DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
 
 
CMCS Informational Bulletin 
 
 
DATE:  December 19, 2012 
 
FROM:  Cindy Mann, Director 
    Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:  Maternal and Child Health Updates in Medicaid and CHIP  
 
 
This Informational Bulletin provides information to states and other stakeholders on the following 
topics: 
  FY 2012 CHIPRA Performance Bonus Awards 
  Annual Report on the Quality of Care for Children in Medicaid and CHIP 
  Issue Brief on Early Elective Deliveries  
FY 2012 CHIPRA Performance Bonus Awards 
We are pleased to announce todays awards of nearly $306 million in Fiscal Year (FY) 2012 
Childrens Health Insurance Program Reauthorization Act (CHIPRA) Performance Bonuses to 23 
states.  CHIPRA established performance bonuses, giving states an incentive to support enrollment 
and retention of eligible children in Medicaid and CHIP and helping to defray the costs associated 
with increasing enrollment of the lowest income children.   
To qualify for a performance bonus, states must implement five out of eight program features 
specified in the law, which are aimed at streamlining their childrens health coverage programs.  
They also must increase childrens enrollment in Medicaid above a baseline level.  The amount of the 
bonus correlates with the increase in Medicaid enrollment  the more children states enroll, the 
higher the bonus. 
The steps states take to simplify enrollment and renewal help increase access to health coverage for 
eligible children and also help states gain administrative efficiencies.  Six of the 23 states awarded 
performance bonuses today have continued to simplify their programs by adopting more than five of 
the required program features. These states include Colorado, Illinois, Iowa, Kansas, New Mexico 
and Oregon. Colorado and Kansas added new program features during 2012.   
We have learned a great deal from the positive outcomes that states have achieved through 
simplification and these lessons have been central to informing our efforts to modernize the Medicaid 
program in general.  CMCS Informational Bulletin  Page 2 
 
Selected 2012 Performance Bonus Highlights  
-  Colorado is receiving a performance bonus for the third time, and earned the highest bonus of 
any state.  Although Colorado had already implemented the required five simplified program 
features, the state continued to streamline its program, adding Administrative Renewal and 
Express Lane Eligibility this year, a total of seven. 
-  South Carolina earned its second bonus this year and is augmenting its Express Lane 
Eligibility procedures. After its early success using SNAP and TANF data to renew coverage 
for children in Medicaid and South Carolina is now using that data to help get eligible 
children enrolled. The states early reports show that families are enrolling and quickly 
signing up for managed care plans.  
-  Utahs 2012 performance bonus is the states first.  To qualify for the bonus, Utah eliminated 
its in-person interview requirement, coordinated its application and renewal procedures, 
adopted administrative renewal and implemented presumptive eligibility. While Utah retains 
an asset test for some families, it simplified the process by no longer requiring families to 
submit paper verification of assets they may have.  
FY 2012 marks the fourth year CHIPRA performance bonuses have been available. The full list of 
performance bonus awardees and details about their efforts are available at 
http://www.insurekidsnow.gov/professionals/eligibility/performance_bonuses.html.  
There will be a final opportunity for states to apply for a CHIPRA performance bonus in FY 2013. 
CMCS staff is available to provide technical assistance to states interested in applying for a 2013 
performance bonus and we encourage Medicaid and CHIP agencies to let us know if they are 
interested in taking advantage of this help.  To learn more about how to qualify for a bonus, please 
refer to http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/sho09015.pdf.  
Annual Report on the Quality of Care for Children in Medicaid and CHIP 
CMS recently released the Secretarys third Annual Report on the Quality of Care for Children in 
Medicaid and CHIP.  This report, required by the Childrens Health Insurance Program 
Reauthorization Act of 2009 (CHIPRA), summarizes state-specific and national information on the 
quality of health care furnished to children in Medicaid and CHIP, and details the progress HHS and 
states have made to systematically measure and report on the quality of care children in Medicaid and 
CHIP receive. 
The 2012 report documents the progress that has been made in building a foundation for a system of 
quality measurement and improvement in Medicaid and CHIP, including an analysis of data reported 
to CMS by states on the initial core set of health care quality measures for children in Medicaid and 
CHIP (Initial Core Set).  The report also offers the first nationwide review of improvement projects 
initiated by state managed care plans, and supported by the 75 percent Federal matching rate  CMCS Informational Bulletin  Page 3 
 
available to states contracting with External Quality Review Organizations (EQROs).  Key findings 
from the 2012 report include: 
Measurement and Reporting 
  In the second year of voluntary state reporting on the Initial Core Set measures, forty-eight 
states and the District of Columbia (D.C.) voluntarily reported one or more of the measures 
for FFY 2011 for Medicaid and/or CHIP children.  The median number of measures reported 
by states for FFY 2011 was 12, up from 7 for FFY 2010.   
  Of the 41 states (including D.C. and Puerto Rico) that contract with managed care plans to 
deliver services to Medicaid and CHIP enrollees, 37 submitted EQRO technical reports to 
CMS for the 2011-2012 reporting cycle.  The most frequently-reported childrens 
performance measures in the EQRO reports are similar to those in the Initial Core Set.  
Quality and Access to Care 
  Most children, across all states, had at least one primary care visit during the reporting 
period, with the median rate ranging from a high of 97 percent among children ages 12-24 
months to 88-90 percent for the other age groups.  
  Childrens access to dental services in FFY 2010 was similar to patterns observed in FFY 
2009.  A median of 43 percent of children ages 1 to 20 received at least one preventive dental 
service (e.g., dental cleanings, application of dental sealants) paid for by Medicaid.   
Consumer Experiences with Health Care 
  Data from the Child Medicaid Consumer Assessment of Healthcare Providers and Systems 
(CAHPS) Health Plan Survey from 25 states in 2010 indicate that parents generally could 
get care for their child when needed for an illness or injury (state median of 76 percent 
responding always), but it was more difficult to get routine care (state median of 65 percent 
responding always) or specialty care (state median of 47 percent responding always). 
It is CMSs expectation that the measurement and reporting tools now in place can guide HHS and 
states in the next phase of efforts to more thoroughly measure the care obtained by children covered 
by Medicaid and CHIP, and improve the quality of care provided to children enrolled in these 
programs. 
The Annual Secretarys Report is available at:  
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-
Care/Downloads/2012-Ann-Sec-Rept.pdf  
The Appendices to the report as well as the Executive Summary can be found at: 
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Quality-
of-Care.html   CMCS Informational Bulletin  Page 4 
 
Issue Brief on Early Elective Deliveries 
We are pleased to announce a new issue brief which provides strategies for state Medicaid agencies 
to reduce non-medically necessary, early elective deliveries to improve birth outcomes for women 
and newborns in Medicaid and CHIP.  The issue brief is available on the Medicaid.gov web site at 
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Quality-
of-Care-Maternal-and-Child-Health.html .    
The issue brief highlights the experiences of North Carolina and Ohio funded by CMS to improve 
birth outcomes by reducing early elective deliveries, as well as a canvass of current state 
activity.  Additionally, the issue brief outlines options for states to use Medicaid payment, regulation 
and policy levers to contribute to regional and national, public-private initiatives, such as CMS' 
Strong Start Initiative for Mothers and Newborns.  The Strong Start Initiative for reducing early 
elective deliveries, led by the CMS Innovation Center in partnership with CMCS, is a multi-pronged 
approach which includes a media campaign targeted to pregnant women and technical assistance 
activities with the Partnership for Patients Hospital Engagement Networks.  Regional events will be 
hosted within the next several weeks to extend outreach into communities around the nation.   
 For more information on Strong Start and an encore recording of a recent webinar, featuring expert 
speakers from American College of Obstetricians and Gynecologists, the March of Dimes, providers 
and payers, hosted by the CMS Innovation Center on best practices and the importance of 
reducing early elective deliveries on  the health of mothers and newborns, please visit: 
www.innovation.cms.gov/initiatives/strong-start.  Questions regarding Medicaid strategies to reduce 
early elective deliveries may be directed to Lekisha Daniel-Robinson, Division of Quality, Evaluation 
& Health Outcomes within the Children and Adults Health Programs Group at Lekisha.Daniel-
Robinson@cms.hhs.gov .