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Adult Health Care Quality Measures

The Social Security Act (Section 1139B) requires the Secretary of HHS to identify and publish a core set of health care quality measures for adult Medicaid enrollees. The  Adult Core Set includes a range of quality measures encompassing both physical and behavioral health. In August 2023, CMS released a final rule  to require State reporting of standardized quality measures. Beginning in 2024, reporting on the behavioral health measures on the Adult Core Set is mandatory for states. The Adult Core set will continue to be updated annually, with future updates provided in a manner to allow states to address any changes ahead of mandatory reporting periods.

2025 Adult Core Set

CMS released the 2025 Child and Adult Core Health Care Quality Measurement Sets in a May 2024 State Health Official Letter. As noted above, reporting on the 2025 Adult Core Set will occur in Fall 2025.

Section 1139B of the Social Security Act, as amended by Section 2701 of the Affordable Care Act, notes that the Secretary shall issue updates to the Adult Core Set beginning in January 2014 and annually thereafter. The Core Set Annual Review Workgroup reviews the Adult Core Set and identifies ways to improve it, using the annual review and selection process. The 2025 Final Report includes  the Workgroup recommendations, public comments and feedback to CMS. The Core Set History table and Historical Policy Guidance documents provide a history of the updates to the measures included in the Child and Adult Core Sets.

The Adult Core Set includes several measures focused on behavioral health. These along with similarly focused measures from the Child Core Set have been identified as the 2025 Behavioral Health Core Set. Similarly, measures from the Child and Adult Core Sets’ focused on maternal and perinatal health have been identified as the 2025 Core Set of Maternal and Perinatal Health Measures for Medicaid and CHIP (Maternity Core Set).

State data derived from the core measures are part of CMS’s annual Child and Adult Core Sets measure reporting, which includes publication of chart packs and datasets that highlight publicly reportable measures.

Annual Reporting on the Quality of Health Care for Adults Enrolled in Medicaid

CMS annually releases information on state progress in reporting the Adult Core Set measures and assesses state-specific performance for measures that are reported by at least 25 states and that met CMS standards for data quality. The Core Set year represents the year that data is reported to CMS, the data generally represents care delivered the prior year. Information about performance on frequently-reported health care quality measures in the Adult Core Set is provided below, in addition state-specific quality information can also be viewed in the Quality of Care section of the State Medicaid & CHIP Profiles web page.

Adult Medicaid Quality Measurement Program

By January 1, 2013, a Medicaid Quality Measurement Program will be established to fund the development, testing, and validation of emerging and innovative evidence-based adult health quality measures. As specified in the legislation, this program is to be established in the same manner as the Pediatric Quality Measures Program.