Medicaid programs in 37 states have agreed to judge the care their enrollees receive by whether patients actually get healthier, rather than by whether providers completed routine process steps. The Centers for Medicare & Medicaid Services (CMS) announced the voluntary partnership, called Investing in Health Outcomes, on September 25, 2026, according to a CMS press release.
As of September 24, the participating states covered about 56 million Medicaid and CHIP enrollees and about $701 billion in fiscal year 2024 Medicaid spending, according to the agency's Investing in Health Outcomes program page. CMS Administrator Dr. Mehmet Oz said, "For too long, Medicaid has measured whether boxes are checked instead of whether patients are getting healthier," and added that this "must change."
For families on Medicaid, quality measures can sound abstract, but they shape which health plans get rewarded and what doctors are pushed to prioritize. If the shift works as intended, the focus could move toward results patients can feel, such as blood sugar that stays under control or asthma that is managed well enough to keep a child out of the emergency room.
A Measurement System with Hundreds of Moving Parts
CMS says the current system has grown unwieldy. A May 2026 agency analysis of Medicaid managed care programs in 42 states found about 450 quality reporting requirements covering roughly 260 unique quality measures, Fierce Healthcare reported. Because states use different measures, it is hard to compare one state's Medicaid performance with another's.
The agency pointed to diabetes as an example: states may track blood sugar control using different A1c cutoffs. (A1c is a blood test that reflects average blood sugar over the past few months.) A process measure asks whether a step happened, such as whether a patient had an A1c test during the year. An outcome measure asks whether the patient is better off, such as whether the test result stayed within a target range.
Process measures are easier to collect but can reward paperwork without improving health. Outcome measures are closer to what patients care about, but they are harder to track and can be affected by factors outside a doctor's control, such as housing, income, and access to healthy food.
Four Commitments, No Mandate
States that signed the Medicaid Quality Pledge agreed to four principles. First, they will prioritize health outcomes over process, with a focus on prevention, chronic disease management, and behavioral health. Second, they will narrow their lists of quality measures to a shared set that "reduces regulatory burden without sacrificing accountability," according to CMS.
Third, the states agreed to move toward digital quality measurement that uses near-real-time data in place of insurance claims and manual chart reviews wherever feasible. CMS acknowledges this will require investments in basic technology over time. The fourth commitment ties payment to results, so that health plans and providers are rewarded for performance on outcome-focused measures.
The partnership is voluntary, and the CMS announcement did not list the 37 participating states. The governors of Oklahoma, Colorado, Utah, and Connecticut issued supporting statements. "When you incentivize outcomes, you see improvement. That's what we did in Oklahoma," said Oklahoma Gov. Kevin Stitt. Colorado Gov. Jared Polis said, "We need to spend less and demand better results." Utah Gov. Spencer Cox said, "Taxpayers deserve to know their dollars are making a genuine, lasting difference."
CMS plans workshops later this year on choosing priority measures and value-based payment arrangements, cutting reporting burden, and digital quality measurement. The announcement did not include a final list of outcome measures, a deadline for states to adopt them, or details on how progress will be reported to the public.
What It Means for Enrollees
The initiative arrives as states prepare for federal Medicaid work requirements that take effect January 1, 2027, for many adults. MedicalDaily recently reported that six states will require medical proof for work requirement exemptions instead of accepting enrollees' word.
Several questions remain open. The announcement did not explain how states will account for patients who start out sicker or poorer, a common concern with outcome-based payment. Without adjustments for those differences, plans paid for better numbers could have less incentive to serve the hardest-to-treat patients. Because participation is voluntary, how Medicaid quality is measured may also continue to vary from state to state for some time.
For now, nothing changes in how enrollees get care, and people on Medicaid do not need to take any action because of the pledge. Enrollees who want to know how their plan performs can ask their state Medicaid agency or health plan for its quality ratings. Patients managing chronic conditions such as diabetes, high blood pressure, asthma, or depression may stand to gain the most if plans are rewarded for keeping those conditions under control.
CMS Deputy Administrator Stephanie Carlton said, "We are shifting the focus from paperwork and process to real accountability for what matters: health outcomes."
Key Questions Answered
What did CMS announce? A voluntary partnership with 37 states, called Investing in Health Outcomes, to measure Medicaid and CHIP quality by patient health results rather than process steps.
Which states signed? The CMS announcement did not list the 37 participating states. Oklahoma, Colorado, Utah, and Connecticut are among the states whose governors publicly backed the effort.
What is the difference between process and outcome measures? A process measure checks whether a step happened, such as a blood sugar test. An outcome measure checks whether the patient's health improved, such as whether blood sugar is under control.
Is the program mandatory? No. States joined voluntarily by signing the Medicaid Quality Pledge.
Will my Medicaid benefits change? No. The pledge affects how states and health plans measure and reward quality, not enrollees' benefits.
What happens next? CMS plans workshops later in 2026 on selecting measures, payment arrangements, reporting burden, and digital data collection.
Published by Medicaldaily.com
