February 1, 2022

Administrator Chiquita Brooks-LaSure
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

Dear Administrator Brooks-LaSure:

New York State (NYS) understands that all our health care providers have been working tirelessly throughout the pandemic to serve and support their patients.  The available vaccines have provided relief to so many New Yorkers, and NYS has been deploying every effort available to ensure access and to encourage New Yorkers to get vaccinated.  To encourage vaccinations for young people, Governor Kathy Hochul has instituted a comprehensive initiative to increase vaccination rates throughout the state and support pediatricians, parents, and guardians.  The State has launched multiple campaigns to promote COVID-19 vaccination for 12-17-year-olds entitled #VaxtoSchool and for 5-17-year-olds entitled #VaxForKids focused on marketing efforts promoting education, decreasing misinformation, increasing vaccine equity/access, and harnessing social media to reach parents and guardians in English and Spanish and has set up over 200 community pop-up vaccination sites in convenient, youth- and school-centric areas statewide, emphasizing zip codes with low vaccination rates.  The State also launched the 'Vaccinate, Educate, Graduate' Vaccine Incentive Scholarship to increase awareness of the availability and efficacy of COVID-19 vaccines and provided incentives to New Yorkers 5-11 years of age to get a COVID-19 vaccination.

While these efforts have ensured vaccination access for all families, immunization adoption rates and even access to information and care are still unacceptably low. As of January 26, 2022, 67.0% of adolescents ages 12 to 17 years and only 26.7% of young children ages 5 to 11 years are fully vaccinated, lagging behind all other age groups and leaving our school children, who are at increased risk, the most vulnerable.

Addressing youth vaccination rates has become even more urgent with the current wave of cases from the Omicron surge. From the week of December 5-11, 2021, to the week of January 9-15, 2022, hospital admissions for or with COVID-19 among people aged ≤ 18 years increased approximately six-fold statewide. During the January 10-16, 2022, week, only 6% of the hospitalized COVID infected 5-11-year-olds were vaccinated. 

It is critical to immunize children to protect those who are not yet eligible to be vaccinated and those high-risk family and friends who may not maintain immunity or have reduced immunity.

The January 15, 2022, seven-day average hospitalization rate for children 0-4 years, who are ineligible to be vaccinated, was 3.2 per 100,000, which exceeds statewide rates observed for all ages in mid-November 2021 and through previous surges. This indicates the high rate of hospitalization for children all over New York State. 

While New York State, local governments, and federal regulators have been tirelessly educating families on the safety and efficacy of the COVID-19 vaccine, parents and guardians continue to rely on their physicians as a trusted source of guidance for recommendations, questions, and discussion about the COVID-19 vaccine.  However, physicians have expressed concerns regarding the many obstacles to provide guidance, including staff shortages, increased burden from COVID-19 on the healthcare system, dwindling resources and failure of commercial health insurers to reimburse physicians for counseling when no vaccine is administered.   

On December 2, 2021, the Biden-Harris Administration announced a new requirement for Medicaid to cover COVID-19 vaccine counseling visits in which healthcare providers talk to families about the importance of kids’ vaccination.  This action empowers the parents and guardians of 40% of all children in the United States to visit their trusted provider for a consultation to discuss the vaccine and address any concerns and ensures that their provider is appropriately compensated for this critical visit. 

We are urging CMS to issue guidance to all insurers to cover COVID-19 vaccination consultations for youth and their families as preventive services, irrespective of vaccine administration.  Under New York and Federal law, this would ensure coverage with no-cost sharing for families and fair and equitable reimbursement to providers.  We believe this will ensure that health care providers are available to answer families’ questions and engage in discussion about the COVID-19 vaccine and ultimately improve youth vaccine rates.

The NYS Department of Health and Department of Financial Services agree that all families should be able to meet and seek counsel with their providers for pediatric COVID-19 vaccine information without the burden of a copay or cost sharing.  Pediatricians and other providers should also be reimbursed for providing counseling to patients and their parents.  This will help combat the pandemic of misinformation, compensate our valued health care providers, and help them have the necessary time to discuss the COVID-19 vaccine with patients and families.

CMS has taken bold, necessary actions to ensure care needed to combat this pandemic.  We applaud your recent actions requiring all insurers, including commercial insurers, to cover at-home testing; and your guidance requiring coverage of vaccine consultations for families enrolled in Medicaid.  We need your further leadership and support to empower all families to seek these consultations and start these discussions while ensuring health care providers are appropriately compensated.   We appreciate your continued public health partnership in supporting efforts to promote vaccination and combat misinformation as part of the strategy to address the pandemic in New York State.  Thank you for your continued efforts to address COVID-19 and improve the health and welfare of all New Yorkers. 

Our agencies are available to assist in any way to make this important coverage available for all families.  



Adrienne A. Harris
Superintendent of Financial Services

Mary T. Bassett, M.D., M.P.H.
Commissioner of Health