COVID-19 vaccination rates for people on Medicaid in Berkshire County lag significantly behind the general population, according to data from one insurance provider.
As of Aug. 10, slightly less than 46 percent of Berkshire Fallon Health Collaborative members 12 and older were vaccinated fully, compared with 68 percent of all eligible Berkshire County residents, according to the collaborative and the Massachusetts Department of Public Health.
“While this is comparable to figures being seen across the state [for Medicaid enrollees], we are troubled by the low COVID-19 vaccination rates ... especially now as the delta variant spreads,” said Dr. Linda Weinreb, vice president and medical director for the Medicaid programs and Accountable Care Organizations at Fallon Health.
The Berkshire Fallon Health Collaborative covers medical care for MassHealth recipients who are insured through Fallon Health, live in or near Berkshire County and have primary care providers at Berkshire Health Systems, Community Health Programs and other local doctor’s offices. That means many, but not all, local Medicaid recipients get their care through the collaborative, which has about 17,000 members eligible for vaccination.
The state-provided vaccination rate for the general Berkshire County population might be inflated, since the rate is based on census estimates, rather than the 2020 census, and likely includes a number of second-home owners who got vaccinated in the Berkshires but are not counted in the region’s total population.
But, the vast difference in vaccination rates between Medicaid enrollees and the general population still underlies the challenge of immunizing low-income residents, even in one of the most vaccinated states in the country.
The data also illustrates the risk for the county’s lower-income population as the delta variant continues to kill people in Berkshire County and across the state.
Insurance, income linked to vaccination rate
Across the country, local and state data shows massive disparities between Medicaid patients and the general population. Those gaps are evident in states with high overall vaccination rates, such as Oregon, and those with far lower rates, such as Louisiana.
In Florida, one recent report showed that only 34 percent of eligible residents on managed care Medicaid plans had received at least one shot, compared with 66 percent statewide.
Links between wealth and higher vaccination rates also have been evident since early in the rollout. In May, a Kaiser Family Foundation analysis found that counties with a high share of people living in poverty had vaccination rates well below those counties with a low share of people living in poverty.
In Massachusetts, county-level data also shows a link between higher median income and higher vaccination rates.
Out of the state’s 14 counties, the four with the highest reported rates of fully vaccinated residents had a median household income of almost $90,000, according to U.S. Census data, and a poverty rate of 6.5 percent. The four counties with the lowest vaccination rates had a median income of about $71,000, with an average of 11 percent of residents living in poverty.
Doctors and public health experts say there are many reasons why low-income populations, including Medicaid patients, have lower vaccination rates.
“In some cases, some members of this population may be hard to reach or have competing demands that make getting the vaccine difficult,” Weinreb said. “Even when we are able to connect, some members are declining the vaccine.”
Fallon outreach has shown that many enrollees distrust the vaccine or are waiting for advice from their primary care physician, according to the organization. Fallon also cited transportation and linguistic barriers, especially in the Berkshires, where many residents live far from vaccine clinics and pharmacies.
Michael Leary, spokesperson for Berkshire Health Systems, said distrust of mRNA technology, as well as the lack of full Food and Drug Administration approval, have slowed vaccine uptake.
“And some younger Berkshire Fallon Health Collaborative members feel they don’t need it due to their age,” he added.
Medical providers and Fallon Health say they have tried to use targeted campaigns to push up vaccination rates, including through email, social media and automated text messages.
Fallon Health has identified unvaccinated and partially vaccinated members through state data and used that information for outreach, according to the organization. Leary said local vaccine providers also use that information to guide where they host pop-up clinics.
Meanwhile, the BFHC Mobile Health Unit, operated by Community Health Programs, continues to serve as one of the county’s key outreach methods to segments of the population less likely to get vaccinated — including low-income residents, non-English speakers, undocumented residents and people living in more rural areas.
Michelle Derr, director of family services at CHP, leads a team that brings up to 200 shots each day around the county with the van.
Four minutes before the start of a pop-up vaccine clinic in a Great Barrington parking lot, …
After months spent talking to people about their vaccine hesitancy, Derr knows just how tricky it can be to reach the unvaccinated, including those on MassHealth and people with no insurance at all. Lately, the number of first doses the team can administer has dropped to a trickle, she says.
“It’s tough,” she said. “There are so many reasons why someone doesn’t want to get vaccinated. You can’t just say, ‘Trust us.’ You have to have deeper conversations.”
Many of the people the vaccination team seeks out have no primary care provider — that is, they are listed as patients with CHP or another organization but the patient never has been to the office and does not know their own care provider. That means Derr and her team have to build the relationship, and the trust, that other people already might have with their doctor.
Many also are homeless and struggling with mental health issues, Derr says. One man at a recent clinic approached the van hesitantly and went through numerous excuses, including that he never gets sick, before admitting that he had a deep fear of needles. The previous time he received a shot, the man told Derr, he reacted violently and ended up in a hospital psychiatric unit.
“I think a lot of mental health issues and baggage has somehow become attached to the vaccine,” Derr said. “To give the COVID shot, you have to get through a lot of other baggage; that’s what we’re finding.”
The team did not manage to persuade him to get vaccinated, but he was signed up for a CHP program that he was eligible for, and the team plans to keep talking to him about the COVID-19 vaccine.
“We just have to develop that trusting relationship with him and have more conversations,” Derr said. “I’m pretty sure we’ll get him.”
As she speaks with people who change their minds and decide to get the shot, she also has found that the full FDA approval has not made a difference, though that could change with time.
“No one said yet that [FDA approval] was the reason they got vaccinated,” she says. “It was just another excuse for the real reasons they’re not doing it, which are deeply personal and they’re not going to share.”
The Biden administration has urged states to offer financial incentives to Medicaid enrollees who get vaccinated. In the Berkshires, Community Health Programs has distributed gift cards at vaccination sites, though the state has not put in place formal financial incentives for MassHealth members.