The cliff

The Continuity Cliff

The Continuity Cliff

2024 Medicaid/CHIP · child vs adult by shared domain

Medicaid / CHIP Core Set

The continuity cliff

The Child and Adult Core Sets never share a measure abbreviation, so the dataset structurally hides a question that matters: can a state be strong for kids and weak for the same adults in the same domain? We normalize both programs to the 5 domains they share and compare, per state, where children versus adults sit in the national band. Positive deltas are the cliffs. Methodology · State Core Set Scorecard
delta = child − adult+ children fare better− adults fare better

Shared domains

5

Domains measured by both Core Sets

States where kids lead

23

Mean delta above +0.02 across shared domains

States where adults lead

21

Mean delta below −0.02 — the inverse tail

Child → adult by state

Each line connects a state’s child composite (left) to its adult composite (right) in the selected domain. A downward-right slope is a cliff — children sit higher in the national band than adults. Click a state to open its detail.

52 states with data for both programs
0.000.250.500.751.00ChildAdultband

Source as of 2025-04-28. Only (state, domain) pairs where both programs reported are plotted; a missing side is never imputed.

Biggest cliffs, both directions

Ranked by each state’s mean delta across the shared domains it reports. This is a two-sided finding: most cliffs favor children, but a real tail of states looks better for adults than for kids.

Widest kid-advantage

Highest mean delta — children sit furthest above adults.

  1. MontanaMTwidest in Experience of Care (+0.82) · 2 domains+0.40
  2. West VirginiaWVwidest in Care of Acute and Chronic Conditions (+0.40) · 5 domains+0.22
  3. ColoradoCOwidest in Primary Care Access and Preventive Care (+0.39) · 5 domains+0.18
  4. ArkansasARwidest in Behavioral Health Care (+0.34) · 5 domains+0.17
  5. DelawareDEwidest in Primary Care Access and Preventive Care (+0.47) · 5 domains+0.14
  6. South CarolinaSCwidest in Primary Care Access and Preventive Care (+0.31) · 5 domains+0.13
  7. New MexicoNMwidest in Primary Care Access and Preventive Care (+0.30) · 4 domains+0.13
  8. Puerto RicoPRwidest in Maternal and Perinatal Health (+0.52) · 5 domains+0.12

Widest adult-advantage (inverse tail)

Lowest mean delta — adults sit furthest above children.

  1. UtahUTwidest in Care of Acute and Chronic Conditions (−0.18) · 4 domains−0.41
  2. WisconsinWIwidest in Experience of Care (−0.10) · 2 domains−0.27
  3. New JerseyNJwidest in Experience of Care (−0.10) · 5 domains−0.21
  4. VirginiaVAwidest in Experience of Care (−0.15) · 2 domains−0.19
  5. Rhode IslandRIwidest in Primary Care Access and Preventive Care (0.00) · 5 domains−0.17
  6. HawaiiHIwidest in Experience of Care (+0.18) · 5 domains−0.14
  7. IdahoIDwidest in Primary Care Access and Preventive Care (+0.14) · 4 domains−0.12
  8. AlaskaAKwidest in Experience of Care (−0.09) · 2 domains−0.11