Medi-Cal Funded Induced Abortions Calendar Year 2005

Data Qualifications

These tables summarize information on induced abortions that occurred during calendar year 2005 that were paid by Medi-Cal during the same calendar year or January through September of the following year. The 21-month payment window per calendar year was used to allow for delays in submitting or processing claims.

Information for enrollees in County Organized Health Systems or Health Care Plans, known as managed care, is included on some tables but is known to be substantially underreported. Estimates were made of the expected additional abortions and the estimated totals are also reported.

Medi-Cal claims processed and paid through the fiscal intermediary are the basis for the fee-for-service component on these tables. The incentive for complete reporting is great since fee-for-service providers must submit a claim to be reimbursed for their services. Encounter reports submitted by the COHS and HCPs form the basis for the managed care component of the tables. Unlike fee-for-service claims, encounters are reported sporadically.

To estimate the underreported abortions in managed care, the abortion rate was calculated for the fee-for-service female Medi-Cal population (after excluding aid categories such as Presumptive Eligibility, Minor Consent and Undocumented which are served solely via fee-for-service Medi-Cal) and then applied to the managed care female eligible population.

Caution is advised when comparing with previous reports of Medi-Cal abortions for two reasons. One is the change in the estimation method for underreported abortions in managed care, and the other is that reports for previous years have grouped the County Organized Health System (COHS) abortions with fee-for-service rather than managed care. At one time the COHS services were only in San Mateo and Santa Barbara counties, and their reported encounters were streamed into the dataset used for building the fee-for-service research file. At this time there are eight counties reporting as COHS, all with varying levels of completeness of encounter reporting. The sources for these tables are actual fee for-service claims, managed care encounters, and the Medi-Cal eligibility files, so the COHS are more appropriately displayed along with the other managed care plans.