Medicaid Adult Vaccine Provider Reimbursement in 2025

This white paper by Avalere Health examines Medicaid provider reimbursement for adult vaccines in 2025, focusing on comparisons across 50 states and Washington, DC. The analysis builds on previous assessments and reflects changes in the policy landscape influenced by the Inflation Reduction Act of 2022 and the One Big Beautiful Bill Act of 2025. The review highlights the reimbursement landscape for five vaccine categories, including COVID-19 and RSV vaccines, across various provider types such as physician offices, pharmacies, and Federally Qualified Health Centers (FQHCs). Key findings indicate minimal changes in reimbursement rates, with physician offices generally receiving lower rates than Medicare. The paper also notes modest increases in administration rates for non-COVID-19 vaccines, while COVID-19 immunization administration reimbursement has declined in several states. Additionally, the report discusses the implications of evolving federal guidance and budget constraints on Medicaid vaccine access, emphasizing the need for adequate reimbursement to support vaccine delivery for beneficiaries.