The North Dakota Department of Health says it can no longer afford to supply free vaccines for all children.

Instead, as of Jan. 1, the department will begin billing the insurance companies of children who have coverage. The move is in reaction to what has been, in effect, a decrease in federal reimbursement.

The change affects about 60 percent of the children in North Dakota, but the state's largest insurer said most parents don't have to worry.

"Generally, across the board, they are likely to see minimal or no change," Dr. Jon Rice, a spokesman for Blue Cross Blue Shield of North Dakota, said. He said most plans cover recommended vaccinations, such as those against polio, chicken pox and measles, mumps and rubella.

Still, the state is urging parents to review their insurance policies so they know what's covered and what isn't prior to the change.

"Every child is precious and deserves to grow up healthy and strong," Dr. Terry Dwelle, the state health officer, said. "Making sure our children are vaccinated is one of the most important ways of protecting their health. I encourage parents to check their insurance policies to see which vaccines are covered by their plans."

More than 80 percent of infants age 19 to 35 months in North Dakota receive their recommended vaccinations, compared to a nationwide average of 77 percent.

"We are among the best states in the country in regards to immunization rates for the children," Dr. Rafael Ocejo, a pediatrician at Bismarck's Medcenter One hospital, said. "Parents play a huge role in this."

But Dwelle said the number of recommended vaccinations has gone up in recent years, while the federal allotment for the state has not. Newer recommendations from the Centers for Disease Control and Prevention include shots against rotavirus, human papillomavirus and meningococcal virus. No additional money has been given to the states to pay for them, however. That's the reason for the shift in policies.

While the change in billing applies to the majority of children and their families, there will be no change for many others. Children who are uninsured, underinsured, eligible for Medicaid or are American Indians will continue to receive free immunizations through Vaccines For Children, a federal entitlement program.

For more information, contact your insurance provider or visit http://www.ndhealth.gov.

(Reach reporter Tony Spilde at 250-8260 or tony.spilde@;bismarcktribune.com.)