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Vaccine vials

End of public health emergency ushers in changes to vaccine, Medicaid policies

August 1, 2023

The end of the COVID-19 public health emergency (PHE) on May 12 brought important changes to the state-level response to the pandemic.

State public health authorities no longer are required to submit weekly reports of COVID-19 surveillance to the Centers for Disease Control and Prevention.

There also are numerous changes to vaccine policy and Medicaid eligibility.

Changes in Medicaid

The end of the PHE brought sweeping changes to public health care coverage for children and adolescents. Starting April 1, state Medicaid programs could begin disenrolling covered individuals who no longer are eligible for the program or who lost coverage for procedural reasons, such as not returning required paperwork.

Each state is required to file a data report with the Centers for Medicare & Medicaid Services on this process, called unwinding, on the eighth of every month following its start.

Early disenrollment data released by states are troubling. Data aggregated by the Kaiser Family Foundation ( show the following:

  • As of July 25, more than 3.7 million enrollees in 37 states and the District of Columbia lost coverage after going through the redetermination process or for procedural reasons. The percentage of those who lost coverage varied widely among reporting states.
  • Disenrollment across reporting states varies from 82% in Texas to 10% in Michigan. 

The data come on the heels of recent survey findings that suggest many Medicaid enrollees are not aware that states can disenroll ineligible individuals from the program, and many believe their circumstances have not changed sufficiently to make them ineligible.

“My biggest concern is that families are confused as to why they have to re-enroll, since they have been eligible for three years now,” said Pam K. Shaw, M.D., FAAP, chair of the AAP Committee on State Government Affairs. “I see it in my own clinic; families are throwing away their paperwork because they don’t understand the need for it. We have a lot of work to do on educating the public about the importance of re-enrollment, the risks of losing coverage and letting them know we’re here to help.”

AAP chapters can support their members in educating families about changes in their states. They also can advocate with state Medicaid programs to ensure children and adolescents who are eligible for coverage receive it, whether through a Medicaid reconsideration period, the Children’s Health Insurance Program (CHIP) or marketplace coverage.

The AAP will continue to monitor the effects of the Medicaid unwinding as states redetermine eligibility for all enrollees and provide resources for chapters and members.

Vaccine policy changes

During the pandemic, state-licensed pharmacists were permitted to give all vaccines to children ages 3-18 years. This expanded availability is winding down.

The AAP opposed the policy when it was proposed in 2020 due to its potential to adversely impact the pediatric medical home. Expansion of pharmacy-based childhood immunizations and pharmacist vaccine administration authority under state law likely will be a topic of advocacy for AAP chapters into 2024.

Changes also are coming to COVID-19 vaccine formulations and supply policies as the vaccines transition away from government supply to the private market. The AAP is advocating for appropriate safeguards for pediatric practices and a gradual rollout of COVID-19 vaccines to the private market.

AAP chapters can advocate with state immunization programs to ensure that pediatric practices’ business needs are considered and that state programs do not resort to burdensome compliance measures during the transition period.

Bivalent COVID-19 vaccines are available for pediatric patients. While uptake of these vaccines has been disappointing in many states, the next phase in the public adaptation to post-pandemic life presents some opportunities.

While the District of Columbia is the only jurisdiction that plans to implement a school entry requirement for COVID-19 vaccines, the late summer/early fall back-to-school well visits may provide an opportunity for catch-up with newly formulated vaccines.

AAP information on COVID-19 vaccines, including dosing and other guidance, is available at


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