Skip all navigation Skip to page navigation

DHHS Home | A-Z Site Map | Divisions | About Us | Contacts | En Español

 
NC Department of Health and Human Services
Women's and Children's Health Home
N.C. Public Health Home
 
 
North Carolina Immunization Branch

North Carolina Immunization Program (NCIP) Requirements

Clinical and Administrative

Coverage Criteria

The purpose of the coverage criteria is to distinguish which individuals, present in North Carolina, are eligible for state-supplied vaccine from the North Carolina Immunization Program (NCIP). NCIP state-supplied vaccine is generally available for children through the age of 18 in compliance with recommendations made by the Advisory Committee for Immunization Practices (ACIP) and the Vaccines for Children (VFC) program. ACIP recommends certain vaccines for certain individuals who are not covered by NCIP state-supplied vaccine. Health care providers must use privately-purchased vaccine for those individuals who wish to have vaccine and are not covered by this coverage criteria. For the current recommendations for each vaccine, please see the ACIP statements found at: http://www.cdc.gov/vaccines/pubs/ACIP-list.htm. external link

Providers should use this coverage criteria document for all state-supplied vaccine.

Listing of FQHC, RHC, Local Health Department & Deputized Providers (PDF, 372 KB)

 

Recent Updates to the NCIP Coverage Criteria:

Expansion in Availability and Coverage Criteria for State-Supplied Tetanus, Diphtheria and Acellular Pertussis (Tdap) Vaccine for Adult Patients: Local health departments (LHDs) may administer state-supplied Tdap vaccine to uninsured pregnant women 19 years and older (at any time during pregnancy regardless of prior vaccine history of Tdap, but preferably between 27-36 weeks gestation).  In addition, uninsured postpartum women 19 years and older may receive one dose of state supplied Tdap if there is no documentation of a previous Tdap vaccination.  Both pregnant and postpartum women must be being served by the LHD in any capacity.

VFC/North Carolina Health Choice: Children who are covered by North Carolina Health Choice (NCHC) are considered insured, with one exception: NCHC children who are American Indian or Alaskan Native are eligible for VFC vaccines.

VFC/Skin Testing: VFC vaccine cannot be used for allergy skin testing prior to vaccination.

Influenza Vaccine Coverage for 2013-2014: State-supplied influenza vaccine is only available to VFC-eligible children 6 months through 18 years of age; and to non-Medicaid uninsured women who are pregnant during the flu season, and receiving services at the Local Health Department (LHD) and females with a family planning waiver receiving services at LHDs, Federally Qualified Health Centers and Rural Health Centers.

Tdap for Uninsured Pregnant Women: Local Health Departments (LHDs) may administer one dose of state-supplied Tdap vaccine to uninsured pregnant women (> 20 weeks gestation, but preferably between 27-36 weeks) and postpartum women 19 years and older only if the woman is being served by the LHD in some other capacity and there is no documentation of a previous Tdap vaccination.

Females 19 years of age and older with a Family Planning Waiver are considered uninsured and may receive available state-supply vaccines if receiving services at a Local Health Department, Federally Qualified Health Center or Rural Health Clinic.

Program Changes: Effective October 1, 2012, most private providers may no longer provide Vaccines for Children (VFC) immunizations to underinsured children. After October 1, 2012, most private providers may only serve VFC children who are in one of the
following categories:

  • Medicaid
  • American Indian/Alaska native
  • Uninsured

Also effective October 1, 2012, except for situations listed in coverage criteria, state supplied vaccines may NOT be administered to a fully insured patient of any age. Beginning October 1, all vaccines currently available for adults (persons aged 19 years and above) will be available for uninsured adults only.

Please refer to the memo to LHDs dated on August 21, 2012, and the memo dated to Private Providers dated on August 21, 2012.

return to top