At the Centers for Medicare & Medicaid Services (CMS), we are focused on transforming the healthcare system into one that delivers better value to patients through competition and innovation. To achieve this, we have three main objectives: empowering patients, focusing on results, and unleashing innovation. CMS is also committed to improving the quality and completeness of the data reported to CMS.
In the Children's Health Insurance Program (CHIP), information about performance and quality of care is collected through several parts of the CHIP program:
- CHIP State Plan Information
- The CHIP Annual Report
- Medicaid and CHIP Child Core Set Data
- Medicaid and CHIP Scorecard
CHIP State Plan Performance Information
Performance information is found within the Title XXI CHIP State Plan for states with separate CHIP (SCHIP) programs. The CHIP State Plan includes information about the state’s performance goals, strategies for meeting those goals, and how goals will be measured.
CHIP Annual Report
States are required to report quality information to CMS annually through the CHIP Annual Reporting Template System. Information collected in the CHIP Annual Report is posted on Medicaid.gov annually. The reports detail states’ progress toward meeting the goals outlined in the Title XXI CHIP state plan, as well as information about other performance goals the state is using. Additionally, the states provide information on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
Medicaid and CHIP Child Core Set
The Medicaid and CHIP Core Set of Children’s Health Care Quality measures, commonly referred to as the Child Core Set, is a set of standardized health care quality measures that CMS and states can use to measure the quality of care delivered to Medicaid and CHIP beneficiaries and improve quality and health outcomes. Child Core Set measures address several domains of children’s health care including, primary care access and preventive care, maternal and perinatal health, behavioral health, and dental and oral health services.
CMS established and annually updates the Child Core Set in compliance with section 1139A of the Social Security Act. State reporting of the Child Core Set became mandatory in 2024. States may also choose to include CHIP beneficiaries in reporting on the Adult Core Set. Annual updates and guidance on Core Set reporting is available on the Child and Adult Health Care Quality Measures page on Medicaid.gov.
Information about performance on frequently-reported health care quality measures in the Child Core Set on the Core Set Data Dashboard and Child Core Set quality measures web page. In addition, state-specific quality information can also be viewed in the Quality of Care section of the State Medicaid & CHIP Profiles web page.
Send your questions or requests for technical assistance related to the Child Core Set to MACqualityTA@cms.hhs.gov.
Medicaid and CHIP Score Card
CMS developed its Medicaid and CHIP Scorecard to increase public transparency and accountability about the programs’ administration and outcomes. The Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas:
- State Health System Performance: These measures show how states serve Medicaid and CHIP beneficiaries across key domains, including measures like:
- Postpartum Care
- Well-Child Visits
- Immunizations for Adolescents
- Initiation & Engagement of Alcohol & Other Drug Dependence Treatment
- Follow-Up After Hospitalization for Mental Illness
- State Administrative Accountability: These measures provide insight into how states and the federal government work together to administer Medicaid and CHIP, including measures like:
- State Plan Amendments: Days Awaiting Information from States
- Managed Care Capitation Rate Review: Timing of States’ Submissions
- Federal Administrative Accountability: These measures provide insight into how the federal government and states work together to administer Medicaid and CHIP, including measures like:
- State Plan Amendments: Days Under CMS Review
- Managed Care Capitation Rate Review: Days Under CMS Review
- Section 1115 Demonstrations: Time from Submission to Approval