Novu Health Engagement Blog

Upcoming CMS guidance for Medicaid and what it means for your health plan

Ben Wright

What’s coming

The Medicare market has demonstrated that an overall quality rating system like CMS Star ratings is a major game-changer for plan performance, member engagement strategies, and plan bottom line. And it’s no secret that a similar system is on the way for Medicaid plans: the new Medicaid regulations issued by CMS in April 2016 will require each state to have a Quality Rating System for each managed care plan, which must give plans a rating each year. CMS has said that it will issue final guidance on the matter in 2018.

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Chart showing CMS grades quality ratings on a curve.


Once developed, these Medicaid quality ratings will rule the roost for plan performance, as they have in Medicare. States will be required to display the scores for all managed care organizations on their websites, where consumers can use the information to choose a plan based on quality. Meanwhile, states can also be using the scores to assist in their process of all-important contract-granting for managed care plans.

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How to prepare 

Experts agree that the Medicaid quality rating system will, in large part, mimic CMS’s 5-Star rating system for Medicare Advantage (MA) plans, giving us a solid model with which to compare. At NovuHealth, we’re in the business of helping MA plans across the country raise their Star rating, and the key to doing so lies in a focus on outcomes and member engagement. After all, you can’t have superior outcomes without engaged members, just like you can’t create a successful member engagement program without basing it on members’ health.


Between now and 2018, Medicaid plans can focus their energies on closing gaps in care for their members. At NovuHealth, we deliver high-value member behaviors among hard-to-reach member populations by building intelligent rewards and incentives programs. The cornerstones of our programs that allow us to be successful are a multi-channel member experience, consumer engagement best practices and audience segmentation and targeting. These same strategies will be invaluable for Medicaid plans looking to anticipate and ultimately stand out in a quality rating system.


For a look at the bigger picture for Medicaid health plans and how the new quality rating system will fit in, download our white paper: “Driving High-Value Behaviors in Medicaid Plans: Medicaid rewards and engagement programs to activate hard-to-reach members and close gaps in care.”

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About NovuHealth

NovuHealth is the health care industry’s leading consumer engagement company. Combining performance analytics, behavior science and comprehensive technology solutions, our rewards and engagement programs enable health plans to increase high-value member activities—improving member health and driving plan performance. Visit us at