The Centers for Medicare & Medicaid Services (CMS) developed its Medicaid and Children's Health Insurance Program (CHIP) Scorecard to increase public transparency about the programs’ administration and outcomes. States and CMS can use the Scorecard to drive improvements in areas such as state and federal alignment, beneficiary health outcomes, and program administration. A summary of the 2021 Scorecard can be found in the Scorecard Fact Sheet (PDF, 324.5 KB).
The COVID-19 public health emergency (PHE) has had a far-reaching impact on Medicaid and CHIP programs. Highlighted data related to enrollment and service utilization during the PHE are available in the CMS COVID-19 Medicaid & CHIP Service Utilization Data Snapshot (PDF, 1.84 MB).
The data in this section show how Medicaid and CHIP programs vary across states by highlighting variations in areas such as enrollment, care delivery approaches, program improvement efforts, and expenditures.
These measures show how states serve Medicaid and CHIP beneficiaries in six domains important for health care quality.
These measures provide insight into how states and the federal government work together to administer Medicaid and CHIP.
These measures provide insight into how the federal government and states work together to administer Medicaid and CHIP.
Like Medicaid and CHIP beneficiaries, information in the Scorecard spans all life stages. The Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three pillars:
- State Health System Performance
- State Administrative Accountability
- Federal Administrative Accountability
The Scorecard also sheds light on important questions about the scope of Medicaid and CHIP. The National Context page presents data to answer the questions:
- Who enrolls in Medicaid and CHIP?
- How do states deliver care in Medicaid?
- What data are CMS and states developing to support program improvement?
- What are annual expenditures for Medicaid and CHIP?
- What is the rate of improper payments in Medicaid and CHIP?
CMS released the first Scorecard in June 2018. The Scorecard will continue to evolve and will be flexible—CMS may add new areas of emphasis important to the Medicaid and CHIP programs or replace measures as more outcome-focused ones become available. CMS works with a subset of Medicaid agencies and other stakeholders to select measures for the Scorecard. Many measures in the Scorecard come from public reports. For example, most measures in the State Health System Performance pillar come from the Child and Adult Core Sets. This approach allows CMS to align the Scorecard with existing reporting efforts.
Including measures from the Core Sets in the Scorecard builds on states’ investments in collecting and reporting these voluntary measure sets. While there are many reasons some states do not collect or report all Core Set measures, CMS hopes the Scorecard will draw attention to the importance of reporting on these measures. Core Set reporting methods also can vary among states. For example, some states report data on certain populations such as those covered under managed care, but not those covered under fee-for-service. This variation in data can affect measure performance and comparisons between states. Readers should review the detailed measure notes to better understand states’ reported rates. Due to the COVID-19 public health emergency, states had the option to re-submit data from the FFY 2019 reporting cycle for some measures or to use FFY 2020 reporting cycle data. Refer to the state-specific comments for more details on data submitted.
States establish and administer their own Medicaid and CHIP programs. As a result, the populations and benefits covered by Medicaid and CHIP vary across states. For example, in all states Medicaid provides health care coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states Medicaid also covers all low-income adults below a certain income level. This group is sometimes called “expansion adults.” In CHIP, states can choose to set income levels higher than the federal minimum threshold and to cover pregnant women. Federal law also requires states to provide certain mandatory benefits and allows states to cover other optional benefits in Medicaid and CHIP. States deliver Medicaid and CHIP benefits by directly paying providers – called “fee-for-service” payments – or through contracted arrangements with managed care organizations that oversee benefit delivery.
This version of the Medicaid and CHIP Scorecard was released in December 2021. To view the version of the Medicaid and CHIP Scorecard that was published in October 2020, please visit the archived Scorecard page.