INDIANAPOLIS (AP) — Some doctors fear that fewer children across Indiana
will receive important vaccinations under a new state policy barring county
health departments from giving low-cost immunizations to youngsters who are
covered by insurance.
The new State Department of Health policy taking effect July 1 is intended
to reserve vaccinations for the most needy. Under the policy, the state will
ask doctors to stop referring insured patients to county health clinics.
“It’s one thing to expend everything that you’re provided for the cause of
the public,” State Health Commissioner Gregory Larkin told The Indianapolis
Star. “It’s another thing to expend public health dollars unnecessarily for
an insured population and you run out for everyone. ... If we don’t have the
funds, we won’t be able to provide the immunizations.”
It’s not certain that the new policy can be enforced. State officials
acknowledge that they are relying on a good-faith effort by doctors and
health providers to steer the insured away from county health departments
and patients being honest about whether they are insured.
Still, the change has doctors worried about children getting all the shots
they are supposed to have to attend school.
“Why would you put more barriers up to kids being vaccinated?” said Dr.
Sarah Stelzner, co-president of the Indiana chapter of the American Academy
Larkin said the state has no choice. Indiana receives about $90 million from
the federal government for vaccines for uninsured, underinsured and
Medicaid-eligible children and the state adds $11 million. For the past two
years, that’s just barely been enough.
The change could leave those covered by insurance policies with high
deductibles facing bills in the hundreds of dollars for vaccinations in a
A pre-kindergarten visit, for instance, can run about $600 for vaccines. By
contrast, county health departments typically charge only a nominal fee for
Dr. Mary McAteer, a Carmel pediatrician, said she has seen high deductibles
drive more insured patients to the county health department for the
“The health department was a great resource for those people that were
underinsured,” McAteer said. “When they don’t get to go there, it’s going to
be a huge impact. They’re going to have to make some big decisions.”
Marion County Health Department director Virginia Caine said the agency will
continue to vaccinate all comers, but for those who have insurance, it will
bill their insurance company as of July 1. Caine said the department also
will raise its administrative fee from $10 to either $20 or $30.
Parents might also be asked to sign a document if they say they don’t have
“We’re going to have to take it on faith,” Caine said. “There’s no way we
can do an investigation to decide if they have insurance.”
About a third of the patients whom Dr. Paula Gustafson sees in her
Shelbyville office go to the county health department for their
vaccinations, especially for more expensive ones such as Gardasil, a vaccine
against human papillomavirus. The three shots required can run into the
several hundreds of dollars, Gustafson said.
“Right now people have difficulty paying their medical bills, and I can see
this would only add to that,” she said. “For people who have to make a
choice on how to spend money, they may go without it.”