The Recommended Childhood and Adolescent Immunization Schedule is approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) and available on the Centers for Disease Control and Prevention website.

At each non-emergency primary care visit with members less than 21 years of age, the member (if an emancipated minor), or the parent(s) or guardian of the member, must be advised of the vaccinations due and available immediately, if the member has not received vaccinations in accordance with ACIP standards. Documentation must be entered in the member's medical record which must indicate the receipt of vaccinations or proof of prior vaccination in accordance with ACIP standards. If vaccinations that could be given at the time of the visit are refused, documentation must be entered in the member's medical record which must indicate the vaccinations were advised, and the member’s (if an emancipated minor), or the parent(s) or guardian of the member’s voluntary refusal of these vaccinations. If vaccinations cannot be given at the time of the visit, then it is required that the medical record must demonstrate that the member was informed how to obtain necessary vaccinations or scheduled for a future appointment for vaccinations.

The following information applies only to participating physician groups (PPGs) and physicians.

Medi-Cal adult members may obtain routine vaccinations that are not subject to prior authorization (PA) from their participating provider or participating pharmacy. The Medi-Cal Rx Contract Drug List for applicable utilization restrictions about age or quantity. The Contract Drug List can be found on the Medi-Cal Rx website.

The financial responsibility for adult immunizations is the same for in-network or self-referral to out-of-network providers. When the Medi-Cal member of a capitated participating physician group (PPG) obtains a vaccine from a participating pharmacy, the cost of the immunization is deducted from the PPG's monthly capitation amount in the same manner as other injectable medications that are the PPG's responsibility. PPGs remain responsible for adult immunizations. 

At each non-emergency primary care encounter the member must be advised of the vaccinations due and available, if the member has not received vaccinations in accordance with ACIP standards. Documentation must be entered in the member’s medical record which indicates the receipt of vaccinations or proof of prior vaccination in accordance with ACIP standards. If vaccinations that could be given at the time of the visit are refused, documentation must be entered in the member’s medical record which must indicate the vaccinations were advised, and the member’s voluntary refusal of these vaccinations. If vaccinations cannot be given at the time of the visit, then it is required that the medical record must demonstrate that the member was informed how to obtain necessary vaccinations or scheduled for a future appointment for vaccinations,