Several state Medicaid programs have implemented quality rating systems (QRSs) for their managed care programs, that rate health plans based on their performance across a variety of measures. Federal regulations require that states implement and publish a QRS for Medicaid health plans, although states are not required to comply until further guidance is released.
This presentation provided background on existing QRSs, federal Medicaid requirements, and a summary of findings from our recent work examining this issue. MACPAC contracted with Mathematica to examine QRSs in Medicaid managed care programs in five states, the exchanges, and the Medicare Advantage program and assessed how these rating systems are being used to inform beneficiary choice, incentivize plan performance, and hold health plans accountable.