States Set Different COVID-19 Vaccination Priorities for People with High-Risk Conditions

People with medical conditions that put them at higher risk of developing serious COVID-19 illness are next in line to get vaccinated in many states, though states are making very different choices about how to prioritize those within this large group, finds a KFF analysis of state policies.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that there are 81 million adults nationwide with conditions that it identifies as posing an increased risk of severe illness from COVID-19 and are therefore recommended to be prioritized for vaccination. This represents a substantial portion of the nation’s population and, with vaccine supply still limited, not all eligible people will be able to get vaccinated immediately. In addition, there are likely millions of others with a second set of medical conditions that the CDC says might put people at increased risk.

Among states that have released detailed information about how they are prioritizing people with high-risk conditions, 14 include all the conditions identified by the CDC as posing an increased risk in this priority group, while most other states vary from the CDC’s priorities, either limiting the high-risk conditions included, adding other conditions considered from the possible risk factor list, or creating their own list altogether. To date, 14 states have not yet shared their list of conditions or allude more generally to “high risk conditions” without detailing them.

The analysis finds:

• As of Feb. 15, 17 states had opened up vaccine eligibility in part or in full to people with high-risk conditions, though additional states are expected to do so over the next few weeks.
• Almost all states that list eligible conditions or rely on the CDC’s list of increased-risk conditions include cancer, chronic kidney disease, chronic obstructive pulmonary disease, heart conditions, organ transplant, sickle cell disease, and Type 2 diabetes in their priority populations. There is less consistency for other increased-risk conditions, including obesity (29 states), pregnancy (27), and smoking (16).
• Six states also include all the conditions that might put people at an increased risk, while others include only some in their priority group. The most common conditions included are Type 1 diabetes (22) followed by immunocompromised state (19) and pulmonary fibrosis (16).
• Most states do not provide detail on if or how eligibility will be confirmed. For those that do, most say they will rely on an individual’s self-attestation that they have a priority condition.

“Currently, if you have a major medical condition like cancer or kidney disease or COPD, how soon you have a chance to get vaccinated clearly depends on what state you live in”, KFF President and CEO Drew Altman said.

The wide variety in state approaches to prioritizing people with high-risk medical conditions mirrors their approaches with other phases of the vaccine rollout, resulting in different prioritization and eligibility across states and posing challenges for residents hoping to learn when they may be eligible.