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Balancing Standardization and State Flexibility in Medicaid Quality Measurement and Reporting

October 2016
Full report Executive summary

As federal regulations seek greater consistency in Medicaid quality measurement, it will be challenging, but essential, to find a balance that realizes the benefits of standardization across states while maintaining the flexibility of states to innovate and address unique needs and circumstances.

State quality measurement systems that hold Medicaid managed care organizations accountable are at a crossroads. To date, states have had tremendous flexibility to design their quality measurement systems, including selecting metrics, benchmarks, and incentives that are tailored to their Medicaid populations and address state-specific gaps in care.

Federal regulations released in April 2016 will impose more standardization—requiring all states to use a quality rating system that draws from a core set of measures and common methodology. Greater consistency across states could facilitate national benchmarking, support a federal quality improvement agenda, and reduce the burden of data collection and reporting.


  • Federal rules and regulations
  • State quality rating systems
  • Advantage of national standards
  • Advantage of state flexibility
  • Balancing standardization and flexibility

Related Public Policy Research

The "Nuts and Bolts" Behind Quality Measurement in Medicaid Managed Care

To ensure beneficiaries access high-value services, quality measures must be well-tested, evidence-based, peer-reviewed, and focus on outcomes for diverse populations and services.

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The Impact of Medicaid Quality Rating Systems

Little is known about how quality tools impact managed care but the experience of other programs suggests that as tools evolve, their influence on behavior and plan quality could grow.

October 2016