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State Health System Performance
The State Health System Performance measures show how states serve Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries in eight areas:
- Behavioral Health
- Seamless Care Coordination
- Safety
- Wellness and Prevention
- Chronic Conditions
- Affordability and Efficiency
- Person-Centered Care
- Equity
In some cases, states are just beginning to report these voluntary measures. Over time, more states may choose to report these measures and work to incorporate them into quality improvement programs.
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Behavioral Health | Follow-up care after hospitalization for mental illness or intentional self-harm helps improve health outcomes and prevent readmissions. Recommended post-discharge treatment includes a visit with a mental health provider within 30 days after discharge. Ideally, patients should see a mental health provider within 7 days after discharge. Explore the percentage of discharges for children and adolescents ages 6 to 17 in each state who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and had a follow-up visit with a mental health provider within 7 days after discharge and within 30 days after discharge. 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 discharges among children ages 6 to 17 who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health provider within (1) 7 days and (2) 30 days after discharge. Follow-up visits include: Outpatient visits with a mental health provider Intensive outpatient encounters with a mental health provider Partial hospitalizations with a mental health provider Community mental health center visits with a mental health provider Electroconvulsive therapy with a mental health provider Telehealth visits with a mental health provider Observation visits with a mental health provider Transitional care management services with a mental health provider States voluntarily report on Follow-Up After Hospitalization for Mental Illness: Ages 6 to 17 (FUH-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 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. This variation in populations can affect measure performance and comparisons between states. Specifications for this measure changed substantially for Federal Fiscal Year (FFY) 2019. Rates are not comparable with rates reported for previous years. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set FFY 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Follow-Up After Hospitalization for Mental Illness: Ages 6 to 17 (FUH-CH) measure, visit Child Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for either the 7-day Follow-Up or 30-day Follow-Up rate for this measure: CO, DE, ID, MT, PR and UT. The following states reported the measure to CMS, but did not use Child Core Set specifications to calculate the measure: NY and OR. CMS did not include the rates for these states. The Child Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified: States used Child Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications. Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments. The measurement period for this measure was January 2019 to December 2019. AZ reported data for FFY 2019. DS = Data suppressed because data cannot be displayed per the Centers for Medicare & Medicaid Services’ cell-size suppression policy, which prohibits the direct reporting of data for beneficiary and record counts of 1 to 10 and values from which users can derive values of 1 to 10. 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; HCBS = Home- and Community-Based Services; 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. | ||
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Behavioral Health | Follow-up care after hospitalization for mental illness or intentional self-harm helps improve health outcomes and prevent readmissions. Recommended post-discharge treatment includes a visit with a mental health provider within 30 days after discharge. Ideally, patients should see a mental health provider within 7 days after discharge. Explore the percentage of discharges for adults in each state who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and had a follow-up visit with a mental health provider within 7 days after discharge and within 30 days after discharge. 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 discharges among adults age 18 and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health provider within (1) 7 days and (2) 30 days after discharge. Follow-up visits include: Outpatient visits with a mental health provider Intensive outpatient encounters with a mental health provider Partial hospitalizations with a mental health provider Community mental health center visits with a mental health provider Electroconvulsive therapy with a mental health provider Telehealth visits with a mental health provider Observation visits with a mental health provider Transitional care management services with a mental health provider States voluntarily report on Follow-Up After Hospitalization for Mental Illness: Age 18 and Older (FUH-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. 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. This variation in populations can affect measure performance and comparisons between states. Specifications for this measure changed substantially for Federal Fiscal Year (FFY) 2019. Rates are not comparable with rates reported for previous years. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set FFY 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Follow-Up After Hospitalization for Mental Illness: Age 18 and Older (FUH-AD) measure, visit Adult Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for either the 7-day Follow-Up or 30-day Follow-Up rate for this measure: AK, CO, and MT. The following state reported the measure to CMS, but did not use Adult Core Set specifications to calculate the measure: OR. CMS did not include the rates for this state. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified: States used Adult Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications. Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments. The measurement period for this measure was January 2019 to December 2019. AZ and KY reported data for FFY 2019. ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; 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. | ||
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Behavioral Health | Timely follow-up care after an emergency department (ED) visit for mental illness or intentional self-harm may reduce repeat ED visits, prevent hospital admissions, and improve health outcomes. The period immediately after the ED visit is important for engaging individuals in treatment and establishing continuity of care. Explore the percentage of ED visits for adults in each state with a principal diagnosis of mental illness or intentional self-harm with a follow-up visit for mental illness within 7 days of the ED visit and within 30 days of the ED visit. 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 ED visits for adults age 18 or older with a principal diagnosis of mental illness or intentional self-harm and who had a follow-up visit for mental illness within (1) 7 days and (2) 30 days of the ED visit. Follow-up visits include: Outpatient visits Intensive outpatient encounters Partial hospitalizations Community mental health center visits Electroconvulsive therapy Telehealth visits Observation visits States voluntarily report on Follow-up After Emergency Department Visit for Mental Illness (FUM-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. 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. This variation in populations can affect measure performance and comparisons between states. Specifications for this measure changed substantially for Federal Fiscal Year (FFY) 2019. Rates are not comparable with rates reported for previous years. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the FFY 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Follow-Up After Emergency Department Visit for Mental Illness (FUM-AD) measure, visit Adult Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for either the 7-day Follow-Up or 30-day Follow-Up rate: AK, CO, ID, IL, LA, ME, MD, MI, MT, SD, UT, and WY. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified: States used Adult Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications. The following states used NCQA 2019 specifications: OR. Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments. The measurement period for this measure was January 1, 2019 to December 31, 2019. AZ and KY reported data for FFY 2019. Rates displayed reflect state reporting for Medicaid enrollees ages 18 to 64 (39 states), or age 18 and older (1 state). ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; 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. | ||
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Behavioral Health | Opioid use is a growing concern in the United States. The opioid epidemic continues to highlight the need for both preventing inappropriate prescribing and providing access to high quality treatment. High dosage opioid use by people without cancer is an indicator of potential overuse and linked to an increased risk of morbidity and mortality. Explore the percentage of adults who received prescriptions for opioids at high dosage over a period of 90 days or more in each state. Adults with a cancer diagnosis, sickle cell diagnosis, or in hospice are excluded. Lower 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 adults age 18 and older who received prescriptions for opioids with an average daily dosage greater than or equal to 90 morphine milligram equivalents (MME) for 90 days or more during the measurement year. Adults with a cancer diagnosis, sickle cell disease diagnosis, or in hospice are excluded from this measure. States voluntarily report on Use of Opioids at High Dosage in Persons Without Cancer (OHD-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. 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. This variation in populations can affect measure performance and comparisons between states. Specifications for this measure changed substantially for Federal Fiscal Year (FFY) 2019. Rates are not comparable with rates reported for previous years. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Use of Opioids at High Dosage in Persons Without Cancer (OHD-AD) measure, visit Adult Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, CO, DC, FL, GA, ID, IL, IN, KY, ME, MT, NM, NV, OR, PR, RI, UT, VA, and WI. The following states reported the measure to CMS, but did not use Adult Core Set specifications to calculate the measure: NJ, NY, OH, PA, and TX. CMS did not include the rates for these states. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified: States used Adult Core Set specifications, based on Pharmacy Quality Alliance 2020 specifications. Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments. The measurement period for this measure was January 2019 to October 2019. AZ reported data for FFY 2019. Rates displayed in this table reflect state reporting for Medicaid enrollees ages 18 to 64 (26 states) or age 18 and older (2 states). ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; 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. | ||
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Behavioral Health | Treatment for alcohol and other drug (AOD) abuse or dependence can improve health, productivity, and social outcomes. It can also save millions of dollars on health care and related costs. Recommended care for individuals with a new episode of AOD abuse or dependence includes initiating treatment within 14 days of diagnosis (initiation rate) and then continued treatment with two or more additional AOD services or medication treatment within 34 days of the initiation visit (engagement rate). Explore the percentage of adults with a new episode of AOD abuse or dependence who initiated timely treatment and continued engagement with treatment services in each state. This measure reports the treatment initiation and engagement rates among beneficiaries with the following diagnoses: Total AOD Abuse or Dependence Alcohol Abuse or Dependence Opioid Abuse or Dependence Other Drug Abuse or Dependence 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 adults age 18 and older with a new episode of AOD abuse or dependence who (1) initiated timely treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth, or medication treatment within 14 days of the diagnosis (initiation rate) and (2) initiated treatment and were engaged in ongoing AOD treatment within 34 days of the initial visit (engagement rate). States voluntarily report on Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. 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. This variation in populations can affect measure performance and comparisons between states. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Initiation & Engagement of Alcohol & Other Drug Dependence Treatment (IET-AD) measure, visit Adult Health Care Quality Measures. Notes: The following states did not report either the Initiation or Engagement rate for any diagnosis cohorts: AK, AR, CO, DC, ID, ME, MT, NE, NJ, PR, UT, and WY. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. This measure is also specified for calculation using electronic health records. Unless otherwise specified: States used Adult Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications. The following state used NCQA 2019 specifications: OR. Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments. The measurement period for this measure was January 2019 to November 2019. AZ and KY reported data for FFY 2019. Rates displayed reflect state reporting for Medicaid enrollees ages 18 to 64 (30 states) or age 18 and older (10 states). ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; 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. | ||
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Seamless Care Coordination | Without access to high quality outpatient diabetes care, certain diabetes conditions can become life-threatening. These complications may result in costly and avoidable inpatient hospital admissions. Inpatient hospital admissions for these complications can be an indicator that diabetes is not being properly prevented or managed. Explore inpatient hospital admission rates per 100,000 beneficiary months for short-term complications of diabetes in each state. Lower 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 inpatient hospital admission rates for diabetes short-term complications, including: Diabetic ketoacidosis Hyperosmolarity Coma The measure is the rate of inpatient hospital admissions per 100,000 beneficiary months for adults age 18 and older. This measure aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on providing appropriate diabetes care. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen. States voluntarily report on PQI 01: Diabetes Short-Term Complications Admissions Rate (PQI01-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. 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. This variation in populations can affect measure performance and comparisons. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. PQI stands for prevention quality indicators, a set of measures maintained by the Agency for Healthcare Research and Quality (AHRQ). For more information on the PQI 01: Diabetes Short-Term Complications Admissions Rate (PQI01-AD) measure, visit Adult Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, CO, DC, FL, ID, KY, ME, MS, MT, NE, OH, RI, SD, UT, VA, and WI. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified: States used Adult Core Set specifications, based on AHRQ 2020 specifications. Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments. The measurement period for this measure was January 2019 to December 2019. AZ reported data for FFY 2019. Rates displayed reflect state reporting for Medicaid enrollees ages 18 to 64 (34 states) or age 18 and older (2 states). ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; 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. | ||
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Seamless Care Coordination | If a nursing home sends many residents to the hospital, it may indicate that the nursing home is not properly assessing or taking care of its residents. This measure reports the number of unplanned hospitalizations, including observation stays, per 1,000 long-stay nursing home resident days in calendar year 2020. Long-stay resident days are all days after the 100th cumulative day in a nursing home. Lower rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. | CMS calculates this measure using Medicare claims data. Not all of a state’s residents reflected in the data for this measure are enrolled in Medicaid, but Medicaid is the primary payer across the country for long-term care services. |
| State Health System Performance | Source: Provider Data Catalog Note: Data for American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and U.S. Virgin Islands are not available. | ||
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Safety | Antipsychotic drugs are an important treatment for patients with certain mental health conditions, but they are associated with an increased risk of death when used in elderly patients with dementia. The medications also have side effects. If possible, nursing homes should try to address a resident’s expressions of distress by first implementing person-centered approaches that do not involve medications. Addressing each resident’s needs through approaches other than medications—like higher staffing ratios, non-pharmacological interventions, and regular assignment of nursing staff—may lower the use of medications in many cases. This measure reports the percentage of long-stay nursing home residents who received antipsychotic drugs from April 1, 2020 through March 31, 2021. Lower rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. | CMS calculates this measure using data from the Minimum Data Set (MDS). The MDS is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes. Not all of a state’s residents reflected in the data for this measure are enrolled in Medicaid, but Medicaid is the primary payer across the nation for long-term care services. |
| State Health System Performance | Source: Provider Data Catalog Note: Data for American Samoa, Guam, Northern Mariana Islands, and U.S. Virgin Islands are not available. | ||
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Wellness and Prevention | Medicaid is the largest payer for maternity care in the United States. The program has an important role to play in improving maternal and perinatal health outcomes. Timely postpartum visits provide an opportunity to assess a woman’s physical recovery from pregnancy and childbirth. Postpartum visits provide an opportunity to address: Chronic health conditions, such as diabetes and hypertension Mental health status, including postpartum depression Family planning, including contraception and inter-conception counseling Explore the percentage of women delivering a live birth who had a timely postpartum care visit in each state. 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 deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year with a postpartum visit on or between 7 and 84 days after delivery. States voluntarily report on Prenatal & Postpartum Care: Postpartum Care (PPC-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations and calculation methods for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. 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 this measure changed substantially for Federal Fiscal Year (FFY) 2020 and rates are not comparable with rates reported for previous years. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set FFY 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Postpartum Care (PPC-AD) measure, visit Adult Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, AR, AZ, CO, IA, ID, ME, MN, MT, ND, NE, NY, and OR. The following states reported the measure to CMS, but did not use Adult Core Set specifications to calculate the measure: MN and OR. The Adult 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 Adult Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications. 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 October 2018 to October 2019. GA reported data for CY 2018; IN reported data for November 2018 to November 2019; and PR reported data for CY 2019. ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; 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. | ||
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Wellness and Prevention | Medicaid is the largest payer for maternity care in the United States. Infant birth weight is a common measure of infant and maternal health and well-being. Infants weighing less than 2,500 grams at birth may experience serious and costly health problems and developmental delays. Explore the percentage of live births that weighed less than 2,500 grams in each state. Lower 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 live births that weighed less than 2,500 grams in the state during the measurement year. Pregnant women are at higher risk of a low birth weight baby if they have: Chronic health conditions, such as high blood pressure or diabetes Low weight gain during pregnancy High stress levels High-risk behaviors, such as drinking alcohol, smoking cigarettes, or using drugs States voluntarily report on Live Births Weighing Less Than 2,500 Grams (LBW-CH) as part of the Core Set of Children's Health Care Quality Measures. Starting with the Federal Fiscal Year (FFY) 2019 reporting year, states had the option to have CMS calculate this measure using data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Database. CMS calculates this measure for states that do not report the measure or report the measure but do not use Child Core Set specifications. The CDC WONDER Database includes state-submitted natality data that is compiled by the National Center for Health Statistics (NCHS). States that reported the measure using Core Set specifications also had the option to use the rate calculated by CMS using CDC WONDER data. The included populations 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. This variation in populations can affect measure performance and comparisons between states. As a result of the change in the data source used for this measure for some states, rates for FFY 2019 and later are not comparable to rates reported for previous years. |
| State Health System Performance | Source: CMS used two data sources for reporting this measure for the 2020 Child Core Set. The two sources are Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set FFY 2020 reporting cycle as of June 18, 2021 and the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data as of November 24, 2020; see 2020 Child and Adult Health Care Quality Measures. The notes below identify the data source for each state’s rate for FFY 2020. For more information on the Live Births Weighing Less Than 2,500 Grams (LBW-CH) measure, visit Child Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. For FFY 2020, some states calculated and reported a rate in MACPro for LBW-CH using Child Core Set specifications, based on Centers for Disease Control and Prevention 2020 specifications. The Child Core Set specifications include guidance for calculating this measure using state vital records. States may link vital records data to administrative claims data to determine payer source. Denominators are assumed to be the measure-eligible population for states that reported using Child Core Set specifications. Some states reported exclusions from the denominator, as noted in the state-specific comments. The following states calculated and reported the measure in MACPro using Core Set specifications: AL (CHIP), CA, DE, FL, IA, IN, LA, ME, MN, NC, OH, SC, TX, and WV. Additional context for these states is included in the state-specific comments. For states that did not report the measure in MACPro using Child Core Set specifications, CMS calculated LBW-CH using natality data submitted by states and compiled by the National Center for Health Statistics (NCHS) in CDC WONDER. In addition, some states that reported the measure in MACPro using Child Core Set specifications chose to have CMS report the rate based on CDC WONDER data. The rates calculated using CDC WONDER data include resident live births in the state that met the measure eligibility requirements and had a Source of Payment for Delivery of “Medicaid” on the birth certificate. In some states, this group may include deliveries that were paid for by CHIP. Rates for the following states were calculated using CDC WONDER data: AK, AL (Medicaid), AR, AZ, CO, CT, DC, GA, HI, ID, IL, KS, KY, MA, MD, MI, MO, MS, MT, ND, NE, NH, NJ, NM, NV, NY, OK, OR, PA, PR, RI, SD, TN, UT, VA, VT, WA, WI, and WY. The population for all state rates calculated using CDC WONDER data are reported as “Medicaid only” because these rates include births that had a Source of Payment for Delivery of “Medicaid” on the birth certificate. In some states, this group may include deliveries that were paid for by CHIP. 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; HCBS = Home- and Community-Based Services; 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; NCHS = National Center for Health Statistics; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Wellness and Prevention | The American Academy of Pediatrics and Bright Futures recommend nine well-care visits by the time a child turns 15 months of age. Early intervention increases overall wellness and reduces medical costs. Explore the percentage of children who had 6 or more well-child visits in their first 15 months in each state. 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 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 that time. Well-child 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 States voluntarily report on Well-Child Visits in the First 15 Months of Life (W15-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. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Well-Child Visits in the First 15 Months of Life (W15-CH) measure, visit Child Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: ID 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) 2020 specifications. The following state used NCQA 2019 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, 2019 to December 31, 2019. CT reported data for CY 2018 and AZ reported data for FFY 2019. DS = Data suppressed because data cannot be displayed per the Centers for Medicare & Medicaid Services’ cell-size suppression policy, which prohibits the direct reporting of data for beneficiary and record counts of 1 to 10 and values from which users can derive values of 1 to 10. 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; HCBS = Home- and Community-Based Services; 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. | ||
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Wellness and Prevention | The American Academy of Pediatrics and Bright Futures recommend children have at least one well-child visit with a primary care practitioner (PCP) each year. Early intervention increases overall wellness and reduces medical costs. Explore the percentage of children ages 3 to 6 who had at least one well-child visit with a PCP in each state. 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 children ages 3 to 6 who had one or more well-child visits with a PCP during the measurement year. Well-child 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) Parenting education on a wide range of topics States voluntarily report on Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34-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. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34-CH) measure, visit Child Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: ID 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) 2020 specifications. The following state used NCQA 2019 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, 2019 to December 31, 2019. KY reported data for CY 2018 and AZ reported data for FFY 2019. 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; HCBS = Home- and Community-Based Services; 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. | ||
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Wellness and Prevention | The American Academy of Pediatrics and Bright Futures recommend annual well-care visits during adolescence. Annual well-care visits during adolescence promote healthy behaviors, prevent risky ones, and detect conditions that can interfere with physical, social, and emotional development. Explore the percentage of adolescents ages 12 to 21 who had at least one comprehensive well-care visit. 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 ages 12 to 21 who had at least one comprehensive well-care visit with a primary care practitioner (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement year. Comprehensive well-care includes: A physical exam Immunizations Screening Developmental assessment Oral health risk assessment Referral for specialized care if necessary States voluntarily report on Adolescent Well-Care Visits (AWC-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. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Adolescent Well-Care Visits (AWC-CH) measure, visit Child Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: ID 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) 2020 specifications. The following states used NCQA 2019 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 2019 to December 2020. TN (CHIP) reported data for calendar year (CY) 2018 and AZ reported data for FFY 2019. 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; HCBS = Home- and Community-Based Services; 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. | ||
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Wellness and Prevention | 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. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Immunizations for Adolescents (IMA-CH) measure, visit Child Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following state did not report data for the HPV rate: GA. The following states did not report data for either the HPV or Combination 1 rate: AZ, AR, KS, ME, MT, and NY. 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. States may also use immunization registry data to calculate this measure. Unless otherwise specified: States used Child Core Set specifications, based on National Committee for Quality Assurance 2020 specifications. The following states used National Committee for Quality Assurance 2019 specifications: NJ 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 2019 to December 2019. MN and NJ reported data for calendar year (CY) 2018. DS = Data suppressed because data cannot be displayed per the Centers for Medicare & Medicaid Services’ cell-size suppression policy, which prohibits the direct reporting of data for beneficiary and record counts of 1 to 10 and values from which users can derive values of 1 to 10. 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; HCBS = Home- and Community-Based Services; 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. | ||
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Wellness and Prevention | Tooth decay, or dental caries, is one of the most common chronic diseases in children. It is almost entirely preventable through a combination of: Good oral health habits at home A healthy diet Early and regular use of preventive dental services Explore the rate of preventive dental service use by children and adolescents in each state. 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 children and adolescents ages 1 to 20 who were enrolled in Medicaid or Children’s Health Insurance Program (CHIP) Medicaid Expansion programs for at least 90 days, are eligible for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, and who had at least one preventive dental service during the measurement period. States report data for this measure on Form CMS-416, which is used by CMS to collect information about the EPSDT benefit. Starting with the Federal Fiscal Year (FFY) 2020 reporting year, states had the option to have CMS calculate Form CMS-416 using the Transformed Medicaid Statistical Information System (T-MSIS) data that the state submitted to CMS. Data for the Percentage of Eligibles Who Received Preventive Dental Services (PDENT-CH) measure are included in the Core Set of Children's Health Care Quality Measures. As a result of the change in the data source used for this measure for some states, rates for FFY 2020 and later are not comparable to rates reported for previous years. |
| State Health System Performance | Source: Mathematica analysis of FFY 2020 Form CMS-416 reports (annual EPSDT report), Lines 1b and 12b as of July 2, 2021, for the Child Core Set FFY 2020 reporting cycle; see 2020 Child and Adult Health Care Quality Measures. For more information on the Percentage of Eligibles Who Received Preventive Dental Services (PDENT-CH) measure, visit Child Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following state did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: ID and PR. For FFY 2020, some states calculated and submitted their Form CMS-416 reports, while others chose to have CMS produce their Form CMS-416 reports using Transformed Medicaid Statistical Information System (T-MSIS) data. Rates for FFY 2020 are not comparable with rates for previous years due to a data source change in some states. The following states calculated and submitted their Form CMS-416 reports to CMS: AK, AL, AZ, CA, CO, DC, FL, HI, KS, LA, MA, ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, WI, WV, and WY. CMS produced Form CMS-416 reports using T-MSIS data for the following states: AR, CT, DE, GA, IA, IL, IN, KY, MD, MS, NM, NV, OH, OR, PA, SD, VT, and WA. | ||
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Wellness and Prevention | Breast cancer causes approximately 42,000 deaths in the United States each year. The U.S. Preventive Services Task Force recommends that women between the ages of 50 to 74 undergo mammography screening once every two years. Early detection via mammography screening and subsequent treatment can reduce breast cancer mortality for women in this age range. Explore the percentage of women ages 50 to 74 who had a mammogram to screen for breast cancer in each state. 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 women ages 50 to 74 who received a mammogram to screen for breast cancer during the measurement year or two years prior to the measurement year. States voluntarily report on Breast Cancer Screening (BCS-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. 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. This variation in populations can affect measure performance and comparisons between states. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Federal Fiscal Year (FFY 2020) reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Breast Cancer Screening (BCS-AD) measure, visit Adult Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, AR, MT, OR, and SD. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. This measure is also specified for calculation using electronic health records. Unless otherwise specified: States used Adult Core Set specifications, based on National Committee for Quality Assurance 2020 specifications. Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments. The measurement period for this measure was January 2019 to December 2019. AZ and KY reported data for FFY 2019. Rates displayed in this table reflect state reporting for Medicaid beneficiaries ages 50 to 64 (32 states) or ages 50 to 74 (15 states). ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; 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. | ||
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Chronic Conditions | Asthma affects almost six million children under age 18 in the United States. Long-term asthma control medications are recommended for children with persistent asthma. Uncontrolled asthma among children can result in: Emergency Department visits Hospitalizations Lost school days Higher risk of falling behind in school Explore the percentage of children and adolescents with persistent asthma who were dispensed appropriate asthma controller medications in each state. 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 children and adolescents ages 5 to 18 who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year. The Centers for Medicare & Medicaid Services has launched the Improving Asthma Control Learning Collaborative to support state Medicaid and CHIP agencies’ efforts to improve health outcomes among beneficiaries with asthma. This measure also aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on controlling asthma. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen. States voluntarily report on Asthma Medication Ratio: Ages 5 to 18 (AMR-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 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. This variation in populations can affect measure performance and comparisons between states. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Asthma Medication Ratio: Ages 5 to 18 (AMR-CH) measure, visit Child Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following state did not report data to the Centers for Medicare & Medicaid Services (CMS) for ages 5 to 18: VA. The following state did not report data for ages 5 to 11 or 12 to 18: ME. The following states did not report for any age group: CO, ID, IL, MT, NE, NV, PR, OR, and SD. The Child Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified: States used Child Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications. Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments. The measurement period for this measure was January 2018 to December 2019. AZ reported data for FFY 2019 and AL (CHIP), ND, and WY (CHIP) reported data for CY 2019. # = Rate not reported because denominator is less than 30. DS = Data suppressed because data cannot be displayed per the Centers for Medicare & Medicaid Services’ cell-size suppression policy, which prohibits the direct reporting of data for beneficiary and record counts of 1 to 10 and values from which users can derive values of 1 to 10. 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; HCBS = Home- and Community-Based Services; 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. | ||
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Chronic Conditions | Asthma affects nearly 19 million adults in the United States. Long-term asthma control medications are recommended for adults with persistent asthma. Uncontrolled asthma among adults can result in: Hospitalizations Lost work days Reduced productivity Explore the percentage of adults with persistent asthma who were dispensed appropriate asthma controller medications in each state. 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 adults ages 19 to 64 who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year. The Centers for Medicare & Medicaid Services has launched the Improving Asthma Control Learning Collaborative to support state Medicaid and CHIP agencies’ efforts to improve health outcomes among beneficiaries with asthma. This measure also aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on controlling asthma. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen. States voluntarily report on Asthma Medication Ratio: Ages 19 to 64 (AMR-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. 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. This variation in populations can affect measure performance and comparisons between states. |
| State Health System Performance | Source: Mathematica analysis of MACPro reports for the Adult Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Asthma Medication Ratio: Ages 19 to 64 (AMR-AD) measure, visit Adult Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for any age group: AK, ID, IL, IN, MT, NE, NV, OR, PR, and SD. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s MMIS and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified: States used Adult Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications. Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments. The measurement period for this measure was January 2018 to December 2019. AZ and KY reported data for FFY 2019. ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; 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 | ||
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Chronic Conditions | Among diabetic patients, a Hemoglobin A1c (HbA1c) level greater than 9.0% indicates poor control of diabetes. Poor control of diabetes is a risk factor for complications, including renal failure, blindness, and neurologic damage. Explore the percentage of adults with Type 1 or Type 2 diabetes who had their HbA1c in poor control in each state. Lower 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 adults ages 18 to 75 with Type 1 or Type 2 diabetes who had HbA1c in poor control (>9.0%) during the measurement year. This measure aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on providing appropriate diabetes care. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen. States voluntarily report on Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (HPC-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations and calculation methods for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. 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. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (HPC-AD) measure, visit Adult Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, AL, AR, AZ, CO, IL, KY, ME, MI, MN, MO, MT, NC, NE, NY, OK, PR, SC, SD, TX, and WY. The following state reported the measure to CMS, but did not use Adult Core Set specifications to calculate the measure: AR. CMS did not include the rate for this state. The Adult 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. This measure is also specified for calculation using electronic health records. For states that used administrative data only, higher rates on this measure, representing lower performance, may be the result of incomplete information about hemoglobin A1c tests in administrative data. Unless otherwise specified: States used Adult Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications. The following state used NCQA 2019 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 2019 to December 2019. CT reported data for CY 2018. Rates displayed reflect state reporting for Medicaid enrollees ages 18 to 64 (16 states) or ages 18 to 75 (15 states). ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; 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. | ||
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Chronic Conditions | High blood pressure, or hypertension, increases the risk of heart disease and stroke—the leading causes of death in the United States. Controlling high blood pressure is an important step in preventing heart attacks, strokes, and kidney disease. It also reduces the risk of developing other serious conditions. Explore the percentage of adults with a diagnosis of hypertension whose blood pressure was adequately controlled in each state. 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 adults ages 18 to 85 diagnosed with hypertension with adequately controlled blood pressure, defined as less than 140/90 mm Hg, during the measurement year. This measure aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on blood pressure control. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors, including high blood pressure, and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen. States voluntarily report on Controlling High Blood Pressure (CBP-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations and calculation methods for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. 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 this measure changed substantially for Federal Fiscal Year (FFY) 2019. Rates are not comparable with rates reported for previous years. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Controlling High Blood Pressure (CBP-AD) measure, visit Adult Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, AZ, CA, IA, ID, IL, ME, MI, MN, MO, MT, NC, NE, NY, OK, PR, SD, and WY. The following state reported the measure to CMS, but did not use Adult Core Set specifications to calculate the measure: AR. CMS did not include the rate for this state. The Adult 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. This measure is also specified for calculation using electronic health records. Unless otherwise specified: States used Adult Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications. The following state used National Committee for Quality Assurance 2019 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 2018 to December 2019. TN reported data for January 2017 to December 2018 and KY reported data for FFY 2019. Rates displayed reflect state reporting for Medicaid enrollees ages 18 to 64 (16 states) or ages 18 to 85 (17 states). ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; 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. | ||
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Affordability and Efficiency | Unnecessary visits to a hospital emergency department (ED) may indicate lack of access to more appropriate sources of medical care, such as primary care providers or specialists. Excessive visits to the ED can result in overcrowding and increased ED wait times. Understanding the rate of ED visits among children covered by Medicaid and the Children’s Health Insurance Program (CHIP) can help states identify strategies to improve access to and utilization of appropriate sources of care. Explore the rate of ED visits per 1,000 beneficiary months for children and adolescents in each state. Lower 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 rate of ED visits per 1,000 beneficiary months for children up to age 19. States voluntarily report on Ambulatory Care: Emergency Department Visits (AMB-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 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. This variation in populations can affect measure performance and comparisons between states. |
| State Health System Performance | Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Ambulatory Care: Emergency Department Visits (AMB-CH) measure, visit Child Health Care Quality Measures. Notes: The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: CO, ID, MT, and PR. The following states reported the measure to CMS, but did not use Child Core Set specifications to calculate the measure: VA and WI. CMS did not include the rates for these states. The Child Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified: States used Child Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2020 specifications. The following state used NCQA 2019 specifications: OR. Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments. The measurement period for this measure was January 2019 to December 2019. AZ reported data for FFY 2019. 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; HCBS = Home- and Community-Based Services; 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. | ||
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Affordability and Efficiency | In the future, the Scorecard will include a measure that reports on Emergency Department visits among adult Medicaid beneficiaries. |
Measure to be included in a future Scorecard. | State Health System Performance | ||||
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Patient-Centered Care | This measure reports on states’ use of three experience of care surveys administered to long-term services and support (LTSS) beneficiaries. Surveys included in the count are: CAHPS Home and Community-Based Services Survey (HCBS CAHPS) HCBS CAHPS is a cross-disability survey of HCBS beneficiaries’ experience receiving LTSS. The survey is designed to facilitate comparisons across state Medicaid HCBS programs that target adults with disabilities, including frail elderly, individuals with physical disabilities, persons with developmental or intellectual disabilities, those with acquired brain injury and persons with severe mental illness. Please refer to CAHPS Home and Community-Based Services Survey for more information. National Core Indicators (NCI) In-Person Survey NCI is a collaborative effort by developmental disability agencies to gather a standard set of performance and outcome measures on individuals with intellectual or developmental disabilities. Please refer to National Core Indicators for more information. National Core Indicators for Aging and Disabilities (NCI-AD) NCI-AD is a collaborative effort by state Medicaid, aging, and disability agencies to gather a standard set of performance and outcome measures on older adults and individuals with physical disabilities. Please refer to National Core Indicators Aging and Disabilities for more information. Administration of the three surveys is voluntary. States vary in how often they administer surveys and the proportion of the LTSS population covered by surveys. The count below includes surveys administered since 2019. Due to the COVID-19 public health emergency, states paused administering the NCI-AD survey during the 2020-2021 reporting cycle. States may also use other surveys to understand the experiences of their LTSS beneficiaries. |
| State Health System Performance | Source: Data on states’ HCBS CAHPS administration status were verified by the Centers for Medicare & Medicaid Services (CMS). Data reflect administration between 2019 and 2021 to Medicaid fee-for-service populations and to managed LTSS populations. CMS was not able to verify information for Hawaii, Illinois, Kentucky, Mississippi, Montana, Oklahoma, Virginia, or Washington D.C. Data on states’ NCI administration come from NCI administrative records and reflect administration during the 2019-2020 and 2020-2021 reporting cycles. Data on states’ NCI-AD administration come from NCI-AD administrative records and reflect administration during the 2019-2020 reporting cycle. | |||
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Patient-Centered Care | Medicaid is the primary payer for long-term care services. CMS and states support service delivery through a range of settings—from institutional care to community-based long-term services and supports. These services can provide beneficiaries with disabilities and chronic conditions: Independence Improved health Improved quality of life In the future, the Scorecard will include measures that describe the delivery and outcomes of long-term care services for Medicaid beneficiaries as measures and data become available. |
Measure to be included in a future Scorecard. | State Health System Performance |