In 1995, researchers at the George Washington University Center for Health Services Research and Policy examined immunization practices of managed care plans in a Los Angeles County community with high levels of under-immunized infants, toddlers and preschoolers.
The assessment—carried out through an inspection of documents, an extended site visit, and telephone interviews of representatives from four managed care plans that market benefits for Medi-Cal (California Medicaid)—examined how Medicaid managed care contract provisions are translated into protocols and practices in this urban community.
The interviews, site visits and analysis of contracts between managed care plans and their clients revealed:
- The failure of Medi-Cal contracts in Los Angeles to meet immunization standards set by Medi-Cal.
- The lack of self-regulation by managed care plans in applying these immunization standards, i.e., immunization of two-year-olds.
- The inability of state agency audits to document and assess immunization performance related to the children at highest risk of neglect.