June 5, 2018

CMS releases first-ever scorecard for Medicaid and CHIP

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    CMS on Monday published a scorecard that for the first time allows the public—and state and local governments—to compare state Medicaid and CHIP performance on various quality metrics.

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    MAC Scorecard details

    CMS in a fact sheet said it developed the Medicaid and CHIP scorecard, called the MAC Scorecard, to improve the programs' "transparency and accountability through public reporting." The MAC Scoreboard is designed to provide a state-by-state breakdown of:

    • Annual expenditures for CHIP and Medicaid;
    • CHIP and Medicaid beneficiaries, including enrollment numbers; and
    • Data that CMS and states are collecting to support CHIP and Medicaid improvements.

    CMS said the federal and state governments can use data from the scorecard to improve:

    • Beneficiary health outcomes;
    • State and federal alignment; and
    • Program administration.

    The MAC Scorecard currently contains information for every state based on both federal and state-reported data regarding:

    • Federal administrative accountability, which includes metrics on how the federal and state governments collaborate, including measures such as how many days it takes CMS to review state Medicaid amendment proposals and time from submission to approval for Section 1115 Medicaid demonstration waivers;
    • State administrative accountability, which includes metrics on how the federal and state governments collaborate to administer Medicaid and CHIP, including measures such as the number of days the federal governments waits for information from states and the time of state submissions; and
    • State health system performance, which includes metrics on how states serve CHIP and Medicaid beneficiaries across key areas, such as follow-up after hospitalization for mental illness, immunizations for adolescents, postpartum care, and well-child visits.

    According to the Washington Post, the MAC Scorecard does not rank states based on the metrics, but it does provide insights on how Medicaid and CHIP are serving beneficiaries. For instance, the scorecard shows that, on average, a little more than half of women covered by Medicaid receive care both when they are pregnant and after they give birth. In addition, the data show that an average of one in five babies covered by Medicaid receive checkups during their first 15 months of life, and that, on average, fewer than half of teenagers and children covered by Medicaid receive preventive dental visits.

    The data show variation across the states, but users might not be able to use that data to make direct comparisons between states, because states sometimes use different reporting methods and different measures, Modern Healthcare reports. CMS in the fact sheet said, "There is more work ahead for CMS and states before the scorecard can be used to draw effective state-to-state comparisons."

    CMS said it intends to update the scorecard with additional metrics, including measures on cost and beneficiary satisfaction, Medicaid managed care, and Medicaid work requirements. CMS Administrator Seema Verma said CMS is currently working with states that are implementing work requirements to determine how to measure the requirements' performance. In addition, future versions of the MAC Scorecard will allow users to compare year-to-year data, Roll Call reports.

    CMS also said the agency ultimately could use the scorecard as a tool to hold states accountable for performance outcomes, which could help states avoid having to submit duplicate information to CMS. States will not face penalties based on how they perform on the first iteration MAC Scorecard, Modern Healthcare reports.


    Verma said the federal government's "data collection and reporting efforts have been inconsistent at best," adding, "It's important that we're also holding ourselves accountable for achieving results." She said, "The scorecard will be used to track and display progress being made throughout and across the Medicaid and CHIP programs, so others can learn from the successes of high-performing states. By using meaningful data and fostering transparency, we will see the development of best practices that lead to positive health outcomes for our most vulnerable populations."

    Matt Salo, executive director of the National Association of Medicaid Directors (NAMD), called the move to release a scorecard to centralized data "commendable," though he questioned which measures and data CMS would use to update to scorecard, and what "the implications" of updating the scorecard could be.

    NAMD in a statement expressed concerns about the scorecard, saying, "There are significant methodological issues with the underlying data, including completeness, timeliness, and quality of the data." In addition, the group said, "Conclusions may be drawn when making comparisons across states with significantly different structures and care delivery approaches."

    As such, NAMD asked CMS to "use an accurate and comparable data set," adding that it is "committed to … work[ing] with CMS to address [its] concerns, and to refine and improve data reporting" (Williams, Roll Call, 6/5; Dickson, Modern Healthcare, 6/4; Commins, HealthLeaders Media, 6/4; Goldstein, Washington Post, 6/4; CMS Fact Sheet, 6/4; CMS Release, 6/4).

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