Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life: Ages 3-6

About This Measure

This measure reports state performance based on the percentage of children ages 3 to 6 who had one or more well-child visits with a primary care practitioner during the measurement year. 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 a comprehensive annual preventive visit at ages 3, 4, 5, and 6. These visits should include:

  • A health history
  • Physical examination
  • Immunizations
  • Vision and hearing screening
  • Developmental/behavioral assessment
  • An oral health assessment (at ages 3 and 6)

In addition, these visits should include age-appropriate anticipatory guidance on a range of topics to engage parents in promoting their child's healthy development.

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

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Stem plot with a median of 68% and the states and values:

State Percent
Alaska 48%
Alabama* 60%
Arkansas 60%
California 71%
Colorado 57%
Connecticut 85%
Dist. Of Col. 78%
Delaware 77%
Florida 74%
Georgia 70%
Hawaii 76%
Iowa* 65%
Idaho 48%
Illinois 71%
Indiana 75%
Kansas 65%
Kentucky 71%
Louisiana 63%
Massachusetts 86%
Maryland 81%
Maine 67%
Michigan* 75%
Minnesota 57%
Missouri 65%
Mississippi* 54%
Montana** 45%
North Carolina 69%
Nebraska 56%
New Hampshire* 79%
New Jersey 78%
New Mexico* 56%
Nevada* 65%
New York 84%
Ohio 65%
Oklahoma 57%
Oregon 61%
Pennsylvania 76%
Rhode Island 80%
South Carolina 55%
Tennessee* 68%
Texas* 76%
Utah* 64%
Virginia 74%
Vermont 73%
Washington 63%
West Virginia* 74%
Wyoming* 45%

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, 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. MS (Medicaid) reported data for January 2015 to December 2016.

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.

CA: Rate includes managed care population (26 MCOs), representing 66 percent of the population. Rate excludes the 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 841,458. 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 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 58,898.

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 15,264.

FL: Rate includes FFS, PCCM, and managed care populations (21 MCOs). Denominator is the sum of the samples; measure-eligible population is 391,873.

GA: Rate includes managed care population (3 MCOs), representing 92 percent of the population for the measure. Rate excludes FFS population and enrollees in one MCO, in which most enrollees did not meet continuous enrollment criteria. Rates are calculated by MCOs and compiled by the state's EQRO. Denominator is the sample size; measure-eligible population is 183,334.

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 103,495. Rate was calculated by the state's EQRO.

IA: Medicaid 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 61,658. Rates were calculated by MCOs and compiled by EQRO and state staff.

KY: Rate includes managed care population (4 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 used 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. One MCO used the administrative method and was excluded from the state's rate. Denominator is the sample size; measure-eligible population is 90,961. 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. Rate was derived using both administrative and hybrid method data. Two MCOs used the hybrid method and three MCOs and the PCCM program used the administrative method. Denominator is the measure-eligible population. 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 3,433.

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 67,770.

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 32,534. 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 15,905.

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 136,209.

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 61,191.

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. Sixteen MCOs used the hybrid method and 3 MCOs 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 18,563.

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 168,466. Rate was calculated by the state's EQRO.

TX: Medicaid rate includes FFS and managed care populations (24 MCOs). Rate is derived using both administrative and hybrid method data. Rates for FFS population, STAR HEALTH plans, and STAR+PLUS plans were calculated using the administrative method. Rates for STAR plans were calculated using the hybrid method. Denominator is the measure-eligible population. 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 23,510. 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 assumes that the targeted medical codes are associated with the appropriate providers and thus does not apply the screen that the visit must occur with a PCP.

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 28,733. Rate was calculated by the state's EQRO and data analytics contractor.

WY: Medicaid rate includes FFS population.