FAQs for The HRSA COVID-19 Coverage Assistance Fund
The HRSA COVID-19 Coverage Assistance Fund (CAF) is a program established by and administered by the Health Resources and Services Administration (HRSA), using funds appropriated by Congress under the Provider Relief Fund (PRF). Contractor support is provided by the SSI Group (SSI). The CAF reimburses eligible health care providers for claims associated with COVID-19 vaccine administration provided to underinsured individuals, who are defined for this purpose as having a health plan that either does not include COVID-19 vaccine administration as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing.
The Biden-Harris Administration is providing free access to COVID-19 vaccines for every adult living in the United States. Accordingly, the Health Resources and Services Administration’s (HRSA) COVID-19 Coverage Assistance Fund (CAF) will cover the costs of administering COVID-19 vaccines to patients whose health insurance doesn’t cover vaccine administration fees, or does but typically has patient cost-sharing. While patients cannot be billed directly for COVID-19 vaccine fees, costs to health care providers on the front lines for administering COVID-19 vaccines to underinsured patients will now be fully covered through CAF, subject to available funding. As vaccination efforts accelerate, patients will increasingly gain access to COVID-19 vaccines at locations near where they live with providers they trust.
Cost-sharing, for this purpose, means the share of costs not covered by insurance that a patient would pay out of pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but does not include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. See, e.g., Cost Sharing.
The HRSA COVID-19 Coverage Assistance Fund reimburses providers for claims for COVID-19 vaccine administration provided to individuals who have health insurance, but whose health plan either does not include COVID-19 vaccination as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing. In contrast, the HRSA COVID-19 Uninsured Program reimburses providers who have conducted COVID-19 testing, provided COVID-19 treatment and/or administered Food and Drug Administration (FDA) authorized COVID-19 vaccines under an Emergency Use Authorization (EUA) or FDA-licensed COVID-19 vaccines under a Biologics License Application (BLA) to individuals who did not have any health care coverage at the time the service was rendered. Both programs work toward the goal of supporting providers in increasing access to COVID-19 vaccines for individuals living in the United States. Because claims for underinsured individuals require additional coordination with insurers, however, separate portals have been established for each patient population. More information about the HRSA Uninsured Program can be found at: COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured
The program is being administered by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) through its contractor, The SSI Group (SSI).