COVID-19 Update: Booster Updates and New Medicaid Reimbursement Guidance

Situation Report | October 4, 2021

Booster Vaccine 

The New York State Clinical Advisory Task Force endorsed the recommendations of the U.S. Centers for Disease Control and Prevention (CDC) Director on which individuals should obtain the COVID-19 booster dose:   

New Yorkers who received the Pfizer-BioNTech COVID-19 vaccine should receive their booster dose at least six months after their primary vaccine series IF:  

  • They are 65 years and older or residents in long-term care settings. 
  • They are 50 – 64 years of age with underlying medical conditions.  

New Yorkers who received the Pfizer-BioNTech COVID-19 vaccine may receive their COVID-19 booster dose at least six months after their primary vaccine series IF:  

  • They are 18-49 years with underlying medical conditions, based on your individual benefits and risks. 
  • They are 18 – 64 years and are at increased risk for COVID-19 exposure and transmission because of your occupational or institutional setting, based on your individual benefits and risks.  

At this time, individuals must have received the Pfizer-BioNTech vaccine for their initial vaccine series at least six months ago to be eligible. Individuals who received the Moderna or Janssen/Johnson & Johnson (J&J) vaccine are not currently eligible for a booster dose at this time, but may be in the near future. 

New York has launched a new website with information about booster doses, additional doses, eligibility, frequently asked questions and resources for providers on-the-ground to support in the dissemination of information to eligible populations.

The State will be supporting outreach to all eligible New Yorkers, including through email and SMS-based messages, traditional and digital marketing efforts and local notifications to fully vaccinated New Yorkers through the State’s Excelsior Pass platform. 

Updated Resources 

DOH has posted an updated “Information for Health Care Professionals about the Screening Checklist for the COVID-19 Vaccine Updated: September 29, 2021”; a screening and consent form; and “Guidance for   The New York State COVID-19 Vaccination Program September 29, 2021.”

Medicaid Reimbursement 

The state Department of Health (DOH) has updated the following policy and billing guidance document regarding Medicaid’s reimbursement policy for the administration of COVID-19 vaccines authorized for emergency use and instructions for providers to bill the cost of administration of authorized COVID-19 vaccines: 

Additional information is provided on reimbursement for the Pfizer booster dose. 

This document is available on the COVID-19 Guidance for Medicaid Providers webpage, which is updated regularly with guidance and information.