Recognizing that prevention and early detection of diseases and conditions vastly improve health outcomes, the Affordable Care Act (ACA) requires Medicaid (Medi-Cal in California) and non-grandfathered private plans to cover a set of preventive services without cost-sharing. To ensure that beneficiaries and enrollees fully benefit from advances in science and medicine, Congress tied coverage of preventive services to services, screenings, and vaccines recommended by the United States Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), and the Health Resources and Services Administration (HRSA). Similarly, coverage of vaccines for minors under Medicaid’s Vaccine for Children (VFC) program is also tied to ACIP vaccine recommendations formally adopted by the Centers for Disease Control and Prevention (CDC), emphasizing the importance of an evidence-based approach to coverage of preventive services among children and adolescents.
Unfortunately, this evidence-based approach is now under threat. Secretary of Health and Human Services (HHS), Robert F. Kennedy, Jr. (RFK Jr.), recently replaced all 17 members of ACIP with hand-selected appointees widely viewed as unqualified. Reports have also resurfaced that he is similarly planning to replace all members of the USPSTF. These changes raise concerns that these reconfigured panels would base future recommendations on flawed science, unfounded conspiracy theories, and questionable evidence to pursue their anti-science agenda. Under RFK Jr., access to basic preventive services now considered essential is in jeopardy. In response to these actions taken by HHS and the uncertainty they have created, Governor Gavin Newsom recently signed into law AB 144, a budget bill that seeks to protect access to health services for Californians in the face of federal attacks. The bill includes two important provisions that counter RFK Jr.’s efforts to dismantle the preventive services framework.
Changes to Vaccine Coverage in Medi-Cal
AB 144 specifies that Medi-Cal coverage of vaccines for adults and children extends to those vaccines recommended by ACIP, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and “any modification or supplement to a recommendation adopted by the California Department of Public Health” (CDPH). This move will protect Medi-Cal beneficiaries, particularly minors enrolled in the program, from losing access to vaccines that continue to be recommended or are newly recommended in the future by reputable clinical organizations, even if ACIP removes any current recommendation.
To put things in context: During ACIP’s September meeting, the panel voted to limit access to the combined measles, mumps, rubella, and varicella (MMRV) vaccine for young children, contrary to the recommendations from other organizations. While the panel also contradictorily voted to maintain VFC coverage for young children, it may revise such a decision in the future. In that case, and if the CDC approves such a recommendation, the MMRV vaccine would no longer be covered for children under age 4 as part of the VFC program. Under AB 144, however, Medi-Cal would nonetheless continue to cover the MMRV vaccine because the vaccine continues to be recommended by the AAP. Future vaccines may be incorporated through recommendations from any of the listed organizations or through action from CDPH.
The vaccines provision in AB 144 is not a perfect solution for the chaos that could be caused by HHS’s actions regarding ACIP. For instance, since federal law ties coverage and payment under VFC to ACIP-recommended vaccines, California would not be able to take advantage of the full benefits of VFC regarding purchasing and stock availability of vaccines. The State may instead need to use other authority under the Medicaid Act for purchasing and covering non-ACIP vaccines (such as EPSDT for children, preventive services, physician services, clinic services, among others). Still, ensuring Medi-Cal coverage of evidence-based vaccines in the face of HHS’s anti-science crusade will protect underserved populations in California from losing access to key services.
Changes to Coverage of Other Preventive Services in Private Plans and Medi-Cal
The second important provision in AB 144 seeks to protect the right of Californians to access all preventive services currently recommended by USPSTF, ACIP, and HRSA in non-grandfathered individual and group plans, as well as Medi-Cal. The bill preserves coverage of preventive services and vaccines recommended as of January 2025. That means that if USPSTF, ACIP, or HRSA change any of the current recommendations in the future, plans in California will continue to be required to cover existing recommendations. In the MMRV vaccine example: under AB 144, private plans in California and Medi-Cal must continue covering this vaccine regardless of whether the CDC formally adopts the new ACIP recommendation because the previous MMRV vaccine recommendation was in effect on January 2025. Additionally, by giving CDPH the authority to make modifications or supplement the recommendations made by USPSTF, ACIP, or HRSA, AB 144 seeks to account for potential changes in clinical evidence that may require adjustments in coverage in the future.
As with the Medi-Cal vaccine policy, California will have to carefully navigate federal barriers when implementing AB 144, particularly when it comes to requiring Qualified Health Plans (QHPs) to cover services not recommended by the USPSTF, ACIP, or HRSA. The ACA allows states to require coverage of benefits in addition to the federally required essential health benefits (EHBs), but states are required to defray or cover the costs of such services in QHPs. Because federal rules tie the EHB category of preventive services to USPSTF, ACIP, and HRSA recommendations, California can require plans to cover additional services, without having to defray the cost, only if adopted through the EHB benchmarking process. AB 144, however, limits CDPH’s authority to make “modifications or supplements” to USPSTF, ACIP, or HRSA recommendations, which reduces the likelihood that CDPH’s recommendations would trigger defrayal. In addition, California will still be able to add new services altogether or make significant changes to the USPSTF, ACIP, and HRSA recommendations by proposing changes to the state’s benchmark plan, although those changes will need to comply with actuarial limits and will require federal approval.
In enacting AB 144, California has taken bold and concrete action to protect the State’s population against federal changes that seek to reduce access to essential preventive services. These actions are particularly important for low-income and underserved populations at higher risk of chronic conditions such as substance use disorders, HIV, and hepatitis C. In addition, these actions constitute an important guardrail against anti-science efforts that put in danger the public’s health in the face of communicable diseases, such as the flu and COVID-19, which also disproportionately impact individuals with disabilities and immunocompromised individuals.
This post is part of a blog series on coverage of preventive services in the face of recent HHS actions:
- RFK Jr.’s new regime puts vaccine coverage for low-income children in jeopardy
- California takes bold action to protect access to preventive services
- COVID-19 vaccine blog. (Coming soon)
