Sixty-seven percent of Americans have been fully vaccinated to protect against the COVID-19 public health emergency as of August 2022, however, many individuals who received their initial vaccines have yet to receive the recommended booster vaccination.¹ In March 2022, the FDA authorized individuals meeting certain criterion to obtain second booster vaccines.² May 2022 brought another recommended expansion increasing eligibility for boosters to children.

The COVID-19 public health emergency has disproportionately impacted individuals dually eligible for Medicare and Medicaid.³ Further, this population may experience additional challenges accessing or completing their primary COVID-19 vaccine series (e.g., both doses of a two-dose vaccine or one dose of a single dose vaccine), and these challenges may persist related to booster vaccination. This blog post will address the most recent CDC guidance surrounding boosters in addition to some strategies health plans use to increase rates of members obtaining booster vaccines.

Updated CDC Booster Guidance⁴

Guidance surrounding boosters changed since the publication of the November 2021 blog post and Medicare-Medicaid Plans (MMPs) have employed a variety of innovative methods to increase rates of booster vaccine compliance. Certain Americans are eligible for two booster vaccines and children as young as six months are now eligible for initial vaccination. Updated CDC guidance from August 2022 is highlighted in the table below:

Eligible for one booster	Eligible for two boosters
1. Everyone ages five years and older may get one booster vaccine after completing their primary vaccine series*	1. Adults ages 50 years and older 2. People ages 12 years and older who are moderately or severely immunocompromised 3. People who got two doses (one primary dose and one booster) of Johnson & Johnson’s Janssen vaccine

The CDC goes on to offer the following additional guidance for those interested in second booster doses:⁴

• Make sure four months have elapsed the first COVID-19 booster dose.
• Remember that second boosters can only be Moderna or Pfizer-BioNTech (and for ages 12-17, only Pfizer-BioNTech).
• You can self-attest that you have a moderately or severely weakened immune system. This means you do not need any documentation that you have a weakened immune system to get a COVID-19 vaccine (including booster) wherever they are offered.

Health Plan Strategies to Increase Booster Vaccine Rates

In the November 2021 blog post, we offered strategies health plans could utilize to galvanize individuals towards obtaining their recommended boosters. MMPs continue to innovate, and a variety of best practices are highlighted below.

General strategies

• Health plan care coordinators discuss booster shots with members during their regularly scheduled outreach and offer resources and supports such as transportation or assistance scheduling the booster appointment.
• Plans are improving vaccine accessibility by ensuring they have educational materials about the booster shot for members who speak languages other than English, are deaf/hard of hearing, or blind.
• Plans include updated COVID-19 vaccine information on their websites, including information about boosters.
• One plan uses broadcasts and commercials, including a vaccine documentary (8-10 minutes), that explains the science behind the vaccine.
• Plans provide their care managers with the link to share with members to receive at-home rapid tests. Care managers assist members with ordering tests or connect them to local pharmacies.

Targeting outreach to specific groups

• One plan sent a text message to all homebound members with a link to schedule an in-home vaccination, which was facilitated by the state.
• For members who are unable to leave their homes to receive a booster, the care management team assists with arranging a booster in the home setting.
• One plan sent a letter to all unvaccinated immunocompromised members (707 MMP Members) urging them to get their COVID-19 vaccinations, including a booster shot when eligible.
• Plans used texting campaigns that identified those who need the first dose, a second dose, and booster shots.

Working with community partners

• One plan provides Feeding America trucks with flyers about booster shot eligibility and vaccine locations.
• Another plan also partners with community entities to serve as trusted sources of information or “messengers,” particularly among certain racial or ethnic minority groups with lower vaccination rates. These partnerships allow the plan to further their reach, gain the trust of members and the community, and build confidence in COVID-19 vaccines.
• One California MMP partners with 22 Community Based Organizations in San Diego and Los Angeles to improve education and access to all vaccines (including boosters). The health plan sponsored extended hours and pop-up clinics with local partners in Los Angeles that resulted in an increase in booster shots and other vaccines.
• Some plans leverage partnerships with local sports teams. One plan provides banners and flyers throughout the basketball season. Another plan partnered with a local minor league soccer team to conduct vaccination outreach during games. Other plans use professional sports figures in public service announcements and advertising campaigns promoting vaccination.

Provider education

• One plan includes information about the booster shot in their provider newsletter, asking that providers promote the booster with MMP members.
• Another plan ensures that their provider network is properly equipped with materials and resources to share accurate information with their members and to promote confidence in the COVID-19 vaccine.

Multi-prong messaging and outreach

• Plans share information with members through auto-dialer messaging, offering home vaccination and information on vaccine events.
• Some plans leverage multiple outreach approaches to members for booster shots, including a letter, postcard, and email reminders.
• Several plans conduct direct outreach to members (including text, mail, and digital campaigns) promoting the booster.
• One plan conducted a partner mailing with providers including a letter and a vaccine safety flyer.
• Some plans discuss vaccine hesitancy and booster shots in Enrollee Advisory Committee calls.

Events

• One plan hosted vaccine events in various cities to increase their members’ access to vaccines including boosters; this plan targeted the cities with the highest percentages of this plan’s members.
• Another plan partnered with their county to host community vaccine sites at their Community Resource Centers in some of the member communities with high rates of unvaccinated members. These vaccine clinics at Community Resource Centers are paired with food distribution services to address the high demand for food access from member communities.

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¹ Centers for Disease Control and Prevention. Covid Data Tracker Weekly Review. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html.

² U.S. Food & Drug Administration (2022). Coronavirus (COVID-19) Update: FDA Authorizes Second Booster Dose of Two COVID-19 Vaccines for Older and Immunocompromised Individuals. Retrieved from https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-second-booster-dose-two-covid-19-vaccines-older-and.

³ Centers for Medicare & Medicaid Services. (2021). Preliminary Medicare COVID-19 Data Snapshot. Retrieved from https://www.cms.gov/files/document/medicare-covid-19-data-snapshot-fact-sheet.pdf.

⁴ Centers for Disease Control and Prevention (2023). Stay Up to Date with COVID-19 Vaccines. Retrieved from Stay Up to Date with COVID-19 Vaccines | CDC.