The Centers for Medicare & Medicaid Services (CMS) is launching an initiative with a founding group of 37 state partners to focus on how quality is measured in Medicaid and the Children’s Health Insurance Program (CHIP). The effort will put health outcomes — not processes and paperwork — at the center of how success is defined. CMS and its partners will prioritize measures that demonstrate meaningful improvements in prevention, chronic disease management, and behavioral health.
“For too long, Medicaid has measured whether boxes are checked instead of whether patients are getting healthier — that must change,” said CMS Administrator Dr. Mehmet Oz. “We should judge success by what matters — preventing disease, managing chronic conditions, and improving patients’ health.”
“We are shifting the focus from paperwork and process to real accountability for what matters: health outcomes. We are encouraged at this level of commitment from states, and we are ready to get to work with them to implement this vision,” said CMS Deputy Administrator Stephanie Carlton.
“States are essential partners in improving health outcomes for the millions of Americans our programs serve,” said Dan Brillman, Director of Medicaid and CHIP. “This pledge gives those partnerships a shared set of goals — achieving measurable improvements in health, reducing unnecessary reporting burden, and using better data to drive improvement. We look forward to continuing our work alongside states to turn these principles into meaningful results for beneficiaries.”
A May 2026 CMS analysis of Medicaid managed care programs across 42 states found approximately 450 reporting requirements corresponding to roughly 260 unique quality measures for federal and state-specific quality reporting programs, largely with a focus on processes and utilization. Additionally, variations in state requirements can add to the reporting burden, especially for measures assessing similar topics. For example, measures of diabetes control may be captured using different blood sugar levels (e.g., three different types of A1c cutoffs), making it difficult to compare performance across states.
CMS’ new effort, Investing in Health Outcomes, allows states to commit to a voluntary Medicaid Quality Pledge built around four principles:
- Prioritize health outcomes over process, with a focus on prevention, chronic disease management, and behavioral health.
- Streamline quality measure inventories to reduce burden without sacrificing accountability.
- Advance digital quality measurement, using near-real-time data instead of claims and chart abstraction where feasible.
- Align financial accountability with outcomes-oriented measures.
These four principles represent a north star vision for Medicaid quality, which will serve as the basis for future state implementation efforts.
Excerpt from the official page. The original is authoritative. Continue reading at US CMS Newsroom ↗