No Changes to Child Core Set of Health Care Quality Measures in Medicaid and CHIP for 2019

CMS has announced that the Child Core Set of Quality Measures in Medicaid and CHIP will remain the same for 2019. No new measures will be introduced, nor will any 2018 measures be retired. CMS is required to review the core measures annually, and does so in partnership with the National Quality Forum (NQF) and a diverse and broad group of child health stakeholders and quality experts. Each year, NQF and CMS publish a report on the review process, which also identifies gaps in measures that can inform pediatric health quality measure development. More information about the most recent review of the child core set can be found in this blog. (Additionally, Say Ahhh! readers may find it interesting to see how the child core set has evolved over time in this table.)

What is the Child Core Set of Health Care Quality Measures?

The child core set is a set of standardized, evidence-based measures to assess the quality of care children receive in Medicaid and CHIP. Enacted as part of the 2009 CHIP Reauthorization Act, it is the best source for comparing the experience and health outcomes of children enrolled in Medicaid and CHIP, allowing states to identify gaps in their own performance and where they may learn from the experience of higher performing states.

Are states required to report the child core set?

Currently, reporting on the child core set is voluntary for states. If states choose to report the data, they also have the option to report Medicaid and CHIP data separately or combined. However, the most recent renewal of CHIP funding in February 2018 establishes a 2024 date for mandatory reporting on the child core set.

Where can I find the latest information on state reporting the child core set data?

CMS releases an annual chartpack and state-level data on state reporting on the child core set. However, state-level data is only released if at least 25 states report a measure. The most recent release of child core set data was in October 2018, as detailed in this blog. But it’s important to note differences in the years associated with the data. In the October 2018 report, states reported on the 2017 child core set based on calendar year 2016 health care services utilization services. Reporting on the 2019 child core set based on calendar year 2018 health care utilization should be published by CMS in 2020. Confusing? Yes!

How can advocates use the child core set to advance quality health care for children?

Advocates do not need to be quality measurement experts to encourage their state Medicaid and CHIP agencies to prioritize improvement in children’s health care. If you’re interested in learning more about quality measurement, check out our primer. It doesn’t include the latest on the child core set or reporting on the measures, but it provides basic information on quality measurement and requirements to assess performance and identify opportunities to improve the quality of health care for children in Medicaid and CHIP.

How can advocates make the case for prioritizing reporting and improvements in the quality of care children receive in Medicaid and CHIP?

Given that states will be required to report on the full set of child health quality measures in 2024, it’s easier to encourage them to move toward full reporting as soon as possible. The real challenge is getting states to prioritize improvements in child health quality. Most quality efforts are focused on high cost populations in order to reduce spending on health care. But since children are the lowest cost population to cover, states and/or managed care plans focus their performance improvement projects on higher cost populations (i.e., seniors in need of long term care, individuals with disabilities, or adults with multiple chronic conditions) in order to achieve quick cost savings. This work is important but state officials and Medicaid and CHIP administrators need to appreciate that the return on investment in quality improvement for children in Medicaid and CHIP will be cross-sector and longer term.

There are shorter term, although not necessarily immediate, gains to be made in improving children’s health. For example, children who are born with low birth weight are 50 percent more likely to need expensive special education services as earlier as 5-7 years down the road. Preventing low-weight births can produce more immediate savings in neonatal intensive care services, as well as a reduction in pre-school early intervention services and special education services in elementary school.

But our efforts must not be short-sighted. If we are to bend the health care cost curve 20-30 years down the road, we need to invest in childhood health rather than filling up the pipeline with children who may develop multiple chronic conditions in adulthood that are rooted in childhood.

Tricia Brooks
Tricia Brooks is a Senior Fellow at the Center for Children and Families

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