State social services workers signed up homeless residents for Medicaid at a resource fair in Richmond in 2018. Enrollment in the program has more than doubled since Medicaid expansion, leading to rising demand for mental health services. (Ned Oliver/ Virginia Mercury)
Virginia health officials are still struggling to boost vaccination rates among the state’s Medicaid members, a major concern as the shots, once seen as the path to ending the pandemic, are increasingly the main public health tool for managing COVID-19 as cases persist.
Less than half of eligible enrollees — 41 percent in total — have been fully vaccinated, a figure that includes members age 5 and older according to data from the Virginia Department of Medical Assistance Services, which oversees the state’s public health coverage. Among adults 21 and older, 49 percent have received both shots — still far less than Virginia overall, where 72.3 percent of the total population and just over 82 percent of adults are fully vaccinated.
The wide gulf in uptake between Medicaid members and the general population has been an ongoing challenge as state and national leaders pivot to vaccines as a core strategy in preventing future surges. As case rates have fallen, the U.S. Centers for Disease Control and Prevention have rolled back indoor masking guidelines and eased the agency’s metrics for calculating community transmission levels. Virginia Gov. Glenn Youngkin also repealed a mandatory vaccination-or-testing program for state employees on his first day in office and worked with legislators to end mask requirements in K-12 schools.
While Youngkin has vocally opposed public health mandates, he’s urged Virginians to get vaccinated and boosted as part of the state’s “return to normalcy.” While so-called breakthrough infections can still occur among immunized patients, the shots greatly reduce the risk of COVID-19 hospitalization and death — part of the reason why the CDC rolled back recommended masking guidelines as cases began to decline.
With lower vaccination rates, though, many Medicaid members in Virginia remain at higher risk for severe outcomes if they contract the virus. Neither DMAS nor the Virginia Department of Health has been collecting data on how many hospitalizations and deaths have occurred among the state’s Medicaid population. But enrollees are some of Virginia’s most vulnerable residents, according to DMAS, with lower incomes and a greater likelihood of co-occurring conditions that can increase the dangers of COVID-19.
“There’s a huge overlap between higher-risk health conditions and being a lower income person and then therefore being enrolled in the Medicaid program,” said Dr. Chris Ghaemmaghami, a professor of emergency and internal medicine for University of Virginia Health and a physician specialist for VDH’s COVID-19 response. “Virginia’s not unique, but those are definitely the folks who have been hit the hardest by this.”
The renewed focus on immunization has led to a concentrated effort to reach the state’s most undervaccinated communities. Macaulay Porter, a Youngkin spokesperson, said the administration oversaw more than 1,000 vaccine events across the state between Jan. 20 and Feb. 19. More than 900 events are scheduled through the end of April, she added.
And for the first time, the state Department of Health is pooling data with DMAS and Virginia’s six managed care organizations — private insurance companies that provide coverage to Medicaid members under contract with the state.
Cheryl Roberts, the deputy of programs and operations for DMAS, said the state’s outreach efforts largely centered on making vaccines generally convenient for different communities. That could include holding clinics on weekends or after normal business hours, for example, or hosting mobile events at businesses popular with traditionally underserved groups.
“This is almost like round two,” she said. “Whereas before we were trying to target the whole state, now we’re saying, ‘Let’s look at these smaller pockets to see if we can make a difference.’” Both VDH and DMAS collect demographic information on vaccine uptake, and the state’s managed care organizations collect detailed data on the vaccination status of individual Medicaid members.
The approach has led to more targeted outreach, according to officials. Thanks to data-sharing efforts, Ghaemmaghami said agencies were able to identify a mobile home neighborhood in the Western Tidewater Health District where vaccination rates were far lower than the main downtown area just a few miles away. The agency now plans to schedule a mobile clinic specifically for that neighborhood.
“If we get 30, 40 people vaccinated who we haven’t been able to reach for the last year, I think that’s really a success,” he said. Tracy Douglas-Wheeler, the chief executive officer for the Virginia Community Healthcare Association, said the low uptake among Medicaid members also underscores long-existing disparities in health care access.
The association represents Virginia’s 26 federally qualified health centers, which serve thousands of Medicaid members across the state. She — like state health officials and managed care organizations — said there have been extensive efforts to reach underserved communities since the early days of Virginia’s vaccine rollout, including more than $20 million for strategies including mobile clinics and community outreach workers.
But without a clear sense of where exactly unvaccinated Virginians are located, it can be difficult to reach everybody. “We have people who live in such rural areas that they have to travel 35, 40 miles just to get to a provider,” Douglas-Wheeler said. “And they don’t have reliable transportation — they can’t take a bus or subway to get there.”
Even with those barriers, though, officials are still facing some of the same resistance that’s present among unvaccinated Virginians everywhere — not just among the Medicaid population.
Like the general population, younger Medicaid members are less likely to be vaccinated than homebound and senior enrollees, according to Tammy Whitlock, deputy director of complex care for DMAS. Officials say it’s not for a lack of trying. Optima, one of the state’s six managed care organizations, has been reaching out directly to its members since the start of the rollout to encourage vaccinations. For more than a year, the company has been offering transportation to appointments and a $50 gift card to fully vaccinated enrollees, but it hasn’t done much to boost uptake, according to Traci Massie, Optima’s director of government programs.
“We were hoping to get a lot of engagement with that and we just haven’t seen it,” she said. Health officials think outreach fatigue and misinformation has played a major role, but say they’re still trying new initiatives. DMAS is currently working with the Virginia Department of Education to establish more clinics in schools, and plans to start reaching out to summer camps, according to Roberts. Other recent vaccine events have also featured other health screening opportunities, and one clinic in Roanoke offered a food truck and groceries for attendees to take home.
“If we’re not succeeding in hitting the percentages of Medicaid members we’d like to see, it isn’t for lack of trying,” said Dale Gauding, a spokesperson for Optima and its parent company, the health system Sentara. “There’s just been an enormous amount of outreach going on across the state.”
Editor’s note: This story has been updated to reflect Dr. Chris Ghaemmaghami’s current titles. He is a professor of emergency and internal medicine for University of Virginia Health and a physician specialist for VDH’s COVID-19 response.
Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our web site. Please see our republishing guidelines for use of photos and graphics.