Some Medically-Vulnerable Californians Will Be Vaccine-Eligible Monday, But Barriers Remain

Updated March 12, 10:51 a.m.

Somewhere between four and six million Californians with certain health conditions will become eligible for a COVID-19 under new state guidelines starting Monday, but physicians say it’ll be a challenge to get the vaccine to everyone. 

California’s most medically vulnerable residents between the ages of 16 and 64 — including people living with cancer, type 2 diabetes and obesity — become eligible for vaccine appointments starting March 15. 

Here is the current list of conditions that qualify someone for the vaccine. 

• Cancer, current with debilitated or immunocompromised state
• Chronic kidney disease, stage 4 or above
• Chronic pulmonary disease,  oxygen-dependent
• Down syndrome
• Immunocompromised state (weakened immune system) from solid organ transplant
• Pregnancy
• Sickle cell disease
• Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies (excludes hypertension)
• Severe obesity (Body Mass Index ≥ 40 kg/m2)
• Type 2 diabetes mellitus with hemoglobin A1c level greater than 7.5%

There is also an accommodation for people with other disabilities who would be difficult to treat or likely to die if they caught COVID-19, or who are unable to access vital services due to the threat of the virus. 

The new eligibility criteria also include residents of regional centers, independent living centers, in-home supportive services, and community-based adult services/adult day health centers, plus those with a Medi-Cal HIV/AIDS waiver, Medi-Cal home, community-based alternatives waiver, or Medi-Cal assisted living waiver. Public transit workers — including airport workers for commercial airlines — will also be eligible.

The state guidelines, updated March 11, say people on this list “are strongly encouraged to seek vaccination with a primary health care provider or system, or in an alternate clinical setting.” Current guidelines don’t specify whether this group can receive doses at mass vaccination clinics and whether a doctors’ note is required.

Until now, only seniors, long-term care facility staff and residents, health workers and people in the education, food and agriculture and public safety sectors have been eligible for the vaccine.  

Initially, people with chronic medical conditions were in line to be vaccinated after people age 75 and up. When the state shifted to an age-based system, the tier including younger, high-risk people was eliminated.

People with chronic disabilities were critical of the state for not prioritizing them, leading state health officials to announce in February that the group would once again be prioritized starting March 15.

As California is still short on doses of vaccine, physicians will ultimately have discretion over which of their patients to approve for vaccination first when the rules change next week.

Physicians are concerned about demand outweighing supply. UC Davis Health is notifying patients that they “may not have enough vaccination doses to support currently eligible groups after this weekend.”

“Since we’re focused on trying to resolve the immediate issues around vaccine availability, we’re not yet at the point where we have worked out how we will support vaccinating these newly eligible groups,” they wrote in a statement.

The new state guidance says health providers “may use their clinical judgment” to vaccinate individuals

Dr. Jeff Luther, a family physician based in Long Beach, says he’s already started getting phone calls from patients asking about eligibility.

“For instance one last week, a patient saying ‘Hey I have asthma and I’m obese, can I get the vaccine?’ And according to the government lists, his asthma’s not bad enough and he’s not obese enough to qualify,” he said. 

“Clarifying for people ... is going to be a big challenge for doctors’ offices that are already busy trying to provide medical care,” Luther said.

He says physicians are also looking to the state for more guidance on whether patients need a doctors’ note to sign up for their shots.

“Especially because a lot of people who qualify don’t have a relationship with a physician or a medical practice and they kind of would be left in the cold,” he said.

Dignity Health said in a statement that they are “not aware of a doctor’s note or other medical verification requirement, and understand it will rely on the honor system.”

They said they don’t have an estimate on the number of patients in their system who will become eligible Monday. They said they’re also anticipating demand from patients outside their system, who will be able to book appointments at Dignity Health sites through the state’s vaccine portal.