The CMS on Monday released a new tool that tells the public how Medicaid agencies are performing based on the healthcare outcomes of their beneficiaries.
The scorecards will judge state Medicaid agencies on metrics including well-child visit rates, follow-ups after a mental illness hospitalization, children's preventive dental services and immunization.
"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," CMS Administrator Seema Verma said. "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."
State rankings stem from core measures data that states voluntarily report to Medicaid and CHIP each year. But that doesn't mean the public will be able to compare states' performance directly, as they use varying reporting methods and may not use the same measures. Some states have access to different data on populations covered under fee-for-service as compared to populations covered under managed care.
Nevertheless, the CMS hopes the scorecards will draw attention to how states are performing and encourage them to report on more measures in the future. It is also possible that the CMS could one day require all states to report on a core set of measures, Verma said.
States won't be penalized for low performance on the metrics, but Verma said that could change in the future. The CMS and congressional lawmakers are discussing legislation to give the CMS additional enforcement flexibility over states with poor outcome measures, she said.
Verma did not provide details on what potential punitive actions the agency is seeking.
The agency will consider adding additional measures to the Medicaid scorecard in the future. One under consideration would track how many Medicaid enrollees are working or are in job training. States would report on the measure whether or not they have a work requirement waiver, Verma said.
But the scorecards have left some stakeholders concerned. The National Association of Medicaid Directors said the metrics may not be comparable between states because each one chooses which measures to use.
"Conclusions may be drawn when making comparisons across states with significantly different structures and care delivery approaches," the group said in a statement.
The association urged the CMS to use an accurate and comparable data set in future iterations of the scorecards, noting the underlying data have significant methodological issues, such as completeness, timeliness and data quality. Most of the data comes from 2015, the last year for which adequate data was available.
Also, in some cases, data reflect a state's beneficiaries in fee-for-service or managed care, but not necessarily beneficiaries in both delivery models. This can result in relatively healthy populations being compared with those with disabilities or complex conditions, it said.
The CMS will also score itself on the time it takes to review submitted rates for Medicaid plans, 1115 waiver applications and state plan amendments.
"I think it's pretty historic to put up processing times," Verma said. "There is a lot of criticism out there on that issue, and I think it's also important that we're holding ourselves accountable."