HCA medical director: federal vaccine guidance changed but PEB coverage unchanged; state law gives DOH authority

Dr. Heather Schultz, medical director for the ERB division, told the board that federal vaccine recommendation processes changed in 2025—some HHS actions bypassed the traditional ACIP process and ACIP also made revisions—prompting confusion among patients and providers. She emphasized that these procedural shifts did not produce new evidence of safety or effectiveness and that, for PEB members, preventive vaccines that are evidence‑based remain covered with no cost sharing under the Affordable Care Act.

"The bottom line is there's no coverage changes," Schultz said, listing examples (newborn Hepatitis B, routine MMR at age 1 and annual respiratory vaccines) and noting that Medicare plan coverage rules for Medicare retirees continue to follow CMS guidance. Staff added that the legislature passed House Bill 2242, which replaces ACIP as the statutory source for commercial‑insurer coverage decisions with the Washington State Department of Health and directs the state to look to regional partnerships such as the West Coast Health Alliance for guidance.

Why it matters: staff said communication to members is a priority because the federal change created a confusing information environment. The board discussed centralizing vaccine coverage information on a PEB landing page and working with community partners to reach members who may not use digital channels.