NCQA Endorses Medicaid and CHIP Quality Improvement Act

NCQA supports Senator Brown’s proposed legislation to measure and improve quality of care for all Medicaid and CHIP beneficiaries.

February 4, 2015

The Honorable Gene Green
United State House of Representatives
2470 Rayburn House Office Building
Washington, DC 20515

The Honorable Joe Barton
United State House of Representatives
2107 Rayburn House Office Building
Washington, DC 20515

Dear Congressmen:

The National Committee for Quality Assurance (NCQA) strongly endorses your Stabilize Medicaid & CHIP Coverage Act of 2015 (HR700). This legislation will ensure 12‐months of continuous coverage for millions of Americans in Medicaid and the Children’s Health Insurance Program (CHIP), which will improve the efficiency and continuity of their care. It also, very importantly, will strengthen our ability to measure and improve the quality of care in these programs. Better quality care, in turn, will improve enrollees’ health, increasing their ability to find employment and private sector coverage. We greatly appreciate your leadership on this and look forward to working with you to make this a reality.

Currently, millions of eligible people covered by Medicaid and CHIP lose coverage each year when states require frequent re‐enrollment. Many also lose coverage because of short‐term income fluctuations that do not put private coverage within reach. These coverage disruptions leave people without access, harming the continuity and effectiveness of care and causing costly, avoidable complications. They also require avoidable administrative costs for states, plans and providers. By ensuring at least 12 months of continuous coverage, your legislation will yield both better care and significant savings.

Twelve month continuous enrollment also is essential for measuring the quality of care, supporting pay‐ for‐performance initiatives and driving quality improvement. NCQA develops and maintains a standardized set of quality measures called “HEDIS” that many states use for these efforts. When people have Medicaid or CHIP coverage for less than 12 months, we must exclude them from these measures to ensure their accuracy. As a result, plans and providers cannot get credit for providing good care to patients who lose eligibility and sometimes do not have enough people on which to report. Accurate performance measurement for all enrollees will provide a better picture of the quality of care delivered, identify gaps and make needed improvements.

Frequent coverage disruptions that so clearly harm access, quality of care, and our ability to measure quality are unique to Medicaid and CHIP. The poor quality and weak accountability that result may well lead to poorer health and less ability for enrollees to fully engage in education and other efforts to become gainfully employed. Your legislation therefore could be an important bridge that leads program enrollees to increased workforce participation and wages that support private sector coverage.

Thank yo u for your leadership on t his important issue. The Stabilize Medic aid & CHIP Coverage Act provides a common‐sense improvement to Medicaid and CHIP and we are happy to provide our support. Please do not hesitate to contact us if we can ever be of any assistance to you.


Margaret E. O’Kane

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