Consumer Assessment of Healthcare Providers & Systems (CAHPS) Health Plan Survey

Overview

The CAHPS Health Plan Survey is a tool for collecting standardized information on enrollees' experiences with health plans and their services. The Centers for Medicare & Medicaid Services (CMS) Medicaid and CHIP Child Core Set and Medicaid Adult Core Set, together referred to as the Core Sets, and state CHIP annual reporting both include measures based on the CAHPS Health Plan survey.

Starting with the 2024 Core Set, reporting of the CAHPS surveys included in the Child Core Set and the behavioral health measures on the Adult Core Set is mandatory for the 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. More information on mandatory Core Set reporting requirements is available in 42 CFR Parts 433, 437, and 457, and the Initial Core Set Mandatory Reporting Guidance State Health Official Letter. State CHIPs also have annual CAHPS reporting requirements that are described in section 2108(e) of the Social Security Act (the Act). To reduce reporting burden, CMS has streamlined these two reporting requirements into one annual data submission to the Agency for Healthcare Research and Quality (AHRQ) CAHPS Health Plan Database.

Survey Background

Since its launch in 1997, the CAHPS Health Plan survey has become the national standard for measuring and reporting on consumers’ experiences with their health plans.

Health plans, public and private purchasers, and other organizations use the survey results for multiple purposes:

To monitor the performance of health plans and reward plans for high-quality care.
To support consumers in assessing the quality of health plans and choosing the plans that best meet their needs.
To identify the strengths and weaknesses of health plans and target areas for improvement.

To learn more about the Health Plan CAHPS survey, visit here.
The National Committee for Quality Assurance (NCQA) and CMS use the CAHPS Health Plan Survey to meet their respective needs. NCQA asks all plans seeking accreditation or providing quality measures for the Healthcare Effectiveness Data and Information Set (HEDIS) for public reporting to submit the results of a modified version of the CAHPS Health Plan Survey. This modified survey is designated with an "H" after the version number (e.g., CAHPS 5.0H, CAHPS 5.1H).

Learn more about HEDIS from NCQA.

Medicaid and CHIP Core Sets & CHIP Annual Report

The following versions of the CAHPS survey should be used to meet requirements for both the Core Sets and state CHIP annual reporting:

Child Medicaid and CHIP: CAHPS Health Plan Survey 5.1H – Child Version Including Medicaid and Children with Chronic Conditions Supplemental Items
Adult Medicaid: CAHPS Health Plan Survey 5.1H, Adult Version (Medicaid)

Any updates or changes that AHRQ makes to the CAHPS survey will be reflected in annual updates to the CAHPS measures on the Core Sets, and in annual updates to the CAHPS section of the CHIP Annual Report template as applicable.

States must separately survey and submit data for their Medicaid (including Title XXI-funded M-CHIP) and S-CHIP populations. The survey samples must be representative of all the eligible Medicaid (including Title XXI-funded M-CHIP) or S-CHIP beneficiaries.

For more information on CAHPS requirements for the Core Sets and state CHIP annual reporting, check out the CAHPS Fact Sheet. More information about CHIP annual reporting is also available on the CHIP Reports and Evaluations page.

CAHPS Data

Explore the CAHPS Health Plan Data using the CAHPS Data Tools website. CAHPS data are also published in annual Chartbooks.

National Adult Medicaid CAHPS Pilot

In fall 2014, the Center for Medicaid and CHIP Services (CMCS) conducted a Nationwide Adult Medicaid (NAM) CAHPS survey of Medicaid enrollees to attain national and state-by-state measures of access, barriers to care, and experiences with care across delivery systems and major population subgroups. This one-time survey interviewed a representative sample of adults ages 18 and older enrolled in Medicaid during October through December 2013. These data were used to inform CMS and state efforts to improve health care delivery for Medicaid enrollees. View additional information in this CMCS Informational Bulletin.

To access the NAM CAHPS Public Use File (PUF), view the dataset on data.medicaid.gov