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William E. Lafferty, MD, Lois Downey, MA, Christine M. Holan, BS, Alice Lind, MPH, William Kassler, MD, MPH, Guoyu Tao, PhD and Kathleen L. Irwin, MD, MPH

William E. Lafferty is with the Department of Health Services, University of Washington, Seattle. Lois Downey is with Harborview Medical Center, University of Washington. Christine M. Holan is with the Oregon Medical Professional Review Organization, Portland, Ore. Alice Lind is with the Washington State Medical Assistance Administration, Olympia, Wash. William Kassler is with the New Hampshire Department of Health and Human Services, Concord. Guoyu Tao and Kathleen L. Irwin are with the Centers for Disease Control and Prevention, Atlanta, Ga.

Correspondence: Requests for reprints should be sent to William E. Lafferty, MD, Department of Health Services, Box 357660, University of Washington, Seattle, WA 98195-7660 (e-mail: billlaf{at}u.washington.edu).

Objectives. This Seattle project measured sexual health services provided to 1112 Medicaid managed care enrollees aged 14 to 18 years.

Methods. Three health maintenance organizations (HMOs) that provide Medicaid services for a capitated rate agreed to participate. These included a non-profit staff-model HMO, a for-profit independent practice association (IPA), and a non-profit alliance of community clinics. Analyses used health maintenance organizations’ administrative data, chart reviews, and Medicaid encounter data.

Results. Health maintenance organizations provided primary care to 54% and well care to 20% of Medicaid enrollees. Girls were more likely than boys to have their sexual history taken or to be given condom counseling. Only 27% of sexually active girls were tested for chlamydia, with significantly lower rates of testing among those who spoke English as a second language. The nonprofit staff-model plan outperformed the for-profit independent practice association on most measures.

Conclusions. Substantial room for improvement exists in sexual health services delivery to adolescent Medicaid managed care enrollees.

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