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Clinical and Administrative
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. 
Providers should use this coverage criteria document for all state-supplied vaccine.
Listing of FQHC, RHC, Local Health Department & Deputized Providers (PDF, 372 KB)
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:
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.
2012-2013 Influenza Vaccine Coverage Criteria: Influenza vaccine provided by the NCIP is available for children 6 months through 18 years of age who are eligible for the Vaccines for Children (VFC) program. Additionally, regardless of age or insurance status, persons attending a North Carolina college or university, and close contacts of infants who are less than 6 months of age are eligible for NCIP inactivated influenza vaccine (TIV). Close contacts include, but are not limited to, household members, clinical staff, day care personnel, etcetera, of any age. Because there is no federal contract for LAIV this year, the NCIP will not be able to provide LAIV for adults. Please refer to the memo dated July 10, 2012 (PDF, 65 KB).
Any provider (local health departments and private providers) with transition vaccine should use this coverage criteria document.
Providers who had state-funded, state-supplied vaccine on hand on or before June 30, 2010 should use the June 14, 2010 Coverage Criteria until all doses are administered.
