Despite state and national efforts to address inequalities in COVID-19 vaccination, most states still show lagging vaccination rates among people of lower incomes and education levels, even as gaps for racial and ethnic groups have largely disappeared in recent months. 

The states that track the COVID-19 vaccination status of Medicaid beneficiaries continue to report disparities. Low-income people were less likely to be vaccinated in all eight states that provided data to CQ Roll Call this month.

COVID-19 has disproportionately affected minority groups and those facing economic and social barriers to health care. The Biden administration created numerous policies designed to improve health equity.

Daniel Tsai, the Center for Medicaid and CHIP Services director, acknowledged at a September industry conference that vaccination rates in Medicaid are generally lower than for other populations but said federal officials were “very actively working on getting vaccinations higher.” 

“Equity is a core component underlying everything that we are doing on Medicaid” and the Children’s Health Insurance Program, said Tsai. “We want to think about how the Medicaid program can actively help reduce health inequities.”

Glen P. Mays, professor and chair of the Colorado School of Public Health Department of Health Systems, Management and Policy, said transportation, vaccine misinformation and a lack of knowledge on how to get free vaccines remain hurdles.

“Big picture, there’s been an amazing campaign in terms of getting this many people covered with a vaccine over mostly short periods,” said Mays. “That being said, I think we do know there are still significant gaps, and definitely disparities in vaccine coverage.”

Inequities

A CQ Roll Call analysis of state data in June revealed gaps in COVID-19 vaccination rates between the general population and enrollees in Medicaid or CHIP.

A Kaiser Family Foundation brief from September still showed gaps in vaccination by insurance, education levels and income. Individuals with an annual income under $40,000 had a 68 percent partial vaccination rate, compared with 79 percent for incomes $90,000 or higher.

The Centers for Disease Control and Prevention uses a social vulnerability index, or SVI, to measure 15 factors affecting health equity. The SVI considers variables like poverty, minority status, housing type and household composition.

A CDC study examining data from the first 2.5 months that vaccines were available in the United States found the counties with high social vulnerability had lower vaccination rates than those with low vulnerability.

Mays recommends using localized communication and engagement strategies, including trusted messengers such as community leaders, to boost vaccination rates.

The Centers for Medicare and Medicaid Services and state Medicaid departments both report taking steps to reduce disparities.

A CMS spokesperson said the agency is working with states to collect and report Medicaid-specific vaccination data and hopes to make meaningful national data available. The official called promoting
COVID-19 vaccines a “top priority.”

“This Administration has worked tirelessly to work with our state Medicaid partners to ensure they have the resources they need to provide vaccines,” the spokesperson said by email. CMS noted federal officials offer states free vaccines and technical assistance.

Still, lower-income people remain less likely to be protected by shots. 

Local snapshots

Arizona: State data showed that as of Sept. 17, about 41 percent of enrollees 12 or older had at least one vaccine dose. For the general population, that rate was 66 percent.

California: Department of Health Care Services data released Oct. 4 show a 24.6 percentage point difference statewide between the share of the general population 12 and up who got at least one dose of the COVID-19 vaccine and people in Medicaid.

The overall vaccination rate was 78.9 percent, compared with 54.3 for Medicaid.

Thirty-one of 58 counties have a difference of at least 20 percentage points in the one-dose rate between the general population and the Medicaid, known as Medi-Cal, population. 

“While Medi-Cal COVID-19 vaccination rates are gradually improving across the state, the percentage of Medi-Cal beneficiaries with at least one dose lags the population-at-large rate, sometimes by as much as 30 percent,” the department’s biweekly report reads.

State data show that 16 counties have at least 55 percent of Medicaid residents vaccinated. In June, that number was four. 

In comparison, among the general population, 51 of 58 counties met that goal by October.

Georgia: The Department of Community Health shared data for Sept. 27 in mid-October that showed that 537,212 — almost 21.4 percent — of its Medicaid members were at least partially vaccinated.

That contrasts with 54.3 percent of total residents, Georgia Department of Public Health information for the same date shows.

For full vaccination, state data showed 10.1 percent of Georgia Medicaid members were fully vaccinated by May 31. That number grew to 18 percent by Sept. 27.

Idaho: The Department of Health and Welfare reported 19.7 percent of Medicaid enrollees 12 and up had at least one dose of the vaccine by Oct. 13, compared with 59.5 percent of total state residents 12 and up.

The state had reported slightly higher numbers in June due to duplicate data that was subsequently corrected, a spokesperson said.

Oregon: The Oregon Health Authority provided data showing 54.1 percent of Medicaid beneficiaries 12 and older were at least partially vaccinated on Oct. 20. Statewide, that number was 78.1 percent for the general population, according to the CDC.

Utah: The Department of Health said 138,227, or 46 percent, of Medicaid and CHIP enrollees over 12 received at least one vaccination by the last week of September. And 41 percent of individuals 12 and over enrolled in Medicaid or CHIP were fully vaccinated.

In comparison, 73.4 percent of all Utah residents 12 and older had at least one dose, and 65.6 percent were fully vaccinated. 

In mid-August, the state issued a report showing vaccination rate gaps by socioeconomic status. For individuals 19 to 29 years old, there was a 21.5 percent difference in vaccination rate between Medicaid and the general population. For 30- to 39-year-olds, that jumped to 22.6 percent.

Utah Department of Health public information officer Kolbi Young said that since June, the state has made it easier for adults who are caretakers or have dependent children to use subsidized transportation, including bus vouchers and free shuttles to vaccination appointments.

Virginia: Department of Medical Assistance Services data show that the percentage of Medicaid beneficiaries 12 or older with at least one dose grew from 33 percent in June to 46 percent on Oct. 6. Still, CDC data show 80.3 percent of all Virginians 12 and older were vaccinated by the same date.

West Virginia: The Department of Health and Human Resources, Bureau for Medical Services reported on Oct. 15 that about 30 percent of its vaccine-eligible population was fully vaccinated. But the state’s fully vaccinated rate for all eligible individuals was 57.8 percent on Oct. 15 — an almost 28 percent gap between Medicaid and the general population.

Timothy F. Murphy, Community Health Equity Research Institute director at the University at Buffalo, said while vaccine disparities along racial or ethnic lines narrowed, more specific data are needed to understand how to reach holdouts and combat misinformation.

He cautioned that statewide data can be deceptive.

“Even looking at an entire ZIP code number, you know, doesn’t tell the whole story,” said Murphy. “I do think that having, having access to more localized and more specific data would be very helpful and very important in terms of addressing this issue.”