Immunizations for Adolescents: Age 13

About This Measure

This measure reports state performance on the percentage of adolescents who turned 13 years old during the measurement year and had up-to-date immunizations, including one meningococcal and one Tdap or Td vaccine (Combination 1) by their 13th birthday. Higher rates are better.

The data presented below are taken from the Child Core Set for Federal Fiscal Year (FFY) 2016. Reporting is currently voluntary and reporting methods can vary by state. For example, some states have access to different data on populations covered under fee-for-service as compared to populations covered under managed care. This variation in data availability can impact measure performance. Readers should review the detailed measure notes located after the graph to better understand states’ reported rates.

A key indicator of the continuity of primary care is whether adolescents are up to date on their immunizations. The adolescent immunization measure includes two individual vaccine rates: (1) Meningococcal vaccine and (2) Tetanus, diphtheria, and pertussis vaccine (Tdap) or tetanus and diphtheria vaccine (Td).

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

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Stem plot with a median of 70% and the states and values:

State Percent
Alabama* 74%
Arkansas 48%
California 74%
Colorado 65%
Connecticut 86%
Dist. Of Col. 76%
Delaware 70%
Florida 67%
Georgia 86%
Hawaii 52%
Iowa* 38%
Idaho 57%
Illinois 65%
Indiana 77%
Kansas 62%
Kentucky 72%
Louisiana 88%
Massachusetts 82%
Maryland 85%
Michigan* 87%
Minnesota 79%
Missouri 50%
Mississippi* 47%
Montana** 38%
North Carolina* 66%
Nebraska 53%
New Hampshire* 70%
New Jersey 83%
New Mexico 44%
Nevada* 77%
New York 74%
Oklahoma 22%
Oregon 62%
Pennsylvania 85%
Rhode Island 87%
Tennessee* 67%
Texas* 79%
Utah* 79%
Virginia 59%
Vermont 64%
Washington 72%
West Virginia* 84%
Wyoming* 20%

Source: Mathematica analysis of MACPro reports for the Child Core Set FFY 2016 reporting cycle; see 2016 Child and Adult Health Care Quality Measures.

Notes:

* Indicates that the rate is for the state's Medicaid population only.

** Indicates that the rate is for the state's CHIP population only.

States with no asterisk indicates a rate for the state’s combined Medicaid and CHIP populations.

The following states did not report data to CMS for this measure: AK, AZ, ME, ND, OH, SD, and WI.

Measure Specific Tables (MSTs) available on Medicaid.gov provide important context for understanding state performance on each measure. MSTs include information about variation in included populations, methods, and data sources used to calculate the measure, as well as deviations from Core Set measure specifications.

Unless otherwise specified:

  • States used Child Core Set specifications, based on HEDIS 2016 specifications. The following state used HEDIS 2015 specifications: AR. This table excludes WY (CHIP), which used Child Core Set specifications to calculate the measure but did not provide data for the Combination 1 rate, and SC, which did not use Child Core Set specifications to calculate the measure.
  • The measurement period for this measure was January 1, 2015 to December 31, 2015. NY reported data for CY 2014; AR reported data for July 2013 to June 2014.

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.

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 below.

State-Specific Comments:

AL: Medicaid rate includes Medicaid FFS and PCCM populations. Denominator excludes children enrolled in separate CHIP. Data sources are MMIS and state vital records.

AR: Rate includes FFS and PCCM populations. Data sources are MMIS and state immunization registry. Denominator is the sample size; measure-eligible population is 19,106.

CA: Rate includes managed care population (26 MCOs), representing 66 percent of the population. Rate excludes FFS population (representing 19 percent of the population) as well as managed care enrollees who were not in the same MCO for the entire continuous enrollment period (representing 15 percent of the population). Denominator is the sample size; measure-eligible population is 180,585. Rate is provisional due to changes in the Medicaid program and data systems during this period.

CO: Rate includes FFS, PCCM, and managed care populations (6 MCOs). Rate excludes 1 MCO, representing less than one percent of the population. Rate was calculated by the state's EQRO.

CT: Rate includes FFS population. Denominator is the sample size; measure-eligible population is 14,661.

DE: Rate includes managed care population (2 MCOs), representing 94 percent of the population. Rate excludes FFS population, representing 6 percent of the population. Denominator is the sample size; measure-eligible population is not available.

DC: Rate includes managed care population (4 MCOs), representing 96 percent of the population. Rate excludes FFS population, representing 4 percent of the population. Denominator is the sample size; measure-eligible population is 2,735.

FL: Rate includes FFS, PCCM, and managed care populations (21 MCOs). Denominator is the sum of the samples; measure-eligible population is 66,956.

GA: Rate includes FFS and managed care populations (4 MCOs). Denominator is the sample size; measure-eligible population is 53,520.

HI: Rate includes managed care population (5 MCOs). Rate was derived using both administrative and hybrid method data. One MCO used the administrative method and four MCOs used the hybrid method. Denominator is the measure-eligible population. Rate was calculated by the state's EQRO.

ID: Rate includes FFS and PCCM populations.

IL: Rate includes FFS, PCCM, and managed care populations (13 MCOs). Rejected claims are included. Pending claims are excluded because they are adjudicated in sufficient time to not impact measurement. Administrative data sources are claims, public health registry data, and immunization data from state data system. Rate was audited by the state's EQRO.

IN: Rate includes managed care population (3 MCOs), representing 87 percent of Medicaid children and 97 percent of CHIP children. Rate excludes enrollees in a program for beneficiaries with disabilities who do not require a level of care in a nursing home or through a Section 1915(c) home- and community-based services waiver (representing 3 percent of Medicaid children) and FFS populations (representing 10 percent of Medicaid children and 3 percent of CHIP children). Denominator is the sample size; measure-eligible population is 20,835. Rate was calculated by the state's EQRO.

IA: Medicaid rate includes FFS, PCCM, and managed care populations (1 MCO). State applied optional exclusions. Rate does not include ICD-9 diagnosis code 999.4 with a date of service prior to October 1, 2011. State used a continuous enrollment criterion of a one-month gap per full calendar year. Rate includes paid claims only.

KS: Rate includes managed care population (3 MCOs). Rates were calculated by MCOs and compiled by EQRO and state staff.

KY: Rate includes managed care population (5 MCOs), representing 95 percent of the population. Rate excludes FFS population, representing 5 percent of the population. Denominator is the sample size; measure-eligible population is 20,214. Rate was calculated by the state's EQRO and data analytics contractor.

LA: Rate includes FFS and managed care populations (5 MCOs).

MD: Rate includes managed care population (8 MCOs), representing more than 90 percent of the population. Rate excludes FFS population, representing less than 10 percent of the population. Denominator is the sample size; measure-eligible population is 20,532. Rate was calculated by the state's EQRO.

MA: Rate includes PCCM and managed care populations (5 MCOs). Rate excludes FFS population (representing 20 percent of the population), but the majority of these children would not have been measure-eligible, including children who have other primary insurance, children with limited Medicaid benefits, children in premium assistance programs, new enrollees who have not yet enrolled in an MCO, and children in state custody. Denominator is the sum of the samples; measure-eligible population is 16,317. One MCO used data from CY 2013.

MI: Rate includes Medicaid managed care population (13 MCOs). Rate excludes CHIP population and Medicaid FFS population. Rate was derived using both administrative and hybrid method data. One MCO used the administrative method and 12 MCOs used the hybrid method. Denominator is the measure-eligible population.

MN: Rate includes FFS and managed care populations (8 MCOs). Rate includes paid claims only.

MS: Medicaid rate includes managed care population (2 MCOs), representing 65 percent of the Medicaid population. Rate excludes FFS population, representing 35 percent of the population. Denominator is the sample size; measure-eligible population is 2,057.

MO: Rate includes managed care population (3 MCOs), representing 58 percent of the child Medicaid population and 33 percent of the CHIP population. Rate excludes FFS population (representing 33 percent of the child Medicaid population and 45 percent of the CHIP population) and individuals with both FFS and managed care coverage during the year (representing 9 percent of the child Medicaid population and 22 percent of the CHIP population). Denominator is the sample size; measure-eligible population is 12,996.

MT: Rate includes CHIP FFS population. Rate excludes Medicaid population as well as claims from Federally Qualified Health Centers and Rural Health Clinics because these services are processed separately.

NE: Rate includes FFS and managed care populations (3 MCOs).

NV: Medicaid rate includes managed care population (2 MCOs), representing 75 percent of the population. Rate excludes FFS population, representing 25 percent of the population. Denominator is the sample size; measure-eligible population is 5,783. Rate was calculated by the state's EQRO.

NH: Rate includes managed care population (2 MCOs), representing 90 percent of the population. Rate excludes FFS population, representing 10 percent of the population. Denominator is the sum of the samples for the MCOs; measure-eligible population is 3,104.

NJ: Rate includes managed care population (5 MCOs), representing more than 90 percent of the population. Rate excludes FFS population, representing less than 10 percent of the population. Denominator is the sample size; measure-eligible population is 28,868. Rates were calculated by MCOs and reviewed by the state's EQRO.

NM: Rate includes managed care population (4 MCOs), representing 92 percent of the population. Rate excludes FFS population, representing 8 percent of the population. Denominator is the sample size; measure-eligible population is 13,413.

NY: Rate includes managed care population (19 MCOs), representing 89 percent of the Medicaid population and all CHIP children. Rate excludes FFS population, representing 11 percent of the Medicaid population. Denominator is the sum of the samples.

NC: Medicaid rate includes FFS and PCCM populations. Data source is state immunization registry.

OK: Rate includes FFS and PCCM populations. Rate excludes enrollees in home- and community-based services waivers, representing less than 1 percent of the population. State used a continuous enrollment criterion of any number of allowable gaps up to 45 days in either the measurement year or the year prior. State used a public reporting tool from the State Health Department to calculate this measure. State reported that immunizations may be under-reported due to providers not using immunization codes during well-child visits.

OR: Rate includes managed care population (16 CCOs), representing 87 percent of the population. Rate excludes FFS population, representing 13 percent of the population. Data source is the state's immunization registry.

PA: Rate includes managed care population (19 MCOs). Denominator is the sample size; measure-eligible population is 40,960. Data were submitted by MCOs and compiled by the state's EQRO.

RI: Rate includes managed care population (2 MCOs), representing 98 percent of the population. Rate excludes FFS population, representing less than 2 percent of the population. Denominator is the sample size; measure-eligible population is 3,870.

TN: Medicaid rate includes Medicaid managed care population (4 MCOs). Denominator is the sample size; measure-eligible population is 23,919. Rate was calculated by the state's EQRO.

TX: Medicaid rate includes FFS and managed care populations (24 MCOs). Rate was calculated by the state's EQRO.

UT: Medicaid rate includes managed care population (4 MCOs), representing 86 percent of the population. Rate excludes FFS population, representing 14 percent of the population. Rate was derived using both administrative and hybrid method data. One MCO used the administrative method and three MCOs used the hybrid method. Denominator is the measure-eligible population. Data source is audited HEDIS data for each MCO.

VT: Rate includes FFS population. Rate was calculated by the state's EQRO and data analytics contractor.

VA: Rate includes managed care population (6 MCOs), representing 94 percent of the population. Rate excludes FFS population, representing 6 percent of the population. State obtained rates reported by the MCOs to Quality Compass and denominator is not available.

WA: Rate includes FFS, PCCM, and managed care populations (6 MCOs). State matched Medicaid records with its immunization data to better capture immunization history. State included age-inappropriate or conjugate vaccines for vaccination type of interest when they occurred in immunization data, although these vaccines were not in the specifications.

WV: Medicaid rate includes Medicaid managed care population (4 MCOs), representing 58 percent of the population. Rate excludes the Medicaid FFS population, representing 42 percent of the population. Denominator is the sample size; measure-eligible population is 5,726. Rate was calculated by the state's EQRO and data analytics contractor.

WY: Rate includes FFS population. State attributes its low rate for vaccine combinations to children transitioning in and out of Medicaid during the measurement period because they may receive one or both vaccines while not enrolled in Medicaid and these vaccines would not be captured in Medicaid claims data.