This tracker will report on eight state-reported Medicaid and CHIP performance indicators. The analysis of state data is displayed in national maps for the most recent quarter broken into four quartiles with the top quartile reflecting the highest performing states. To smooth out monthly anomalies in state workload and allow for tracking these metrics over time, we are averaging the monthly data over a quarter. In addition to national maps, we have trended out these performance measures for each state starting with the first quarter of 2024, comparing the state’s performance to the national median. States underperforming on several of these measures will face additional system and administrative challenges when implementing policy changes mandated by HR 1, the budget reconciliation act. Read more about the metrics in the report and the blog. These data will be updated for the most recent quarter going forward.
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Methodology
This analysis of state readiness to implement H.R. 1 from the Georgetown University Center for Children and Families (CCF) uses two datasets from the Centers for Medicare & Medicaid Services (CMS): the State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data and the State Medicaid and CHIP Eligibility Processing Data. CCF uses the most recent data available from CMS, which may include retroactive updates.
Monthly shares are computed as numerator divided by denominator when the denominator is greater than zero and the numerator is reported. If denominator is zero, then monthly share is reported as missing, if numerator is zero, then monthly share is reported as zero. Missing values (blank) are excluded from all calculations and do not contribute to numerators or denominators. Quarterly averages are the simple mean of available monthly shares within the quarter.
Definitions
- Call center wait times are the average amount of time an enrollee is on hold waiting for assistance. For this metric, a lower wait time is better.
- Abandonment rate is the percentage of calls in which an enrollee disconnects before reaching assistance. For this metric, a lower rate is better.
- Share of individuals whose applications took longer than 30 days to process is the percentage of Medicaid and CHIP applications with a final determination made more than 30 days after submission. States report application timeliness for children, parents, pregnancy, and expansion adults in 5 buckets: within 24 hours; 1-7 days; 8-30 days; 31-45 days; and over 45 days. CCF combines state data for the last two timeframes to report applications processed in more than 30 days. For this metric, a lower share is better.
- Share of enrollees whose coverage was renewed is the percentage of Medicaid and CHIP enrollees due for renewal who successfully retain coverage. For this metric, a higher share is better.
- Share of enrollees renewed via ex parte is the percentage of Medicaid and CHIP enrollees due for renewal who are successfully renewed through the ex parte process. For this metric, a higher share is better.
- Share of enrollees disenrolled at renewal is the percentage of Medicaid and CHIP enrollees who lose coverage at the time of renewal. For this metric, a lower share is better.
- Share of enrollees disenrolled for procedural reasons is the percentage of Medicaid and CHIP enrollees disenrolled at renewal whose coverage ended due to procedural reasons. For this metric, a lower share is better.
- Share of pending renewals is the percentage of Medicaid and CHIP enrollees due for renewal whose renewals were not completed by the end of the reporting period. States report renewal outcomes, including the number of pending renewals not completed by the last day of the reporting period, then submit updated reporting with the outcomes of pending renewals. For this indicator, CCF uses original data reported to CMS. For this metric, a lower share is better.