Tech Tuesday: Phase I Medicaid and CHIP Performance Indicators Released (Part I)

The long-awaited performance metrics for Medicaid and CHIP were released last week. And even though I’m a self-admitted data junkie, I don’t think it’s an exaggeration to say that CMS’ new approach to performance reporting is momentous. Why? CMS aims to create a system of data collection and reporting that is consistent across the states by setting standards for the “what”, “when” and “where”.

Why is a federal reporting standard important?

Currently, the collection and reporting of Medicaid and CHIP enrollment-related data is haphazard at best. It varies considerably from state to state, with some states consistently reporting at least high-level enrollment data and others rarely making these data available publicly. Without reliable, timely and continual data, we are not able to identify how well Medicaid and CHIP are performing and where to look for best practices or focus improvement efforts.

What will be reported?

The measures provide specific definitions of data to ensure comparability across states, although achieving consistency will likely take some analysis and tweaking over time. CMS describes the initial data elements released in Phase I as the “most critical to measuring the outcomes of the Medicaid and CHIP eligibility and enrollment process as well as those elements that states are most likely planning to collect internally,” which include:

  • Total Call Volume
  • Call Center Wait Times
  • Abandonment Rate
  • Number of Applications Received in Previous Week
  • Number of Applications Received in Previous Month
  • Number of Electronic Accounts Transferred
  • Number of Renewals
  • Total Enrollment
  • Total Number of Individuals Determined Eligible
  • Total Number of Individuals Determined Ineligible
  • Pending Applications/Redeterminations
  • Processing Time for Eligibility Determinations

When will data be reported?

Routine reporting is required with CMS expecting states to report some data weekly through the end of open enrollment, starting with baseline data in September. Other data will be reported monthly, and all data will be reported monthly after March 31, 2014. Monthly data will be due on the 15th of the month for the previous month.

Where will data be reported?

I’m assuming that the T-MSIS (the Transformed Medicaid Statistical Information System that I blogged about a couple of weeks ago) will be repository. But what’s important to stakeholders is that the data will be posted on so there is a single source of data for all 50 states.

CMS was quick to point out that this is Phase I of the performance indicators, so I’m glad to know there is more coming. Certainly, the list of data in Phase 1 will help us assess state capacity to handle calls and process applications on a timely basis. And we’ll be able to measure how quickly enrollment is growing, particularly after January in states expanding Medicaid to low-income adults.

So what’s missing?

At the top of my list are denial and disenrollment reasons, as well as more robust data to ensure that transfers between the marketplace and Medicaid and CHIP are working as expected. And what about data from the marketplace to support the vision of a single, streamlined application and continuum of coverage? I guess we’ll have to wait and see. When CMS put out its request for information on the performance indicators, it asked respondents to comment on whether the measures should be applied to the marketplace. Not only is that a “yes” for most measures, but also there are additional indicators that are needed to assess how well things are going in the new marketplaces.

Interested in hearing more about what’s missing? Look for next week’s Tech Tuesday blog, Performance Indicators Part II.

[For more on related issues, view the Tech Tuesday blog series by Tricia Brooks.]


Tricia Brooks is a Research Professor at the Center for Children and Families (CCF), part of the McCourt School of Public Policy at Georgetown University.