States are subject to federal requirements related to Medicaid Managed Care quality including 1) having a managed care quality strategy, 2) developing a quality assessment and performance improvement program (QAPI), and 3) provisions for external quality review (EQR). Additionally, as part of a comprehensive quality assessment and performance improvement program, states must require managed care plans to implement performance improvement projects (PIPs) with an objective to achieve improvement in the measurement of quality performance.

For states with Medicaid Managed Care, requirements exist for developing state quality plans. As of 2024, the state Medicaid program must include a mandatory core set of measures that health plans report on for both children and adults. ASTHO developed a memo which highlights the Core Set of health care quality measures for adults enrolled in Medicaid which are mandatory (as of 2025).

Tobacco Medicaid Quality for TCN