CMS Creates Medicaid, CHIP Scorecard

WASHINGTON, D.C. (June 4, 2018)—The Centers for Medicare & Medicaid Services (CMS) released the first ever Medicaid and Children’s Health Insurance Program (CHIP) Scorecard, a central component of the Administration’s commitment to modernize the Medicaid and CHIP program through greater transparency and accountability for the program’s outcomes.  For the first time, CMS published state Medicaid and CHIP quality metrics along with federally reported measures in a Scorecard format. 

“Despite providing health coverage to more than 75 million Americans at a taxpayer cost of more than $558 billion a year, we have lacked transparency in the performance and outcomes of this critical program,” said CMS Administrator Seema Verma. “The Scorecard will be used to track and display progress being made throughout and across the Medicaid and CHIP programs, so others can learn from the successes of high performing states.  By using meaningful data and fostering transparency, we will see the development of best practices that lead to positive health outcomes for our most vulnerable populations.”

The first version of the Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas: state health system performance; state administrative accountability; and federal administrative accountability. The metrics included in the first Scorecard reflect important health issues such as well child visits, mental health conditions, children’s preventive dental services and other chronic health conditions. The Scorecard represents the first time that CMS is publishing state and federal administrative performance metrics, which include measures like state/federal timeliness of managed care capitation rate reviews, time from submission to approval for Section 1115 demonstrations, and state/federal state plan amendment processing times. The Scorecard falls in line with President Trump’s commitment to “cut the red tape” by aligning existing reporting requirements with these other data sets and incorporating new data over time.

The Scorecard is a key component of Administrator Verma’s new vision for Medicaid and CHIP that was announced during the NAMD conference in November 2017. “Our vision for the future of Medicaid is to reset the federal-state relationship and restore the partnership, while at the same time modernizing the program to deliver better outcomes for the people we serve,” said Administrator Verma. “We need to ensure that we are building a Medicaid program that is sound and sustainable to help all beneficiaries reach their highest potential.”

CMS has delivered on its commitment to resetting the state-federal partnership by offering states unprecedented flexibility to design health programs that meet the needs of their residents. This includes updates to our Medicaid 1115 demonstration website, new guidance to offer states more flexibility to address the opioid crisis through Medicaid, and a new opportunity for states to test community engagement incentives to help lift adult Medicaid beneficiaries from poverty. As CMS continues to approve groundbreaking Medicaid demonstrations, the agency has maintained a focus on enhancing our evaluation of state health system performance and outcomes.

In addition to ensuring robust evaluations of demonstration projects, CMS will also continue to emphasize the importance of measuring a broad set of health outcome metrics across states. Given its important role in covering over 35 million children across the country, paying for approximately 50 percent of the country’s births, and as the single greatest payer for long-term care services for the elderly and people with disabilities, public reporting of core quality metrics maintains an important responsibility of states and the federal government.

Through its release, the initial Scorecard demonstrates the importance of transparency within Medicaid and CHIP. The data offered within the Scorecard begins to offer taxpayers insights into how their dollars are being spent and the impact those dollars have on health outcomes. In future years, the Scorecard will be updated annually with new functionality and new metrics, including opioid-related and home and community-based services-related quality metrics, as well as the ability to compare spending patterns. CMS will continue to work with states to encourage greater reporting across a broader set of metrics to improve consistency across states.

Through a strengthened partnership with states, CMS will advance policies and projects that increase flexibility, improve accountability and enhance program integrity and are designed to fulfill the Medicaid program’s promise to help Americans lead healthier, more fulfilling lives.  As states continue to seek greater flexibility from CMS, the Scorecard will serve as an important tool in ensuring that CMS is able to collect and report on critical outcome metrics.

Find the Scorecard here.

Find a fact sheet with more information here.