimburse the CDC for those vaccines so debt won’t pile up again.
HFS and the state public health department plan to review vaccine payments every six months to make sure the new program is “fiscally responsible,” the agencies said in their joint statement Wednesday.
The state also plans to improve the way it tracks vaccines given to kids on CHIP insurance.
The rule change also applies to immunizations for children who are undocumented, Pinkwater said.
“We’ve already heard from folks that they’re scheduling people in August to get their back-to-school shots,” she said.
Dr. Giulia Mobarhan, a pediatrician on Chicago’s Northwest Side, said she’s relieved for doctors who fronted money to buy vaccines for their patients on CHIP.
“They were underwriting the policy with their own credit cards,” Mobarhan said. “They no longer have this financial burden.”
She said she tried, but couldn’t afford to buy vaccines up front. Now, she plans to largely resume vaccinating kids on CHIP.
The rule change will likely mean more costs for the state because more doctors might start once again vaccinating patients on CHIP insurance. But it’s unclear how much.