Medicaid and CHIP Health Plan CAHPS
Overview: Medicaid and the Children’s Health Insurance Program (CHIP) use Health Plan Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys to collect data on patient and family experiences with their health plans. These data provide valuable insights into various aspects of health care delivery, such as access to care, communication with health care providers, and customer service.
About the survey: The Health Plan CAHPS surveys are standardized tools used to measure patients’ perspectives on their health plans and services. The surveys cover various topics, including:
- Access to necessary care
- How well doctors communicate
- Health plan information and customer service
- Overall satisfaction with the health plan
These surveys are crucial for understanding and improving patient experiences and ensuring that health plans meet the needs of their beneficiaries.
How the data are used: Starting with the 2024 Core Set, reporting of the CAHPS surveys included in the Child Core Set and the behavioral health measures on the Adult Core Set is mandatory for the 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. More information on mandatory Core Set reporting requirements is available in 42 CFR Parts 433, 437, and 457, and the Initial Core Set Mandatory Reporting Guidance State Health Official Letter. State CHIPs also have annual CAHPS reporting requirements that are described in section 2108(e) of the Social Security Act (the Act). To reduce reporting burden, CMS has streamlined these two reporting requirements into one annual data submission to the Agency for Healthcare Research and Quality (AHRQ) CAHPS Health Plan Database.
CMS publicly reports Health Plan CAHPS data used for the Child and Adult Core Sets on the Core Set Data Dashboard. AHRQ also reports Health Plan CAHPS data on the AHRQ Data Tools website. For more information, please visit the Health Plan CAHPS page on Medicaid.gov or reach out to CMS at MACQualityTA@cms.hhs.gov.