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CMS Provides Transparency on Cost and Quality in
State Medicaid and CHIP Programs
2020 Scorecard
continues to build upon a new era of accountability in Medicaid and
Children’s Health Insurance Program
Today, the Centers
for Medicare & Medicaid Services (CMS) released the third annual update
to its Medicaid and Children’s Health Insurance Program (CHIP) Scorecard.
The Scorecard is the signature Medicaid accountability initiative that
highlights state and federal performance on the administration and health
outcomes of the Medicaid and CHIP programs that collectively account for
approximately $600 billion in annual spending and serve over 74 million
Americans. For the first time, the Scorecard now provides identified per
capita spending data across all states, highlighting variation in program
costs alongside the quality and performance data. First released in 2018,
the Medicaid and CHIP (MAC) Scorecard is a key part of President Trump’s
efforts to ensure greater transparency and accountability of the nation’s
largest health coverage programs.
“From the beginning
of his administration, President Trump has made giving states more
flexibility to provide high quality accessible care for our most vulnerable
citizens on Medicaid and CHIP a priority,” said Administrator Seema Verma.
“At the same time, we also recognize that with greater autonomy must come
greater accountability. The Medicaid and CHIP Scorecard provides
unprecedented transparency on cost and quality across state Medicaid and
CHIP programs.”
This
year’s release builds on the success of the previous Scorecards with a
variety of updates and improvements for users, including the debut of a new
way to view state-specific data on the Medicaid.gov State Profile “Quality
of Care” section. CMS has also improved the overall design and
navigation across the 2020 MAC Scorecard to enhance the user experience.
The
Scorecard includes healthcare quality measures of asthma medication
management for children and adults as well as a measure of follow-up care
for adults after an emergency department visit for mental illness. It also
contains new administrative accountability measures including CMS and state
approval times for managed care contract reviews; and CMS approval times
for enhanced federal funding to support states’ eligibility, enrollment and
information technology systems.
The
2020 Scorecard provides per capita expenditure data across all states. For
the 2018 T-MSIS based per capita expenditure data, seventeen states had a
high level of data usability, and an additional eleven states showed a
moderate level of data usability. The remaining states fell into the
category of having a low level of data usability. The median per capita
expenditures, based on CMS calculations, for all states in 2018 is $8,126,
with a range of $1,807 in Puerto Rico to $14,387 in North Dakota.[1]
This
year, new data were added to the MAC Scorecard’s National Context
page. For example, these new data show the percentage of each state’s
population that is enrolled in Medicaid, which ranges from 9.0% to 36.3 %
and that nationally, about half of those enrolled in Medicaid and CHIP are
children. The National Context page also has new data on the national
percentage of beneficiaries enrolled in Medicaid and CHIP by eligibility
group and the national rate of improper payments in Medicaid and CHIP.
Further,
the national context now provides information on the percentage of Medicaid
beneficiaries currently enrolled in Medicare (i.e., dually eligible
beneficiaries); the percentage of dually eligible beneficiaries in programs
that integrate the delivery of Medicare and Medicaid benefits; and the
approval status for states’ transition plans for home and community-based
services. For example, nearly half of all states (23) have a Medicaid
population where 11.8%-24.2% are dually eligible beneficiaries and 36 states
now enroll dually eligible beneficiaries in integrated care programs. The
addition of these new data in the Scorecard help to further underscore the
importance of understanding the dually-eligible population’s role in the
Medicaid program.
CMS
continues to engage stakeholders in identifying enhancements to the MAC
Scorecard, including receiving input from Medicaid agencies through a
collaboration with the National Association of Medicaid Directors.
CMS analyzed trends
in median state performance on a subset of Child and Adult Core Sets
measures that are included in the MAC Scorecard’s State Health System
Performance pillar. Under this pillar, five states reported all measures in
Federal Fiscal Year (FFY) 19: Connecticut, Massachusetts, New Hampshire, Tennessee
and Washington. Across all states that reported, performance
improved from FFY 2017 to FFY 2019 on several measures, suggesting progress
in the quality of care provided to Medicaid and CHIP beneficiaries. These
measures include:
·
Well-Child Visits in the First 15
Months of Life (performance improved from 60.2% to 65.1%)
·
Adolescent Well-Care Visits
(performance improved from 44.9% to 50.7%)
·
Immunizations for Adolescents
(performance improved from 74.5% to 79.2%)
·
Percentage of Eligibles Who Received
Preventive Dental Services (performance improved from 48.2% to 49.0%)
·
Comprehensive Diabetes Care:
Hemoglobin A1c Poor Control (performance improved from 40.9% to 38.3%).
Lower rates are better for this measure.
Overall, under the
State Health System Performance pillar, states that reported for FFY19 have
opportunities to improve in measures such as: emergency department
utilization rate for children and adolescents; the percentage of children
ages 3 to 6 who had at least one well-child visit with a primary care
provider; the percentage of women delivering a live birth who had a timely
postpartum care visit; and inpatient hospital admission rates for
short-term complications of diabetes (e.g., diabetic ketoacidosis,
hyperosmolarity) in adults ages 18 and older.
The
State and Federal Administrative Accountability pillar measures show, for
example, that the percentage of State Plan Amendments and 1915 waivers
approved in within the first 90 day review period has increased between
2016 and the second quarter of 2020.
When
viewing data in the MAC Scorecard, CMS would caution against making direct
state-to-state comparisons based solely on data presented. For example, for
measures drawn from Child and Adult Core Set, reporting methods can vary
among states. States have access to different data on populations covered
under fee-for-service as compared to populations covered under managed
care. This variation in data availability can impact measure performance.
Users should review the state-specific measure notes to better understand
states’ reported rates. CMS is committed to working with states to improve
standardized measure calculation and reporting which will increase the
ability to do direct state-to-state comparisons in the future.
CMS
is committed to working with states to improve standardized measure
calculation and reporting on measures across the Scorecard. As with other
measurement-focused initiatives, CMS offers states technical assistance and
quality improvement opportunities to assist states in collecting and
reporting measures displayed in the Scorecard, as well as sharing best
practices to support improved state performance.
To view the 2020
MAC Scorecard, please visit: https://www.medicaid.gov/state-overviews/scorecard/index.html
For more
information pertaining to the 2020 MAC Scorecard, please visit:
https://www.medicaid.gov/media/file/2020-medicaid-chip-scorecard-factsheet.pdf
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