Well-Child Visits in the First 15 Months of Life

About This Measure

This measure shows state performance based on the percentage of children receiving six or more visits by 15 months. This measure reports the percentage of children who turned 15 months old during the measurement year and who had 6 or more well-child visits with a primary care practitioner during their first 15 months of life. 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.

The American Academy of Pediatrics and Bright Futures recommend nine well-care visits by the time children turn 15 months of age. These visits should include:

  • A health history
  • Physical examination
  • Immunizations
  • Vision and hearing screening
  • Developmental/behavioral assessment
  • Oral health risk assessment
  • Parenting education on a wide range of topics

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

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Stem plot with a median of 61% and the states and values:

State Percent
Alaska 73%
Alabama* 61%
Arkansas 35%
Colorado 45%
Connecticut 80%
Dist. Of Col. 56%
Delaware 71%
Florida 58%
Georgia 67%
Hawaii 73%
Iowa* 50%
Idaho 58%
Illinois 60%
Indiana 72%
Kansas 59%
Kentucky 62%
Louisiana 51%
Massachusetts 83%
Maryland 67%
Maine 70%
Michigan* 66%
Minnesota 58%
Missouri 58%
Mississippi** 60%
Montana** 43%
North Carolina 61%
Nebraska 41%
New Hampshire* 73%
New Jersey 66%
New Mexico* 49%
Nevada* 53%
New York 65%
Ohio 50%
Oklahoma 68%
Oregon 63%
Pennsylvania 70%
Rhode Island 81%
South Carolina 54%
Tennessee* 58%
Texas* 54%
Utah* 59%
Virginia 62%
Vermont 67%
Washington 53%
West Virginia* 64%
Wyoming* 29%

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: AZ, CA, ND, 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 measurement period for this measure was January 1, 2015 to December 31, 2015.

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 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.

AK: Rate includes FFS population.

AR: Rate includes FFS and PCCM populations.

CO: Rate includes FFS, PCCM, and managed care populations (6 MCOs). Rate excludes 1 MCO, representing less than 1 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 14,061.

DE: Rate includes managed care population (1 MCO), representing 47 percent of the population. Rate excludes FFS population (representing 6 percent of the population) and enrollees in 1 MCO due to continuous enrollment requirements (representing 47 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 3,061.

FL: Rate includes FFS, PCCM, and managed care populations (21 MCOs). Denominator is the sum of the samples; measure-eligible population is 43,554.

GA: Rate includes managed care population (3 MCOs), representing 80 percent of the population. Rate excludes FFS population and enrollees in one MCO, in which most enrollees moved in and out of managed care and did not meet continuous enrollment criteria. Rate is calculated by MCOs and compiled by the state's EQRO. Denominator is the sample size; measure-eligible population is 28,342.

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. 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 31,082. Rate was calculated by the state's EQRO.

IA: Rate includes FFS, PCCM, and managed care populations (1 MCO). State did not use provider specialty to identify visits because the field was not complete in state data. 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). Denominator is the sample size; measure-eligible population is 15,402. Rate was 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. Rate was derived using both hybrid method and administrative method data. Four MCOs calculated the rate using the hybrid method and one MCO used the administrative method. Denominator is the measure-eligible population. Rate was calculated by the state's EQRO and data analytics contractor.

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

ME: Rate includes FFS population.

MD: Rate includes managed care population (7 MCOs), representing more than 90 percent of the population. Rate excludes FFS population, representing less than 10 percent of the population. State excluded 1 MCO that used the administrative method. Denominator is the sample size; measure-eligible population is 20,020. 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 17,402. 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: Rate includes CHIP managed care population (2 MCOs). Denominator is the sample size, which is equivalent to the measure-eligible population.

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 18,605.

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 7,953. 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 2,588.

NJ: Rate includes managed care population (4 MCOs), representing 43 percent of the population. Rate excludes one MCO due to unreliable rate (representing 47 percent of the population) as well as the FFS population (representing less than 10 percent of the population). Denominator is the sample size; measure-eligible population is 9,491.

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 14,173.

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.

NC: Rate includes FFS and PCCM populations.

OH: Rate includes FFS and managed care populations (5 MCOs). Rate was derived using both administrative and hybrid method data. Rate for the FFS population was calculated using the administrative method and the rate for the managed care population was calculated using the hybrid method. Denominator is the total measure-eligible population.

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.

OR: Rate includes managed care population (16 CCOs), representing 87 percent of the population. Rate excludes FFS population, representing 13 percent of the population. Rate includes well-care visits provided by any provider type.

PA: Rate includes managed care population (19 MCOs). Rate was derived using both administrative and hybrid method data. Eighteen MCOs used the hybrid method and one MCO used the administrative method. Denominator is the measure-eligible population. 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 4,989.

SC: Rate includes FFS and managed care populations (6 MCOs).

TN: Medicaid rate includes Medicaid managed care population (4 MCOs). Denominator is the sample size; measure-eligible population is 31,725. Rate was calculated by the state's EQRO.

TX: Rate includes FFS and managed care populations (19 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. Denominator is the sample size; measure-eligible population is 5,637. 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 assumed that the targeted medical codes were associated with the appropriate providers and thus did not apply the screen that the visit must occur with a PCP. For well-child visits during the first 15 months, mothers were identified where possible, and claims for well-infant visits per the specified CPTs during the first 60 days after birth were added to the infant claims for the child because claims for a newborn can be put on the mother's identification number during this period.

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 6,438. Rate was calculated by the state's EQRO and data analytics contractor.

WY: Medicaid rate includes FFS population.