As of October 1, 2023, Medicaid covers all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) with zero cost sharing. This is a major change from previous rules, when coverage varied widely by state and many adults on Medicaid faced copays or coverage gaps for routine vaccinations. The Inflation Reduction Act made this coverage mandatory for all state Medicaid programs, in both fee-for-service and managed care plans.
What Changed in 2023
Before the Inflation Reduction Act took effect, states had significant discretion over which vaccines they covered for adults and how much they charged. Some states covered only a handful of vaccines, and others imposed copays that discouraged people from getting immunized. Section 11405 of the Inflation Reduction Act eliminated that patchwork. Every state Medicaid program now must cover any vaccine that meets two criteria: it is approved by the FDA for use in adults, and it is recommended by ACIP in any category of recommendation. That last detail matters because the requirement is not limited to vaccines on the routine immunization schedule. If ACIP recommends a vaccine for certain risk groups or in outbreak situations, Medicaid must cover it.
States also cannot impose any cost sharing. No copays, no coinsurance, no deductibles for covered vaccines or their administration. This applies to all full-benefit Medicaid enrollees age 19 and older.
Full List of Covered Vaccines
The 2025 ACIP adult immunization schedule includes all of the following vaccines. Because Medicaid must follow ACIP recommendations, each of these is covered when administered according to the recommended guidelines for your age and risk factors:
- Influenza (flu): recommended annually for all adults
- COVID-19: one or more doses of the current seasonal vaccine, with additional doses for adults 65 and older
- Tdap/Td: tetanus, diphtheria, and pertussis boosters
- MMR: measles, mumps, and rubella for adults who lack evidence of immunity
- Varicella (chickenpox): for adults without evidence of immunity
- Shingles (Shingrix): two-dose series for adults 50 and older
- HPV: for adults through age 26 routinely, with shared clinical decision-making for ages 27 to 45
- Pneumococcal: for adults 65 and older, and younger adults with certain risk factors
- Hepatitis A: for adults at increased risk or anyone who wants protection
- Hepatitis B: recommended for all adults through age 59, and older adults with risk factors
- Meningococcal (A, C, W, Y and B): for adults with specific risk factors such as complement deficiency or living in group settings
- RSV: for adults 75 and older, and adults 50 to 74 with increased risk of severe RSV illness
- Mpox: for adults at risk
- Haemophilus influenzae type b (Hib): for adults with certain medical conditions
- Polio (IPV): for unvaccinated adults or those needing a booster
RSV and Shingles: Age and Risk Requirements
Two vaccines that generate a lot of questions are the RSV and shingles vaccines, since both have specific eligibility criteria beyond simply being an adult on Medicaid.
The shingles vaccine (Shingrix) is a two-dose series recommended for adults 50 and older. The second dose is given two to six months after the first. If you are 50 or older and enrolled in Medicaid, both doses are fully covered.
The RSV vaccine is recommended as a single dose for all adults 75 and older. Adults between 50 and 74 qualify if they have an increased risk of severe RSV illness. Risk factors include chronic heart disease, chronic lung conditions like COPD or asthma, diabetes with complications, severe obesity (BMI of 40 or higher), moderate or severe immune compromise, chronic liver disease, sickle cell disease, and residence in a nursing home. Your own statement that you have a qualifying condition is considered sufficient. A provider should not deny the vaccine because you lack medical documentation of the risk factor.
Where You Can Get Vaccinated
You can receive Medicaid-covered vaccines at a doctor’s office, community health center, or retail pharmacy, though the specifics depend somewhat on your state. Forty-eight states cover vaccines administered by pharmacists, but about 40% of those states place some restrictions on pharmacy-administered vaccines, such as limiting which vaccines pharmacists can give or requiring a prescription first.
How the pharmacy bills for your vaccine also varies by state. In roughly two-thirds of states, pharmacy-administered vaccines are billed under the pharmacy benefit, similar to a prescription drug. In the remaining states, they go through the medical benefit, the same way a doctor’s office would bill. Either way, you should not owe anything out of pocket for an ACIP-recommended vaccine. If a pharmacy tells you there will be a charge, it may be worth confirming that they are billing Medicaid correctly or checking with your Medicaid plan.
What Medicaid Does Not Cover
The mandatory coverage requirement applies to vaccines recommended by ACIP. Travel-specific vaccines, such as yellow fever and typhoid, are not part of the ACIP routine or risk-based schedule for domestic use. These are generally not billed to Medicaid and will require out-of-pocket payment. If you need vaccines specifically for international travel, expect to pay for those at the time of your appointment.
The coverage requirement also applies to “full-benefit categorically needy” Medicaid enrollees. If you have limited Medicaid benefits, such as emergency-only coverage, the vaccine mandate may not extend to your plan. Adults with full Medicaid benefits in any state, whether or not the state expanded Medicaid under the Affordable Care Act, are covered under the same federal rules.
Practical Tips for Getting Vaccinated
If you are unsure which vaccines you need, your provider can check your immunization history against the ACIP schedule for your age group. Many states maintain immunization registries that track which shots you have already received, which can help avoid unnecessary duplicate doses.
When scheduling a vaccine at a pharmacy, call ahead to confirm they accept your specific Medicaid plan. Managed care enrollees sometimes need to use in-network pharmacies or providers. Having your Medicaid ID card ready will make the billing process smoother. If you are ever charged a copay for a recommended vaccine, you have the right to dispute that charge, since federal law prohibits cost sharing for these services.