Medicaid and CHIP Beneficiary Profile and Infographic
The Medicaid and CHIP Beneficiary Profile (PDF, 3.99 MB) was developed to provide an overview of the characteristics, health status, access, utilization, expenditures, and experience of care of beneficiaries served by Medicaid and CHIP. Two special populations are profiled in depth: People Dually Eligible for Medicare and Medicaid and Children with Special Health Care Needs.
The Medicaid and CHIP Beneficiaries at a Glance Infographic (PDF, 685.71 KB) includes selected information drawn from the Beneficiary Profile.
The Medicaid and CHIP Beneficiary Profile and Infographic have been updated with the latest available data and additional content. The versions released in 2020 and 2021 are available at the links below:
• Medicaid and CHIP Beneficiary Profile (PDF, 2.13 MB) released 2020
• Infographic (PDF, 211.55 KB) released 2020
• 2020 Medicaid and CHIP Beneficiary Profile (PDF, 3.99 MB) released 2021
• 2020 Infographic (PDF, 685.71 KB) released 2021
- Child Core Set
- Adult Core Set
- Maternal and Infant Health Data Measurement
- Maternity Core Set (PDF, 177.41 KB)
- Behavioral Health Core Set (PDF, 211.83 KB)
- Behavioral Health Clinics Quality Measures
- Health Home Quality Reporting
- CHIPRA Quality Demonstration Grants
- Adult Medicaid Quality Grants
- Nationwide Adult CAHPS
- CAHPS® Home and Community Based Services Survey
- Form CMS-416 (annual EPSDT report)
Core Quality Measures Collaborative Pediatric Core Measure Set
On July 28, 2017, the Centers for Medicare & Medicaid Services (CMS) announced the release of a pediatric measure set as part of the Core Quality Measures Collaborative (CQMC). This set of nine measures is intended for use at the provider level for individual or groups of clinicians and is intended to add focus to quality improvement efforts, reduce the burden of reporting of quality measures, and offer consumers actionable information for decision-making.
This release marks the next step forward for alignment of quality measures between public and private payers. Seven of the nine measures in this pediatric set of quality measures are harmonized with existing state-level measures in the Medicaid and CHIP Child Core Set.
2021 Quality Report to Congress: Efforts to Improve the Quality of Health Care for Children and Adults Enrolled in Medicaid and CHIP (PDF) June 2021. This Report to Congress identifies the efforts undertaken between 2017 and 2019 to advance access and quality of care for children and adults enrolled in Medicaid and CHIP. (PDF, 2.79 MB)
The 2016 CMS Quality Conference: Aligning for Innovation and Outcomes, was held December 13-15 in Baltimore, MD. More than 2,400 participants attended the conference.
This year’s conference brought together public and private quality partners and stakeholders at the federal, state, and local levels, including Medicaid and CHIP agencies, Medicaid managed care plans, External Quality Review Organizations, and researchers and experts. The conference included both plenary and breakout sessions related to quality in Medicaid and CHIP programs, covering a range of innovative health care delivery projects and initiatives that demonstrate improved outcomes.
CMCS hosted three interactive mini-plenaries during the conference. The webinar materials, including an audio recording and transcript, can be accessed below:
- Designing Quality Rating Systems in Medicaid Managed Care
- Aligning Value-based Purchasing and Quality Strategies in Medicaid and Managed Care
- Behavioral Health Homes: Improving Health for People with Serious Mental Illness
Presentation materials from all of the conference sessions will be available February 1, 2017.
For those who were able to attend Medicaid/CHIP events either in-person or online, we appreciate your participation in discussions of real-world projects and initiatives that build relationships and drive improvement.
Your feedback is important to us. If you have additional comments or suggestions, please send them to the TA Mailbox at MACQualityTA@cms.hhs.gov
Analytic Brief: The State of Children's Health Care Quality in Medicaid and CHIP: State Strategies to Promote Reporting and Performance (PDF, 588.66 KB) (March 2016)
This analytic brief highlights key themes and lessons learned from interviews with the six states identified as higher-performing (PDF, 702.69 KB) based on their performance on frequently reported Child Core Set measures for FFY 2013, to facilitate ongoing improvements in the quality of care obtained by children in Medicaid and CHIP.
2015 Annual Reports The following reports produced by CMS summarize state specific information on the quality of health care furnished to individuals covered by Medicaid and CHIP.
- 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP (PDF, 1.33 MB) February 26, 2016
- 2015 Annual Report on the Quality of Care for Adults in Medicaid (PDF, 1.17 MB) February 26, 2016
The CMS Quality Conference 2015: Building partnerships. Delivering Results
The CMS Quality Conference: Building Partnerships, Delivering Results was held December 1-3, 2015 in Baltimore, Maryland. More than 1,900 participants attended the conference.
The 2015 conference brought together CMS quality partners, including states, experts, and other stakeholders from various CMS programs, including the Medicaid/CHIP grant programs, Quality Improvement Networks, and the Center for Clinical Standards and Quality. Historically a conference focused on Medicare, but the 2015 conference highlighted Medicaid’s key role in national efforts to improve quality and strengthen care delivery.
For those of you who were able to attend Medicaid/CHIP events either in-person or online, we appreciate your participation in discussions of real-world projects and initiatives that build relationships and drive improvement.
Your feedback is important to us. If you have additional comments or suggestions, please send them to the TA Mailbox at MACQualityTA@cms.hhs.gov.
Analytic Brief: The State of Children’s Health Care Quality in Medicaid and CHIP: Who Are the Higher-Performing States? (PDF, 702.69 KB) (May 2015)
This analytic brief highlights state performance on the 15 Child Core Set measures reported by at least 25 states for FFY 2013. It assesses state performance overall and in three domains: Perinatal and Infant Care, Well Child Care, and Adolescent Well Care.
2014 Annual Reports, November 2014 The following reports produced by CMS summarize state specific information on the quality of health care furnished to individuals covered by Medicaid and CHIP.
- 2014 Secretary's Annual Report on the Quality of Care for Children in Medicaid and CHIP (November 2014) (PDF, 6.39 MB)
- 2014 Secretary's Annual Report on the Quality of Health Care for Adults Enrolled in Medicaid (November 2014) (PDF, 925.37 KB)
- Improving the Identification of Health Care Disparities in Medicaid and CHIP (2014 Report to Congress) (PDF, 310.49 KB)
- Efforts to Improve Children’s Health Care Quality in Medicaid and CHIP (2014 Report to Congress) (PDF, 625.95 KB)
- Efforts to Improve the Quality of Health Care for Adults in Medicaid (2014 Report to Congress) (PDF, 355.02 KB)
Improving Oral Health Care Delivery in Medicaid and CHIP: A Toolkit for States, June 2014 CMS is working with states to improve their data on children’s oral health care services and develop oral health action plans that identify gaps, target interventions, and monitor progress. This toolkit was developed to help states achieve the goals of the CMS Oral Health Initiative through a data-driven quality improvement (QI) process that can be tailored to each state’s needs and priorities. Get the toolkit (PDF, 2.46 MB).
Resources to Improve Medicaid for Children and Adolescents, December 2013 The National Academy for State Health Policy (NASHP) resource page provides state policymakers, Medicaid officials, and other interested parties with state-specific information about strategies for delivering the Medicaid benefit for children and adolescents in states around the country. See available resources