Why Massachusetts' reimbursement per vaccination is 2x the national Medicare rate


Massachusetts has agreed to pay providers double the national Medicare rate for giving Medicaid beneficiaries COVID-19 vaccines, and is requiring private health plans to do the same for their members, according to The Boston Globe.

Under the requirement, providers will be reimbursed at least $90 for giving two doses of the Moderna or Pfizer-BioNTech vaccine to members of MassHealth — the name of the state's Medicaid program — or private health plans. The rate for Johnson & Johnson's vaccine hasn't been set yet.

The increase is intended to encourage quick vaccination of the state's residents, administration officials told the Globe. It's not a common step other states have taken. Most state Medicaid programs are paying the $45 Medicare rate for the vaccine, Matt Salo, executive director of the National Association of Medicaid Directors, told the newspaper.

While hospitals welcomed the increased reimbursement, Massachusetts insurers expect to spend roughly $400 million on COVID-19 vaccine reimbursement this year, according to the Globe. Those costs will likely be built into insurance premiums.

Read the full report here.

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