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Americans are now being asked to roll up their sleeves on a regular basis to be inoculated against yearly waves of COVID-19, but a complicated web of rules about how the vaccines are paid for has thrown up barriers for some of the people who need it most.

Fatigue over coronavirus messaging has also driven down vaccination rates, health officials acknowledged at a panel in Long Beach Monday, something that’s complicating the rollout of a newly approved COVID shot that the U.S. Centers for Disease Control and Prevention plans to update on a yearly basis like the flu vaccine.

The CDC says September and October are the best months to get vaccinated to guard against expected winter surges. So, if you want a new COVID shot, how do you go about getting one in Long Beach? It depends a lot on your situation.

For the insured

The good news is anyone with private insurance or Medi-Cal should be able to schedule a visit at a pharmacy and provide their insurer’s details to have the cost billed to them. Major retailers like CVS and Rite Aid have said they plan to administer the new vaccines aimed at the latest variants of COVID in the coming days, while Walgreens said it would begin scheduling appointments after Sept. 6.

But it might be tricky to navigate for some. Most insurance plans are required to cover recommended vaccines under the Affordable Care Act, but some, like Kaiser Permanente, won’t cover shots administered by out-of-network providers.

Residents are also asked not to seek out Long Beach Public Health for a COVID shot.

For the uninsured

Sandy Wedgeworth, who directs the city’s communicable disease and emergency response bureau, said their vaccine stockpile is only available to those who are uninsured or underinsured — about 8% of the city’s population, or 37,000 people. While costs can be billed from a pharmacy to a private provider, the same cannot be done by the city health department.

“I don’t really know why,” said Lindsey Megee, the city’s mobile vaccination coordinator.

Wedgeworth said this is contributing to “horrible” local vaccination rates. In 2022, the city’s mobile vaccination team — which offered shots to seniors or those with disabilities — administered nearly 39,000 doses. In 2023, the number fell to 1,733. Since January, Long Beach city health officials have only vaccinated 97 people.

“The trend is horrible,” Sandy said. “We are not getting people vaccinated.”

As of this month, Wedgeworth said nearly 400 people are waiting for an in-home COVID-19 vaccine from the city team. They won’t be able to receive it, Wedgeworth said, because of the system in place.

“Due to program eligibility requirements, none of these clients are able to receive a vaccine from the team,” Wedgeworth wrote.

Low demand and lack of funding

Those who go to their local doctor may experience difficulty finding the vaccine, as many providers don’t carry it due to low demand. In an online query on Tuesday of the state’s My Turn website, the nearest listed provider that carried the vaccine was in Compton. “Right now, there’s not a single provider in Long Beach that’s providing a COVID vaccine, at least on the website,” McGee said. “Which is really crazy.”

And for those without insurance, the future may be uncertain. Vaccines have since last year been funded through the CDC’s Bridge Access Program. Funds were previously forecasted to last until December. Then officials got an email saying the program would end this month, before the fall rollout of updated vaccines.

Megee said that the California Department of Public Health has since said it would provide cities with vaccines but hasn’t said how many.

“It could be that we’re getting 100 doses, or it could be that we’re getting 1,000 (doses),” Megee said. “We just don’t know.”

This means that many uninsured residents will be stuck with a sizable out-of-pocket payment if they want the new vaccine — $201.99 at CVS if you don’t have any insurance, according to a KFF Health News report.

City officials are currently weighing the out-of-pocket cost themselves: They could buy a carton of 10 doses for the Pfizer and Moderna vaccines for between $1,162 and $1544, respectively.

The arrival of the latest vaccines comes amid a surprisingly powerful summer COVID wave — the strongest in terms of infections since 2022. Positive test rates across Los Angeles County reached 14.3% at the start of August, with hospitals averaging 479 cases and 403 COVID-positive hospitalizations each day, according to county statistics.

Wedgeworth said in Long Beach, there have been more than 1,100 reported cases and 56 hospitalizations since July, though these numbers are “vastly” underreported as many self-test at home. By comparison, Wedgeworth said they were testing 10,000 people and vaccinating 6,000 people a day at the height of their COVID-19 response.