CMS Counted 450 Medicaid Quality Reporting Requirements for 260 Measures, and 37 States Pledged to Streamline Them

CMS launched Investing in Health Outcomes on 25 September 2026, with 37 founding states signing a voluntary Medicaid Quality Pledge to measure Medicaid and CHIP quality by health outcomes rather than process. The release does not list the states; governors of Oklahoma, Colorado, Utah and Connecticut gave statements of support.
A May 2026 CMS analysis of managed care programs in 42 states found about 450 reporting requirements covering roughly 260 unique quality measures, mostly focused on process and utilisation. CMS cites diabetes control measured with three different A1c cutoffs as an example of why states cannot be compared.
The pledge has four principles: prioritise outcomes in prevention, chronic disease and behavioural health; streamline measure inventories; move to digital, near-real-time measurement; and align financial accountability with outcome measures.
States commit to develop outcome targets and build outcome measures into quality strategies and upcoming procurements. CMS will hold workshops later this year on measure prioritisation, value-based arrangements, reporting burden and digital measurement.

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The pledge sets a direction without a single measure, target or date, and the lever that will matter is managed care procurement.

Nothing binds yet. The pledge is voluntary and principles only; states commit to develop targets, not to meet any. The real test is whether outcome measures appear in the next round of managed care contracts, which is where Medicaid plans are paid and penalised.
Diabetes is CMS’s own example. Choosing three conflicting A1c cutoffs to illustrate the problem suggests glycaemic control is a likely early candidate for a common outcome measure. For makers of diabetes therapies, including GLP-1s, a single Medicaid outcome standard would shape how plans value glucose control.
Outcome measures need stable enrolment. Most outcome measures count only patients enrolled long enough to be followed. Work requirements start in January 2027, and CMS’s own estimate attributes nearly 43% of projected coverage losses to procedural disenrollment, so the population these measures track will be churning just as they arrive.

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