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Immunizations for Adolescents: Age 13

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 by their 13th birthday in each state:

  • 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 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 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 calculation methods 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. States can also choose to calculate this measure using the administrative or hybrid method. This variation in populations 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 for this measure cannot be trended from FFY 2017 to 2019.

Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set FFY 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Immunizations for Adolescents (IMA-CH) measure, 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: AR, AZ, ID, IA, ME, and MT.

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) 2019 specifications. The following states used NCQA 2018 specifications: 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, 2018 to December 31, 2018.

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; 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.