States Target Medicaid QIPs to Improve Health Access, Outcomes

A new research brief from Medicaid Health Plans of America (MHPA) highlights how Medicaid managed care plans (MCPs) are driving better health outcomes through federally required Quality Improvement Projects (QIPs).¹ Analyzing data from 41 states, the report reveals that MCPs led more than 1200 QIPs during the 2023-2024 cycle, with states prioritizing key areas like behavioral health, chronic disease management, and maternal health.

Mental health, care of acute and chronic conditions, primary care access and prevention, and maternal and perinatal health were identified as key focus areas among a majority of states. | Image credit: Andrii - stock.adobe.com

“Health plans are essential partners in helping states address an array of complex health care challenges facing the Medicaid population and improve outcomes,” said Craig A. Kennedy, MPH, president and CEO, MHPA, in a statement.¹ “As MCPs work with states to design innovative quality improvement strategies, QIPs can serve as important tools for improving the health and experience of enrollees in Medicaid managed care. By evaluating these strategies against a set of performance measures, states and MCPs can identify which interventions are most effective at improving outcomes, and lessons learned can be disseminated across plans, states, and other key stakeholders.”

Unlike other quality improvement initiatives, QIPs are federally mandated projects that states carry out through nearly all Medicaid MCPs. These projects must be independently validated by an accredited organization—a level of oversight not required in traditional fee-for-service Medicaid.

“These performance improvement activities are designed as tests of different interventions addressing some of the most entrenched health problems,” the brief states.² “Moreover, addressing health issues among Medicaid enrollees often involves working with vulnerable communities and coordination across numerous health care settings and providers. Given these challenges, QIPs are multiyear projects that are adapted and refined over multiple iterations.”

Behavioral Health QIPs

In response to rising demand following the COVID-19 pandemic, 33 states implemented behavioral health–related QIPs, with many focusing on improving access and care coordination across settings. Among these, 20 states targeted follow-up care after hospitalizations or emergency department visits, and 17 states emphasized care coordination through case management (13 states) and provider collaboration (9 states). Thirteen states also prioritized substance use disorder treatment, including opioid and alcohol use. Additional QIPs addressed access to mental health services (6 states) and safe prescribing practices for antipsychotic medications (6 states).

Care of Acute and Chronic Conditions QIPs

Chronic conditions are highly prevalent among Medicaid enrollees, with about 75% of younger adults affected—far surpassing rates seen in those with private insurance. In response, many states prioritized QIPs targeting the most common chronic conditions in Medicaid, such as diabetes (18 states), hypertension (8 states), and respiratory conditions like asthma and chronic obstructive pulmonary disorder (4 states). Eight states focused on improving medication management to boost adherence and reduce adverse drug events. Additionally, several states addressed avoidable acute care episodes by implementing QIPs to reduce emergency department visits (5 states) and hospital readmissions (4 states), while 10 states focused on improving care coordination across settings and providers.

Maternal and Perinatal QIPs

As the largest public payer for maternal and perinatal health services—covering over 40% of all births—Medicaid plays a vital role in supporting healthy pregnancies and births. Among the 23 states with maternal and perinatal health–related QIPs, the majority (13 states) focused on improving access and timeliness of both prenatal and postpartum care. Other states concentrated specifically on prenatal (6 states) or postpartum services (6 states). Eight states emphasized better care coordination, including case management and improved information sharing across providers. Additional priorities included high-risk maternal care (4 states), tobacco cessation during pregnancy (2 states), and postpartum depression screening and support (2 states).

References

1. MHPA releases new research brief on Medicaid managed care Quality Improvement Projects. News release. MHPA. July 22, 2025. Accessed July 22, 2025. https://medicaidplans.org/wp-content/uploads/2025/07/MHPA-Press-Release-QIP-Research-Brief.pdf

2. How Medicaid managed care plans improve health outcomes with Quality Improvement Projects. MHPA. Accessed July 22, 2025. https://medicaidplans.org/wp-content/uploads/2025/07/MHPA-QIP-Research-Brief.pdf