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Asthma Medication Ratio: Ages 5 to 18

DOMAIN: Chronic Conditions

Asthma affects almost six million children under age 18 in the United States. Long-term asthma control medications are recommended for children with persistent asthma. Uncontrolled asthma among children can result in:

  • Emergency Department visits
  • Hospitalizations
  • Lost school days
  • Higher risk of falling behind in school

Explore the percentage of children and adolescents with persistent asthma who were dispensed appropriate asthma controller medications in each state.  Higher rates are better on this measure.

The purple dashed line represents the median, or middle, of all values reported.

This measure reports state performance on the percentage of children and adolescents ages 5 to 18 who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year.

The Centers for Medicare & Medicaid Services has launched the Improving Asthma Control Learning Collaborative to support state Medicaid and CHIP agencies’ efforts to improve health outcomes among beneficiaries with asthma. This measure also aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on controlling asthma. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen.

States voluntarily report on Asthma Medication Ratio: Ages 5 to 18 (AMR-CH) as part of the Core Set of Children's Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Child Core Set measure specifications.

The included populations for Child Core Set measures can vary by state. For example, some states report a single combined rate for both the Medicaid and CHIP populations, but other states report separate rates for these populations. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states.

Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Asthma Medication Ratio: Ages 5 to 18 (AMR-CH) measure, visit Child Health Care Quality Measures.


The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following state did not report data to the Centers for Medicare & Medicaid Services (CMS) for ages 5 to 18: VA. The following state did not report data for ages 5 to 11 or 12 to 18: ME. The following states did not report for any age group: CO,  ID, IL, MT, NE, NV, PR, OR, and SD.

The Child Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans.

Unless otherwise specified:

  • States used Child Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications.
  • Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments.
  • The measurement period for this measure was January 2018 to December 2019. AZ reported data for FFY 2019 and AL (CHIP), ND, and WY (CHIP) reported data for CY 2019.
# = Rate not reported because denominator is less than 30.

DS = Data suppressed because data cannot be displayed per the Centers for Medicare & Medicaid Services’ cell-size suppression policy, which prohibits the direct reporting of data for beneficiary and record counts of 1 to 10 and values from which users can derive values of 1 to 10.

ACO = Accountable Care Organization; ADHD = Attention-Deficit/Hyperactivity Disorder; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CPT = Current Procedural Terminology; CY = Calendar Year; ED = Emergency Department; EPSDT = Early and Periodic Screening, Diagnostic, and Treatment; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner.