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Immunizations for Adolescents

A key indicator of the continuity of primary care is whether adolescents are up to date on their immunizations. Continuity of primary care is essential for high-quality, cost effective patient care.

Explore the percentage of adolescents who received the recommended immunizations:

  • Tetanus, diphtheria toxoids, and acellular pertussis vaccine (Tdap) and the meningococcal vaccine (Combination 1 rate)
  • Human papillomavirus (HPV) vaccine (HPV rate)

Higher rates are better.

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

This measure reports the percentage of adolescents who turned 13 years old during the measurement year and had up to date vaccinations on three types of vaccines:

  • Meningococcal vaccine
  • Tdap vaccine
  • HPV vaccine series

States calculate a rate for each vaccine as well as two combination rates for this measure. These data show state reporting for (1) the Combination 1 rate—the percentage receiving both meningococcal and Tdap vaccines—and (2) the HPV vaccine rate.

States voluntarily report on Immunizations for Adolescents (IMA-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 and reporting methods for Child Core Set measures can vary by state. For example, some states report data on certain populations such as those covered under managed care but not those covered under fee-for-service (FFS). This variation in data and calculation methods can affect measure performance and comparisons between states.

Specifications for the HPV Vaccine rate changed substantially for Federal Fiscal Year (FFY) 2018. Rates are not comparable with rates reported for previous years.

Immunizations for Adolescents

Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports as of June 3, 2019 for the Child Core Set FFY 2018 reporting cycle; see 2018 Child and Adult Health Care Quality Measures. For more information on Immunizations for Adolescents (IMA-CH) visit Child Health Care Quality Measures.


The following state did not report data for the Combination 1 rate: CA. The following states did not report either the HPV or Combination 1 rate: AK, AR, CO, ID, ME, ND, and OH.

The Child Core Set specifications include guidance for calculating this measure using the administrative method or the hybrid method. The hybrid method uses a combination of administrative and medical records data to identify services included in the numerator or to determine exclusions from the denominator based on diagnoses or other criteria. Unless otherwise specified, administrative data sources are the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans; medical record data sources are paper and/or electronic health records.

Unless otherwise specified:

  • States used Child Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2018 specifications. The following states used NCQA 2017 specifications: NV and OR.
  • Denominators are assumed to be the measure-eligible population for states using the administrative method; states using the hybrid method often reported the sample size for the medical chart review rather than the measure-eligible population. Some states reported exclusions from the denominator, as noted in the state-specific comments.
  • The measurement period for this measure was January 1, 2017 to December 31, 2017. AZ reported data for FFY 2016.

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; 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.