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Quality of Care

Quality care is generally considered to be that which is safe, effective, patient-centered, timely, equitable, and reliable (IOM 2001). At the system level, quality improvement efforts should focus on receipt of the right care, at the right time, in the right setting, all the time (HHS 2011). Ultimately care should be provided that leads to the best outcomes for patients—improvement in health, maintenance of function, and for patients who are in declining health, appropriate and effective care and supportive services that improve quality of life.

Medicaid and CHIP programs engage in quality improvement through delivery system design, payment incentives, and holding plans and providers accountable for desired quality and cost outcomes. States are increasingly incorporating quality measures into their payment and purchasing strategies. They set quality standards in managed care contracts and create incentives for plans to meet targets for improvements in the process and outcome of care, and in the patient experience.

The Centers for Medicare & Medicaid Services (CMS) disseminates findings from state quality reporting in the Medicaid and CHIP Scorecard, and in the annual Child and Adult core set chart pack reports. CMS has also developed quality initiatives and performance measure sets for specific populations and conditions, including behavioral health, maternal and perinatal health, and long-term services and supports (LTSS).

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Featured Publications

Access to Dental Services for Adults with Intellectual and Developmental Disabilities

June 26, 2025

Individuals with intellectual and developmental disabilities (I/DD) experience a wide range of conditions that affect their physical, intellectual, and emotional development, and are more likely to have Medicaid coverage than those without such conditions. This issue brief examines state Medicaid policies for providing dental services for adults with I/DD and the challenges states face in providing […]

Children and Youth with Special Health Care Needs Transitions of Care

June 10, 2025

Chapter 1 includes four recommendations aimed at addressing challenges with transitioning from pediatric to adult care in Medicaid. Medicaid plays an important role in covering health care services for children and youth with special health care needs (CYSHCN). Almost one in five children has special health care needs, and Medicaid covers almost half of these […]

Access in Brief: Children and Youth with Special Health Care Needs

August 8, 2024

Children and youth with special health care needs (CYSHCN) have a wide range of health care needs, including physical, mental and behavioral health conditions, and levels of limitations that require health and related services beyond that required by children generally. It is important that this population has timely access to care because they can experience […]