When it Comes to Monitoring the Quality of Children’s Health Care in Medicaid, the Golden State Could Fall Even Further Behind


Over 5 million kids in California rely on Medicaid services to grow up healthy and strong, making it by far the largest child-serving health insurance program in the nation. Yet, based on public reporting, California is far behind the nation when it comes to ensuring the quality of the health care provided to these children. Georgetown CCF and Children Now teamed up to analyze California’s reporting of child health quality measures in a new brief.

The brief provides a comparative analysis of Medicaid/CHIP health care quality data (from the Child Core Set) for California and outlines a number of findings, as well as a troubling and longstanding problem: California does not report enough information to know if the state is doing well by the kids who depend on Medicaid. California has consistently lagged behind other states in reporting data on health care quality measures and, in 2014, there were only 12 states that reported fewer Child Core Set quality measures than California. The Child Core Set of health care quality measures is, after all, one of the primary information sources policymakers and advocates use to determine how kids are faring, particularly in comparison to other state Medicaid programs. These data are critical to monitoring how well care is delivered in Medicaid, or Medi-Cal, as the program is known in California.

Simply put, because California does not collect a robust set of quality measures, it is impossible to know if the kids enrolled in Medi-Cal are getting the services they need.

In looking at the data for the limited number of Child Core Set measures reported by California in 2014, there is much room for improvement. For example, among children and adolescents with a primary care visit in the past year, California ranks in the bottom half of states for all age sub-groups. Notably, California ranks in the lowest quartile among states on adolescent access to primary care.

Kids of all ages need regular well child check-ups at least once a year—and younger children more often than that—but the data illustrate that California is not meeting pediatrician-recommended standards for preventive care. Specifically, the data show that one in every four 3–6 year-olds in California Medicaid did not receive a well-child preventive visit in 2014. This means that 25 percent of young kids are not receiving the critical screenings, immunizations, and other key health services they need to stay healthy on track developmentally. Moreover, because California does not report this measure for youth ages 12-19, there is no way to know how many adolescents are missing out on essential well-care preventive visits.

The 2014 data also confirm extremely low utilization of dental care services by kids, a problem that has been pervasive in California Medicaid’s dental program. Fewer than two in five children enrolled in California Medicaid received a preventive dental visit in 2014. Although the importance of children’s oral health is undeniable, California continues to fall short.

Finally, the child health quality data illustrate a missed opportunity for California to focus on health equity. Significant racial disparities exist related to low birth weight in California; low birth weight and infant mortality affect black infants at roughly twice the rate of white infants. This disparity could be better understood—and ultimately addressed—if California would provide disaggregated data that clearly identifies geographic and racial/ethnic disparities. However, unlike 29 other states, California did not to report data on the percent of Medicaid infants with low birth weight.

These findings are worrisome for child health advocates in California, and clearly detrimental to the health of kids across our state. If these trends in child health quality continue on their current trajectory, California could fall even further behind other states not only in how child health care quality is measured, but also on the quality of care that is delivered. Ultimately, what gets measured is what gets managed and improved.

California must step up reporting on key quality indicators, though it is currently not clear the state is prepared to take on that challenge. California Medicaid pays for nearly half of all births in the state but even as the number of specific maternal and perinatal health indicators in the 2016 Child Core Set has expanded from three to seven measures, California collects data on only two measures. One thing is clear from this analysis of child health quality data: Medi-Cal must do better to ensure that California’s low-income kids get the quality health care services they deserve.