On September 25, 2026, the Centers for Medicare & Medicaid Services (CMS) announced Investing in Health Outcomes, an effort to change how Medicaid quality measures are chosen and used. A founding group of 37 states signed a voluntary Medicaid Quality Pledge to put health outcomes ahead of process and paperwork, with a focus on prevention, chronic disease management, and behavioral health. The pledge covers Medicaid and the Children’s Health Insurance Program (CHIP).
This article explains what CMS announced, what the pledge settles and what remains open, which chronic disease measures already exist in Medicaid reporting, and what chronic care programs can do now.
The short answer CMS launched Investing in Health Outcomes on September 25, 2026. As of September 24, 37 states had signed a voluntary pledge to prioritize health outcomes, streamline quality measures, adopt digital quality measurement, and link payment to outcomes. CMS has not yet named specific measures or payment changes, so chronic care programs should watch their state’s next steps. |
The four principles at a glance
Outcomes Put health outcomes ahead of process, with a focus on prevention, chronic disease management, and behavioral health. | Streamline Reduce the number of measures without reducing accountability. | Digital Move toward digital quality measurement using timely data where feasible. | Payment Link payment to performance on outcomes measures. |
Source: the Medicaid Quality Pledge on Medicaid.gov. Current as of October 2026. This article summarizes CMS announcements and is not legal, billing, or medical advice.
What CMS Announced and Why
CMS says the effort will make health outcomes, rather than processes and paperwork, the center of how Medicaid success is defined. It will prioritize measures that show “meaningful improvements in prevention, chronic disease management, and behavioral health,” according to the CMS announcement.
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Source: Medicaid.gov. About 56 million is CMS’s figure for pledged states, and nearly 80 million is the pledge’s figure for all enrollees, so pledged states cover roughly seven in ten. Bars are scaled to the larger number. Pledged states also account for about $701 billion in FY 2024 Medicaid spending.
The reason CMS gives is measurement overload. A May 2026 CMS analysis of Medicaid managed care programs across 42 states found about 450 quality reporting requirements, largely focused on processes and utilization.
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Source: CMS analysis, May 2026, as reported on Medicaid.gov. Many requirements overlap, which adds burden. For example, diabetes control is measured with three different types of A1c cutoffs, which makes it hard to compare performance across states.
Key Dates for Investing in Health Outcomes
| May 2026 | CMS analyzes Medicaid managed care quality reporting requirements across 42 states. |
| September 24, 2026 | 37 states had signed the pledge. |
| September 25, 2026 | CMS announces Investing in Health Outcomes. |
| Later in 2026 | CMS plans workshops on measure prioritization and value based arrangements, reduced reporting burden, and digital quality measurement. |
| Upcoming procurements | States will look for chances to add outcomes measures to their quality strategies and procurements. Timing has not been announced. |
Process Measures vs Outcome Measures Explained
The shift CMS describes is from the left panel to the right panel. The examples are illustrative, and measure stewards define each measure.
Process measure
| Outcome measure
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The Four Principles of the Medicaid Quality Pledge
The third column below is this article’s reading of what each principle may mean for chronic care programs. It is not CMS guidance.
| Principle | What the pledge says | What it may mean for chronic care programs |
|---|---|---|
| Prioritize outcomes over process | Emphasize health outcomes focused on primary prevention, chronic disease management, and behavioral health, starting with existing measures. | Programs that follow patients with conditions such as hypertension and diabetes may be judged more on control of those conditions than on the number of outreach activities. |
| Streamline measure inventories | Converge on a set of measures that “reduces regulatory burden without sacrificing accountability.” | Fewer and more comparable measures could mean less duplicate reporting. The diabetes example above shows where variation exists today. |
| Advance digital quality measurement | Use near real time data as the default where feasible, replacing administrative claims and chart abstraction. | Programs with structured, timely data capture may be better placed. CMS has not said whether home device readings could support any measure. |
| Link financial accountability to outcomes | Ensure that payment meaningfully rewards performance on outcomes measures. | State contracts with health plans and providers may begin to tie payment to outcomes. Details will come through state quality strategies and procurements. |
How the Pledge May Reach Chronic Care Programs
CMS says participating states will use the principles to develop health outcome targets and look for chances to add outcomes measures to state quality strategies and upcoming procurements. The path below is this article’s reading of that description.
Step 1 CMS principles Four principles in the Medicaid Quality Pledge | Step 2 State targets States set health outcome targets and quality strategies | Step 3 Procurements and contracts Outcomes measures may enter health plan procurements and contracts | Step 4 Care programs Providers and chronic care programs may see new measures and payment terms |
What Is Set and What Is Still Open
What CMS has set
| What is still open
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CMS’s press release does not list the 37 states. The Medicaid.gov page includes a map and a data table with each state’s pledge status, so check there for your state.
Chronic Disease Measures Already in Medicaid Reporting
The pledge says to start with existing measures, and CMS has not named which ones states will prioritize. For context, the 2026 Adult Core Set, updated in December 2025, lists these measures under care of acute and chronic conditions.
| Measure | Condition area | Steward |
|---|---|---|
| Controlling High Blood Pressure | Hypertension | NCQA |
| Glycemic Status Assessment for Patients With Diabetes | Diabetes | NCQA |
| Diabetes Care for People With Serious Mental Illness: Glycemic Status Greater Than 9.0 Percent | Diabetes and serious mental illness | NCQA |
| PQI 01: Diabetes Short Term Complications Admission Rate | Diabetes | AHRQ |
| PQI 05: COPD or Asthma in Older Adults Admission Rate | COPD and asthma | AHRQ |
| PQI 08: Heart Failure Admission Rate | Heart failure | AHRQ |
| Plan All Cause Readmissions | All conditions | NCQA |
NCQA is the National Committee for Quality Assurance. AHRQ is the Agency for Healthcare Research and Quality. Which of these measures a state uses in managed care contracts can differ, so confirm with your state Medicaid agency or health plan.
Medicaid Pledge vs Medicare ACCESS Model
CMS is also testing outcome based payment in Medicare through the ACCESS Model. The two efforts are separate, but both place health outcomes at the center.
| Feature | Medicaid pledge | Medicare ACCESS Model |
|---|---|---|
| Program | Medicaid and CHIP | Original Medicare |
| Participation | Voluntary. States sign a pledge. | Voluntary. Organizations take part in a CMS Innovation Center model. |
| Focus | Quality measurement that puts outcomes ahead of process, with chronic disease management as one of three priorities | Technology supported care for chronic conditions, paid in a way that rewards health outcomes rather than required activities |
| Timing | Launched September 25, 2026. Measures and targets are still open. | Began in July 2026 as a 10 year model. |
What Chronic Care Programs Can Do Now
These are practical considerations based on what CMS has announced. They are not CMS requirements.
Step 1 | Check your state’s status Use the map and data table on Medicaid.gov to see whether your state has signed the pledge. |
Step 2 | Review your quality reporting load List the measures your Medicaid health plan contracts require. CMS found about 450 requirements across 42 states, so your load may include overlapping measures. |
Step 3 | Check your outcome data Find out whether your program can report control of blood pressure and glycemic status reliably and in a timely way, since these are existing measures that may be prioritized. |
Step 4 | Watch for workshops and procurements CMS plans workshops later this year, and states will look for chances to add outcomes measures to upcoming procurements. |
Step 5 | Confirm your state’s Medicaid coverage Coverage for Remote Patient Monitoring (RPM) is set state by state. See the section below. |
Quick check: where do you fit
I serve Medicaid patients with chronic conditions
Ask your Medicaid health plans which outcomes measures they report, and check whether your state signed the pledge. Review how well your program can show control of blood pressure and glycemic status.
I contract with a Medicaid health plan
Watch for contract and procurement changes. CMS said states will look for chances to add outcomes measures to upcoming procurements, and its workshops will cover measure prioritization and value based arrangements.
I run or am considering RPM
Check your state’s Medicaid RPM policy first, since coverage varies. The pledge does not address RPM.
Where RPM Fits in Medicaid Chronic Care Programs
The Center for Connected Health Policy (CCHP) found in its Fall 2025 report that 41 state Medicaid programs provide reimbursement for RPM. CCHP stresses that the full policy language matters because policies differ in their details. The pledge does not address RPM, and CMS has not said whether home device readings could support any outcomes measure.
What the pledge does emphasize is chronic disease management and digital quality measurement using timely data. RPM is one way programs collect measured readings, such as blood pressure and glucose, between visits. Clinicians decide what to do with that data. RPM is for monitoring only and does not replace emergency care.
How DrKumo Supports RPM in Chronic Care Programs
The 2026 Adult Core Set includes measures on blood pressure control, glycemic status, and admissions for diabetes complications, COPD or asthma, and heart failure. DrKumo supports provider led, evidence based Disease Management Protocols for hypertension, diabetes, heart failure, and COPD, and provides secure, HIPAA compliant digital health technology that supports RPM programs operated by healthcare providers.
The platform moves physiologic data from patients’ homes to care teams over cellular connectivity, with no WiFi or smartphone app required, using medical devices as defined by the FDA, and applies healthcare cybersecurity practices to patient data. That may suit FQHCs and RHCs, rural health organizations, and community providers that serve Medicaid patients. Which measures apply to a program is determined by states and health plans. Practices can review DrKumo’s comprehensive guide to RPM. DrKumo is a technology provider and is not a clinical entity. Providers retain full clinical responsibility for patient care decisions, and RPM supports monitoring between visits rather than replacing emergency care.
Key Takeaways
CMS and 37 founding states launched Investing in Health Outcomes on September 25, 2026. The voluntary pledge sets four principles: outcomes over process, streamlined measures, digital quality measurement, and payment linked to outcomes.
Specific measures, targets, and payment changes are still open, and CMS says the principles are the basis for future state implementation. Chronic disease management is one of three named priorities, and existing measures such as blood pressure control and glycemic status are the starting point.
Medicaid RPM coverage varies by state, and the pledge does not address RPM. DrKumo’s technology supports RPM programs. DrKumo is a technology provider and is not a clinical entity, and RPM does not replace emergency care.
Data driven care starts here Building chronic care programs around outcomes? To learn how DrKumo can help your organization deliver secure, HIPAA compliant RPM, contact us today. Our team is ready to support your journey toward better patient care.
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Frequently Asked Questions About the Medicaid Quality Pledge
Questions health care teams are asking about Investing in Health Outcomes.
What is Investing in Health Outcomes?
Investing in Health Outcomes is a CMS initiative launched on September 25, 2026, with a founding group of 37 states. It shifts Medicaid and CHIP quality strategy toward health outcomes, with a focus on prevention, chronic disease management, and behavioral health.
What are the four principles of the Medicaid Quality Pledge?
States commit to prioritize outcomes over process, streamline quality measure inventories, advance digital quality measurement using timely data where feasible, and link financial accountability to outcomes measures.
Is the Medicaid Quality Pledge mandatory?
No. States join voluntarily by signing the pledge. As of September 24, 2026, 37 states had signed, covering about 56 million Medicaid and CHIP beneficiaries.
Does the pledge change Medicaid coverage for RPM?
The pledge does not address RPM. Medicaid RPM coverage is set by each state. The Center for Connected Health Policy found in Fall 2025 that 41 state Medicaid programs provide reimbursement for RPM, with differences in the details.
Which chronic conditions does the pledge focus on?
CMS names chronic disease management as a priority without listing specific conditions. For context, the 2026 Medicaid Adult Core Set includes measures on blood pressure control, diabetes, COPD or asthma, heart failure, and readmissions.
References
Sources and method: this article was prepared from primary sources, namely the CMS press release of September 25, 2026, the Medicaid.gov Investing in Health Outcomes page, the 2026 Medicaid Adult Core Set, and CCHP’s Fall 2025 report. The third column of the principles table is the author’s reading and not CMS guidance. Information is current as of October 2026.
Centers for Medicare & Medicaid Services. (2026). CMS Refocuses Medicaid Quality on Health Outcomes, Launches Innovative Partnership With 37 States. CMS.gov.
Centers for Medicare & Medicaid Services. (2026). Investing in Health Outcomes. Medicaid.gov.
Centers for Medicare & Medicaid Services. (2025). 2026 Core Set of Adult Health Care Quality Measures for Medicaid. Medicaid.gov.
Center for Connected Health Policy. (2025). State Telehealth Laws and Reimbursement Policies Report, Fall 2025. Public Health Institute.
CMS Innovation Center. (2025). Improving ACCESS to Technology Supported Care with Outcome Aligned Payments. CMS.gov.
Disclaimer: This article is intended for informational purposes only and does not constitute medical, legal, billing, coding, financial, or policy advice. It summarizes announcements and documents from CMS as of October 2026. Medicaid policy varies by state and is subject to change, and the Medicaid Quality Pledge is voluntary. Always consult official CMS and state Medicaid sources for current requirements. DrKumo is a technology provider and is not a clinical entity. It does not provide clinical services or replace a licensed provider’s clinical judgment. Always consult with a licensed healthcare provider for guidance on diagnosis, treatment, or medical decisions. References to CMS, HHS, Medicaid.gov, and other organizations do not constitute or imply an endorsement by those organizations or the U.S. Government. |
