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Quality of Care

Quality of Care

Medicaid and the Children’s Health Insurance Program (CHIP) seek to provide safe, effective, efficient, patient-centered, high quality and equitable care to all enrollees.  To achieve these goals, the Centers for Medicare and Medicaid Services (CMS) partners with states to share best practices and to provide technical assistance to improve the quality of care.

Quality Initiatives

CMS has initiatives to improve the quality of care provided to Medicaid and CHIP enrollees in the following areas:

Dental Care
Maternal and Infant Health
Home and Community-Based Services
Health Disparities

Performance Measurement
Patient Safety
External Quality Review
External Quality Review Technical Reports
State Quality Strategies
Annual CMS Medicaid/CHIP Quality Conference
Improving Care Transitions


National Quality Strategy

The National Quality Strategy, required by The Affordable Care Act of 2010, is a national plan to improve the delivery of health care services, patient health outcomes, and population health.

Three goals are used to guide and assess local, state, and national efforts to improve health and the health care delivery system:

  1. Better Care
  2. Healthy People/Healthy Communities
  3. Affordable Care

See the National Quality Strategy March 2011 Report to Congress.    

Events & Announcements

Resources to Improve Medicaid for Children and Adolescents

CMS, in partnership with NASHP, developed a resource page for state policymakers, Medicaid officials, and other interested parties with state-specific information about strategies for delivering the Medicaid benefit for children and adolescents, (also known EPSDT).  Use this resource page to access information from state Medicaid agencies on a variety of topics including: 

  • General and specific definitions of medical necessity used by states
  • Initiatives to improve access to preventive and treatment services for children
  • Reporting and data collection strategies around children's services
  • Approaches to behavioral health screening and service delivery
  • Resources developed to support providers and families
  • Initiatives to improve care coordination for children
  • Oral health service delivery for children

Integrating a Dental Caries Disease Management Model into Medicaid Programs Webinar

CMS’s partner, the Medicaid-CHIP State Dental Association (MSDA), hosted a webinar on March 26, 2014 on Integrating a Dental Caries Disease Management Model into Medicaid Programs. The presentation and the audio is available on the MSDA website.

New Releases

Health Care Coverage Analyses of the National Healthcare Quality and Disparities Reports: 2000-2008 Trends observes how quality and access has changed for individuals with private insurance, Medicaid, and no insurance over time, and examines racial and ethnic disparities within insurance groups.

Improving Oral Health Care Delivery in Medicaid and CHIP: A Toolkit for States

The Medicaid Managed Care Encounter Data Toolkit was released on February 24, 2014.  The guide provides a practical guide to collecting, validating, and reporting Medicaid managed care encounter data.  It is designed as a step-by-step guide for state Medicaid staff responsible for managing the daily operations involved in encounter data, as well as a resource for senior managers and policymakers who oversee this function.  It contains case studies, checklists, and links to resources that provide helpful tips and tools.  This toolkit is one of several initiatives sponsored by the Centers for Medicare & Medicaid Services (CMS) to help state Medicaid agencies (1) comply with federal encounter data reporting requirements, (2) improve the accuracy and completeness of the data, and (3) strengthen states’ capacity to analyze and use the data to evaluate and monitor managed care program outcomes.

2013 Annual Report on the Quality of Care for Children in Medicaid and CHIP