The Centers for Medicare & Medicaid Services (CMS) on Sept. 25 launched a new initiative alongside 37 state partners to change how quality is measured in Medicaid and the Children’s Health Insurance Program.
The initiative, Investing in Health Outcomes, aims to emphasize health outcomes rather than processes and administrative requirements. CMS and participating states will focus on measures that demonstrate improvements in prevention, chronic disease management, and behavioral health.
CMS said the initiative responds to the volume and variation of existing Medicaid quality reporting requirements. A May 2026 CMS analysis of Medicaid managed care programs across 42 states identified approximately 450 reporting requirements tied to roughly 260 unique quality measures used for federal and state-specific quality reporting. CMS said many of these requirements focus on processes and utilization rather than health outcomes.
Under the initiative, states can voluntarily commit to a Medicaid Quality Pledge based on four principles:
- Prioritize health outcomes over process, with a focus on prevention, chronic disease management, and behavioral health
- Streamline quality measures to reduce burden without sacrificing accountability
- Advance digital quality measurement, using near real-time data instead of claims and chart abstraction
- Align financial accountability with outcomes-oriented measures
CMS describes these principles as a “north star” for the future of Medicaid quality measurement and said they will serve as the foundation for future state implementation efforts.
The agency plans to hold workshops later this year focused on measuring prioritization and value-based arrangements, reducing reporting burden, and digital quality measurement.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
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