State Performance On Adult Medicaid Core Health Care Measures: An OPEN MINDS Reference Guide

The Children’s Health Insurance Program Reauthorization Act of 2009 and the Patient Protection and Affordable Care Act (PPACA) both contained a requirement that the federal Department of Health and Human Services (HHS) develop and publish a set of health care quality measures, referred to as the Child Core Set and Adult Core Set. The core sets are updated annually. Each year, state Medicaid programs have the option to report on these measures.

The FY 2016 Adult Core Set contained six domains: preventive care, maternal and perinatal health, behavioral health and substance use, care of acute and chronic conditions, care coordination, and experience of care. The set contained 28 measures that address key aspects of these domains. The national core set does not set target goals for each measure. Instead the benchmark used to assess the quality of state outcomes is the national median performance.

Within these two sets of quality measures are a subset of measures focused on mental health and addiction, referred to as the Behavioral Health Core Set. State performance on the fiscal year (FY) 2016 Child Core Set and Adult Core Set have been released. This report summarizes performance on the measures at the national level and provides a state level look at performance on the Adult Behavioral Health Core Set, as well as, trends data for the years 2015 and 2016.