CMS REFOCUSES MEDICAID QUALITY ON HEALTH OUTCOMES, LAUNCHES INNOVATIVE PARTNERSHIP WITH 37 STATES

The following information was released by the Centers for Medicare & Medicaid Services (CMS):

The Centers for Medicare and 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.

Participating states are committing to use these principles to develop targets for health outcomes and identify opportunities to incorporate outcomes-oriented measures into state quality strategies and upcoming procurements.

The Medicaid Quality Pledge and additional information around the Investing in Health Outcomes effort are available online. CMS will also hold workshops later this year focused on measure prioritization and value-based arrangements, reduced reporting burden, and digital quality measurement.

Statements of Support

"When you incentivize outcomes, you see improvement. That's what we did in Oklahoma," said Governor Kevin Stitt. "By moving to managed care, we have put the well-being of Oklahomans at the forefront, all while saving taxpayers money. A national move toward prioritizing outcomes will benefit all Americans. I'm proud to support this initiative."

"The United States spends more on healthcare than any other high-income country, yet achieves worse health outcomes on many measures. We need to spend less and demand better results. That's why it's important to focus on ensuring Medicaid delivers quality care and focuses on data-driven health outcomes. I am glad to support efforts to ensure Americans get better outcomes from the money we spend on healthcare," said Governor Jared Polis.

"Taxpayers deserve to know their dollars are making a genuine, lasting difference. Through this pledge, Utah is doubling down on accountability in Medicaidaligning and modernizing quality data reporting enables us to better focus resources toward proactive chronic disease care, prevention, and behavioral health. When we measure success by actual health outcomes rather than dollars spent, both our state's budget and our communities win," said Governor Spencer Cox.

"Nearly one million Connecticut residents and more than 73 million Americans rely on Medicaid and CHIP for essential health care. Connecticut's HUSKY Health program is a lifeline for children, families, seniors, and people with disabilities," said Governor Ned Lamont."The pursuit of high-quality health outcomes drives everything we do.We are constantly working to make the program stronger, more innovative, and laser-focused on delivering better health outcomes for the people we serve."