Individuals with disability, including physical disability, are disproportionately impacted by the COVID-19 public health emergency and face significant challenges accessing vaccination sites and services.¹ Many individuals with disability have diabetes, cancer, heart disease, obesity, or other health conditions that place them at greater risk of severe illness due to COVID-19, highlighting the importance of addressing barriers to vaccination among this population.² Below are some of the significant challenges individuals with disability face in accessing vaccinations,³ along with strategies and best practices health plan can use to help them address these challenges:

Challenge: Accessibility challenges of vaccination sites and need for assistance in booking vaccination appointments.

• Opportunity for plans: Facilitate vaccine appointments, offer alternative vaccination sites, and improve physical accessibility of sites. Health plans can:
  • Help individuals with scheduling appointments directly, or by connecting individuals to the national Disability Information and Access Line (DIAL) hotline, which helps people with disability find vaccination locations in their communities, assists callers with making vaccination appointments, and connects callers to local services to overcome barriers to vaccination.
  • Offer in-home vaccinations. CMS recently announced an additional payment amount for administering in-home vaccinations to Medicare beneficiaries who are hard-to-reach or face difficulty leaving home, including individuals with disability. This payment change supports nationwide efforts to improve vaccine access across populations. Plans might consider replicating this additional payment to encourage at-home vaccinations. For more information about home-based vaccinations, view our blog posts sharing tips for health plans as well as additional considerations for in-home vaccinations.
  • Provide accessibility assistance. Mobile vaccination sites can increase the reach of vaccination efforts. When setting up these sites, it is important to conduct accessibility site reviews before mobile sites are opened to the public. Health plans should also meet with local disability partners early in the planning phases and integrate key partners into operational planning meetings. There should be continuous site staff training and planning to accommodate the needs of individuals with disability and support them in receiving their vaccination.
  • Improve physical accessibility. Vaccination sites should be ADA compliant and accessible for individuals with disability, including physical disability.
    • Common accessibility challenges include restrooms, handwashing stations, parking areas, doors, open walkways, and elevators, as well as a lack of quiet spaces, privacy rooms or tents, sturdy chairs, wheelchairs available in a range of sizes, and clear signage identifying services available.⁴
    • Vaccination sites should also have accommodations for masking, support persons, and support animals. The Federal Emergency Management Agency (FEMA) developed a checklist organizations can use to ensure vaccination sites and other related programs are accessible to individuals with disability. Plans may consider partnering with entities running vaccination sites to assist with making vaccination sites ADA compliant.
  • Train and support vaccination site workers. Workers at vaccination sites should receive disability and access training to better support vaccination efforts for individuals with disability. This could involve creating and distributing a simple guide with information on etiquette, language and communication access procedures, physical access procedures, and paratransit operations. Vaccination sites may also benefit from designating specific support personnel, mobility aids, or subject matter experts to focus on access issues and needs.

Challenge: Some individuals with disability may lack internet access, live in rural areas, or encounter other barriers that make it difficult for more general vaccination outreach campaigns to reach them.

• Opportunity for plans: Use data to identify and target individuals at greater risk of not receiving their vaccine and which individuals may encounter accessibility barriers. Health plans can also work with local health departments and disability networks to conduct targeted outreach for people at higher risk of infection, as well as at risk of not receiving their vaccine.
  • The Minnesota Department of Health and Department of Human Services recently partnered with private health plans to conduct targeted outreach to individuals enrolled in Minnesota Health Care Programs who live in zip codes with high social vulnerability scores and have not yet received a COVID-19 vaccination, including individuals with disability. Blue Cross and Blue Shield of Minnesota implemented a pilot of this program by conducting text message outreach to individuals that are vulnerable, which resulted in a six times higher than normal rate of walk-in appointments within one week of the text campaign.

Challenge: Lack of information available in accessible formats and languages.

• Opportunity for plans: Health plans can develop accessible and culturally competent materials and provide it directly to members, or partner with vaccination sites or other community partners to develop these resources.
  • Information and materials should be available in multiple languages including braille, use plain language, be screen-reader friendly, and have a large text option. Vaccination sites should also provide language services such as ASL, video remote interpreting (VRI), interpreters, and translators.

Resources for Integrated Care recently held the webinar Promoting Disability Competent Care During COVID-19, which shared innovative strategies to address the unique needs of dually eligible individuals with disability during the COVID-19, including promoting access to COVID-19 vaccines. We also invite you to watch our recent webinar, Supporting the Preventive Health Care Needs of Dually Eligible Women with Disability, to learn more about challenges and barriers that women with disability face in accessing screenings and health services during COVID-19. Additional resources and strategies for addressing COVID-19 vaccine barriers for individuals with disability are located in this information sheet developed by ACL.

[1] CDC. (2021). COVID-19 Vaccines for People with Disabilities. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/easy-to-read/vaccines-people-with-disabilities.html.

[2] CDC. (2021). People with Disabilities. Retrieved from https://www.cdc.gov/ncbddd/humandevelopment/covid-19/people-with-disabilities.html.

[3] Resources for Integrated Care. Promoting Disability-Competent Care during COVID-19. Retrieved from https://www.resourcesforintegratedcare.com/DCC_COVID19/Webinar/2021/Promoting_Disability-Competent_Care_During_COVID-19.

[4] ADA National Network. (2021). ADA National Network Learning Session: Disability Inclusion Considerations in Vaccination Centers and Operations. Retrieved from https://www.adapresentations.org/webinar.php?id=176