Overview
Children Now reviewed eight indicators from the Preventive Services Reports covering the 2019–2022 periods of care for California children and youth in Medicaid (Medi-Cal).
In this chartbook, we have summarized our topline statewide findings and provided data visualizations in four key areas of children’s preventive services: wellchild visits; immunizations; screenings; and vision and oral health care.
Well-Child Visits
Immunizations Screenings
Created by Jan Niklas Prause from the Noun Project
Created by Jan Niklas Prause from the Noun Project
Why this matters for kids
Medi-Cal has a long history of under-delivering on the most basic preventive care for children and youth, like regular check-ups, health screenings, and vaccinations.
The State Auditor has repeatedly found that “less than 50 percent of the children in Medi-Cal have received the required preventive services,” in part due to poor access to care by Medi-Cal Managed Care Plans who are paid by the State to provide health care to children, and in part due to poor oversight on behalf of the Department of Health Care Services (DHCS), the state agency responsible for the more than 5.5 million children and youth enrolled in Medi-Cal.
The Preventive Services Reports that have been released by DHCS since 2020 demonstrate a new era of data transparency, but accountability for sustained improvement in outcomes and utilization will take time to be reflected in the data.
Key take aways
Well-Child Visits
• Infant well-visits are improving (since 2019), but still remain below the national median.
• Only half of kids are getting annual check-ups; and kids of color face the greatest barriers to care.
Screenings
• Developmental screening rates are rising, but American Indian/Alaska Native & Native Hawaiian/Other
Pacific Islander children are least likely to be screened for delays by providers.
• A shockingly low percentage of infants and toddlers are screened for blood lead poisoning, and for some groups only 1 in 10 kids are screened.
• Screening rates for depression and alcohol & tobacco use among adolescents are also far too low.
Immunizations
• Overall, immunization rates are too low, and have fallen since 2019.
• Children and youth in rural areas of California are even less likely to get their full immunizations.
• Immunization rates vary based on primary language, with the highest rates for Chinese & Vietnamese speaking families.
Vision & Oral Health Care
• Fewer than one in five school-aged children and youth had an eye exam.
• Medical and dental providers aren’t doing enough to ensure kids are getting topical fluoride varnish.
Created by Jan Niklas Prause from the Noun Project
Created by Jan Niklas Prause from the Noun Project
Infant well-child visit rates are improving over time, but still remain below the national median.
During well-child visits doctors assess a child’s physical and emotional needs, support their growth and development, and intervene quickly if any issues arise, like help getting nutritious food or housing assistance.
Infant well-child visits
(Indicator W30-6: 6+ visits in the first 15 months of life)
Created by Jan Niklas Prause from the Noun Project
Only
half of kids are getting annual check-ups.
Across all age groups, Black, American Indian/ Alaskan Native, and Native Hawaiian/Other Pacific Islander children face the greatest barriers to accessing preventive care visits.
Medi-Cal well-child visits by race/ethnicity, 2022
3–21 year-olds (Indicator WCV: 1+
Created by Jan Niklas Prause from the Noun Project
by Jan Niklas Prause from the Noun Project
Developmental screening rates are rising, but American Indian/Alaska Native & Native Hawaiian/Other Pacific Islander children are least likely to be screened for delays by providers.
Research shows an association between exposure to the pandemic and delayed development in young children.
Developmental screenings in the first 3 years of life (Indicator DEV)
Developmental screenings in the first 3 years of life, 2022 (Indicator DEV)
Created
Created by Jan Niklas Prause from the Noun Project
A shockingly low percentage of infants and toddlers are screened for blood lead poisoning, and for some groups only 1 in 10 kids are screened.
Blood lead screening—2 tests by 2 years of age (Indicator BLS-1&2)
Systemic and environmental racism mean that some children are more likely to be exposed to lead than others; medical racism means the health system is less likely to catch it.
Blood lead screening by race/ethnicity, 2022 (Indicator BLS-1&2)
Created by Jan Niklas Prause from the Noun Project
Too few adolescents are screened for depression (4%), tobacco use (4%), and alcohol use (3%). However, rates of follow-up among those with a positive screen for depression are relatively high. More young people should be screened for mental health and substance use challenges.
Depression screening & follow-up on positive screen, 12–17 years old, California average, 2022
Overall, immunization rates are too low, and have fallen since 2019. Childhood vaccines protect from several serious and potentially life-threatening diseases, but when vaccination rates decline, these diseases can re-emerge quickly.
Fully immunized 2-year-olds & adolescents
(Indicator CIS-10)
Adolescents (Indicator IMA-2)
Created by Jan Niklas Prause from the Noun Project
Created by Jan Niklas Prause from the Noun Project
Children and youth in rural areas of California are even less likely to get their full course of immunizations.
Long distances and poor access to providers can limit childhood vaccinations for families in rural areas.
2-year-olds & adolescents who were fully immunized, by population density, 2022
2-year-olds (Indicator CIS-10)
Adolescents (Indicator IMA-2)
2-year-olds & adolescents who were fully immunized, by primary language, 2022
Immunization rates
Created by Jan Niklas Prause from the
vary based on primary language, with Chinese & Vietnamese speakers at higher vaccination rates due in part to cultural beliefs around health care and trust in providers.
Adolescents (Indicator IMA-2) 2-year-olds (Indicator CIS-10)
Noun Project
Fewer than one in five school-aged children and youth had an eye exam.
Vision care has important impacts on children’s learning and processing, attention, and behavior.
Comprehensive eye exam in 2022 or 2021, 6–21 years old (Indicator VIS-C)
Created by Jan Niklas Prause from the Noun Project
Created by Jan Niklas Prause from the Noun Project
Medical and dental providers aren’t doing enough to ensure kids are getting topical fluoride varnish.
Good oral health is essential to overall health.
Fluoride varnish is an effective method to reduce early childhood decay and protect teeth.
Topical fluoride varnish by age, 2022 (Indicator TFL-DO)
Created by Jan Niklas Prause from the Noun Project
Created by Jan Niklas Prause from the Noun Project
Data indicator definitions
Child and Adolescent Well-Care Visits—Total (WCV) indicator measures the percentage of members ages 3 to 21 years who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.
The Well-Child Visits in the First 30 Months of Life—Well-Child Visits in the First 15 Months— Six or More Well-Child Visits (W30–6) indicator measures the percentage of children who turned 15 months old during the measurement year who received six or more well-child visits with a primary care provider (PCP).
The Developmental Screening in the First Three Years of Life—Total (DEV) indicator measures the percentage of children who were screened for risk of developmental, behavioral, and social delays using a standardized screening tool in the 12 months preceding or on the child’s first, second, or third birthday.
The Blood Lead Screening—Two Tests by 24 Months of Age (BLS–1 and 2) indicator measures the percentage of children who turned 2 years old during the measurement year, had a screening within six months (before and after) their second birthday, and also had a screening within six months (before and after) their first birthday.
The Depression Screening and Follow-Up for Adolescents and Adults—Depression Screening—12 to 17 Years (DSF–E–DS) indicator measures the percentage of members 12 years of age and older who were screened for clinical depression using a standardized instrument. This is new for measurement year 2022; therefore, trending results are not available. Additionally, national benchmarks are not available for this indicator.
The Depression Screening and Follow-Up for Adolescents and Adults—Follow-Up on Positive Screen—12 to 17 Years (DSF–E–FU) indicator measures the percentage of members 12 years of age and older who received followup care within 30 days of a positive depression screen finding. This is new for measurement year 2022; therefore, trending results are not available. Additionally, national benchmarks are not available for this indicator.
The Tobacco Use Screening (TUS) indicator measures the percentage of children ages 11 to 21 years who had one or more screenings for tobacco use during the measurement year. Please note, due to a lack of reporting within administrative data sources (i.e., MRR or EHR data could be necessary to capture this information), exercise caution when evaluating results as they may be more indicative of data completeness rather than performance. Please note, national benchmarks are not available for this indicator.
The Alcohol Use Screening (AUS) indicator measures the percentage of children ages 11 to 21 years who had one or more screenings for alcohol use during the measurement year. Due to a lack of reporting within administrative data sources (i.e., medical record review [MRR] or EHR data could be necessary to capture this information), exercise caution when evaluating results as they may be more indicative of data completeness rather than performance. Please note, national benchmarks are not available for this indicator.
The Childhood Immunization Status—Combination 10 (CIS–10) indicator measures the percentage of children 2 years of age who had four diphtheria, tetanus, and acellular pertussis; three polio; one measles, mumps, and rubella; three haemophilus influenza type B; three hepatitis B; one chicken pox; four pneumococcal conjugate; one hepatitis A; two or three rotavirus; and two influenza vaccines by their second birthday.
The Immunizations for Adolescents—Combination 2 (IMA–2) indicator measures the percentage of adolescents 13 years of age who had one dose of meningococcal vaccine; one tetanus, diphtheria toxoids, and acellular pertussis vaccine; and have completed the human papillomavirus vaccine series by their 13th birthday.
The Topical Fluoride for Children—Dental or Oral Health Services—Total (TFL–DO) indicator measures the percentage of children ages 1 to 20 years who received at least two topical fluoride applications during the measurement year. Please note, the Topical Fluoride for Children—Dental or Oral Health Services—Total (TFL–DO) indicator is new for measurement year 2022; therefore, trending results are not available. Additionally, since dental services are provided through the Dental FFS and Dental MC delivery systems, rates may not be reflective of MCP performance.
C
The Vision Services—Comprehensive Eye Exam (VIS–C) indicator measures the percentage of children ages 6 to 21 years who had a comprehensive eye exam performed by an optometrist/ophthalmologist during the measurement year or year prior to the measurement year. Please note, the VIS–C indicator is new for measurement year 2022; therefore, trending results are not available. Additionally, national benchmarks are not available for this indicator.
Children’s preventive care: benchmarks & goals
National benchmark
The National Benchmark, where noted, is the 50th Percentile of Medicaid programs nationally, sometimes referred to as the Minimum Performance Level (MPL).
DHCS’ Bold Goals (50x2025 Initiative)
Children’s preventive care is one of three focus areas in DHCS’ Bold Goals: 50x2025 initiative, launched in 2022 as a focused campaign to improve the quality and equity of care. Some of the specific goals stated by DHCS are to:
County & managed care plan variations
• Close racial/ethnic disparities in well-child visits and immunizations by 50%; and
• Ensure all Managed Care Plans exceed the 50th percentile for all children’s preventive care measures. Rates of care vary widely by county and Managed Care Plan. The Preventive Services Report provides some data by county and region for children’s preventive services indicators. Data on available children’s preventive services indicators by Managed Care Plan are published in the External Quality Review Technical Reports.
CHILDREN NOW
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