The Social Security Act (Section 1139B) requires the Secretary of HHS to identify and publish a core set of health care quality measures for adult Medicaid enrollees. The Adult Core Set includes a range of quality measures encompassing both physical and behavioral health. In August 2023, CMS released a final rule to require State reporting of standardized quality measures. Beginning in 2024, reporting on the behavioral health measures on the Adult Core Set is mandatory for states. The Adult Core set will continue to be updated annually, with future updates provided in a manner to allow states to address any changes ahead of mandatory reporting periods.
- 2025 Adult Core Set (Reporting Fall 2025)
- 2024 Adult Core Set (Reporting Fall 2024)
- Annual Reporting on the Quality of Care for Adults Enrolled in Medicaid
- State Reporting Resources & Technical Assistance
- Adult Medicaid Quality Measurement Program
- Annual Core Set Updates
- Related Initiatives
2025 Adult Core Set
CMS released the 2025 Child and Adult Core Health Care Quality Measurement Sets in a May 2024 State Health Official Letter. As noted above, reporting on the 2025 Adult Core Set will occur in Fall 2025.
Section 1139B of the Social Security Act, as amended by Section 2701 of the Affordable Care Act, notes that the Secretary shall issue updates to the Adult Core Set beginning in January 2014 and annually thereafter. The Core Set Annual Review Workgroup reviews the Adult Core Set and identifies ways to improve it, using the annual review and selection process. The 2025 Final Report includes the Workgroup recommendations, public comments and feedback to CMS. The Core Set History table and Historical Policy Guidance documents provide a history of the updates to the measures included in the Child and Adult Core Sets.
The Adult Core Set includes several measures focused on behavioral health. These along with similarly focused measures from the Child Core Set have been identified as the 2025 Behavioral Health Core Set. Similarly, measures from the Child and Adult Core Sets’ focused on maternal and perinatal health have been identified as the 2025 Core Set of Maternal and Perinatal Health Measures for Medicaid and CHIP (Maternity Core Set).
State data derived from the core measures are part of CMS’s annual Child and Adult Core Sets measure reporting, which includes publication of chart packs and datasets that highlight publicly reportable measures.
Annual Reporting on the Quality of Health Care for Adults Enrolled in Medicaid
CMS annually releases information on state progress in reporting the Adult Core Set measures and assesses state-specific performance for measures that are reported by at least 25 states and that met CMS standards for data quality. The Core Set year represents the year that data is reported to CMS, the data generally represents care delivered the prior year. Information about performance on frequently-reported health care quality measures in the Adult Core Set is provided below, in addition state-specific quality information can also be viewed in the Quality of Care section of the State Medicaid & CHIP Profiles web page.
- 2023 Annual Core Set Reporting on the Quality of Care for Adults in Medicaid
- Fact Sheet for 2023 Child and Adult Core Sets Reporting (September 2024)
- Criteria for Using the 2023 Child and Adult Core Set Measures to Assess Trends in State Performance in Medicaid and CHIP (September 2024)
- Coming Soon: 2023 Adult Core Set Chart Pack
- 2023 Measure Performance Tables on the Adult Core Set Measures (September 2024)
- 2023 Adult Health Quality Measures Dataset (September 2024)
- 2022 Annual Core Set Reporting on the Quality of Care for Adults in Medicaid
- Fact Sheet for the Child and Adult Core Set Reporting for 2022 (September 2023)
- 2022 Adult Core Set Chart Pack (January 2024)
- 2022 Measure Performance Tables on the Adult Core Set Measures (September 2023)
- 2022 Adult Health Quality Measures Dataset (September 2023)
- 2021 Annual Core Set Reporting on the Quality of Care for Adults in Medicaid
- Fact Sheet for the Child and Adult Core Set Reporting for 2021 (September 2023)
- 2021 Adult Core Set Chart Pack (January 2024)
- 2021 Measure Performance Tables on the Adult Core Set Measures (September 2023)
- 2021 Adult Health Quality Measures Dataset (September 2023)
- 2020 Annual Core Set Reporting on the Quality of Care for Adults in Medicaid
- Fact Sheet for the Child and Adult Core Set Reporting for 2020 (September 2021)
- 2020 Criteria for Using the Child and Adult Core Set Measures to Assess Trends in State Performance in Medicaid and CHIP (September 2021)
- 2020 Adult Core Set Chart Pack (January 2022)
- 2020 Behavioral Health Core Set Chart Pack (January 2022)
- 2020 Maternity Core Set Chart Pack (November 2021)
- 2020 Measure Performance Tables on the Adult Core Set Measures (September 2021)
- Adult Health Quality Measures Dataset (September 2021)
- 2019 Annual Reporting on the Quality of Care for Adults in Medicaid
- Fact Sheet for the Child and Adult Core Set Reporting for 2019 (September 2020)
- 2019 Criteria for Using the Child and Adult Core Set Measures to Assess Trends in State Performance in Medicaid and CHIP (September 2020)
- 2019 Adult Core Set Chart Pack (October 2020)
- 2019 Behavioral Health Core Set Chart Pack (February 2021)
- 2019 Maternity Core Set Chart Pack (December 2020)
- 2019 Measure Performance Tables on the Adult Core Set Measures (October 2020)
- Adult Health Quality Measures Dataset (October 2020)
- 2018 Annual Reporting on the Quality of Care for Adults in Medicaid
- Fact Sheet for the Child and Adult Core Set Reporting for 2018 (September 2019)
- 2018 Criteria for Using the Child and Adult Core Set Measures to Assess Trends in State Performance in Medicaid and CHIP (November 2019)
- 2018 Adult Core Set Chart Pack (September 2019)
- 2018 Measure Performance Tables on the Adult Core Set Measures (April 2020)
- 2018 Adult Health Quality Measures Dataset (September 2019)
- 2017 Annual Reporting on the Quality of Care for Adults in Medicaid
- Fact Sheet for the Child and Adult Core Set Reporting for 2017 (December 2018)
- 2017 Adult Core Set Chart Pack (December 2018)
- 2017 Measure Performance Tables on the Adult Core Set Measures (December 2018)
- 2017 Adult Health Quality Measures Dataset (December 2018)
- 2016 Annual Reporting on the Quality of Care for Adults in Medicaid
- 2015 Annual Reporting on the Quality of Care for Adults in Medicaid
- 2014 Annual Reporting on the Quality of Care for Adults in Medicaid
- 2013 Annual Reporting on the Quality of Health Care for Adults Enrolled in Medicaid
- Overview of the Adult Core Set Measures 2013
- Benchmarks for Medicaid Adult Health Care Quality Measures (November 2014)
- Findings from EQR Reports Submitted During the 2013-2014 Reporting Cycle
Adult Medicaid Quality Measurement Program
By January 1, 2013, a Medicaid Quality Measurement Program will be established to fund the development, testing, and validation of emerging and innovative evidence-based adult health quality measures. As specified in the legislation, this program is to be established in the same manner as the Pediatric Quality Measures Program.