On September 17, California Governor Gavin Newsom signed Assembly Bill 144 (AB 144) into law, a move in response to recent changes in immunization recommendations by the U.S. Food and Drug Administration (FDA). The bill, which took effect immediately, mandates that health plans cover a wide range of preventive care services, including immunizations, without cost-sharing or utilization management. This legislation is particularly noteworthy for its implications on vaccine coverage requirements.
Among other federal health policy changes, the FDA’s recent updates to COVID-19 vaccine approvals, limiting them to individuals 65 years and older or those with specific risk factors, prompted California to reassess its vaccine coverage policies. AB 144 authorizes California public health officials to base immunization guidance on data from independent medical organizations rather than federal sources, and ensures that despite changes in federal policy, Californians continue to have access to and coverage for immunizations and other preventive care in line with California state recommendations.
Highlights of AB 144
- Immediate Compliance Required: AB 144’s provisions are effective immediately, necessitating prompt adjustments in coverage policies by insurance companies and operational protocols by pharmacies.
- Expanded Coverage Mandates: The bill requires health plans to cover preventive care items and services recommended by the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices as of January 1, 2025. Additionally, the California Department of Public Health (CDPH) is empowered to supplement these recommendations based on data from independent medical organizations not tied to federal health agencies. Importantly, with respect to women, infants, children, and adolescents, plans must cover without cost-sharing the evidence-informed preventive care services and screenings contained in the comprehensive guidelines supported by the U.S. Health Resources and Services Administration.
- No Cost-Sharing: Insurance companies and health care service plans must ensure that these services are covered without imposing cost-sharing on enrollees in California, notwithstanding changes to federal standards. This includes immunizations for COVID-19, RSV, and influenza, as recently recommended by the CDPH.
While the Department of Managed Health Care has issued guidance to health care service plans through an All Plan Letter, it is crucial for insurance companies to note that AB 144 also applies to entities regulated by the California Department of Insurance.