CMS and States Rework Medicaid Quality Measures as 340B Charity Care Draws Scrutiny
The Trump administration said 42 states will work with CMS to redesign how quality is assessed in Medicaid and CHIP, emphasizing outcomes and reducing reporting burdens. The participating states cover roughly 56 million beneficiaries and about $701 billion in fiscal 2024 Medicaid spending. Separately, a report found 340B hospitals spent a smaller share of operating expenses on charity care than non-340B nonprofit hospitals.
The CMS-state partnership covers 42 states whose Medicaid and CHIP populations total about 56 million people and whose fiscal 2024 Medicaid spending was roughly $701 billion. Participants will help simplify quality measure lists, move toward digital measurement using near-real-time data where feasible, and link financial accountability to outcome measures.
A separate Pioneer Institute and CancerCare report found 340B hospitals devoted 2.16% of operating expenses to charity care, compared with 2.82% at nonprofit hospitals outside the program. For uninsured patients, those figures were 1.6% and 2.26%. 340B drug discounts range from 25% to 50%, with no absolute mandate to pass savings to patients.
Medicaid and CHIP enrollees in the 42 participating states could be affected if quality measurement shifts toward outcomes and reduced reporting, though benefits may depend on data capacity. Hospitals in the 340B program may face closer scrutiny over charity care, potentially influencing resources for low-income and uninsured patients. States and providers may need to adjust accountability and reporting systems, with effects on access and administrative workload still uncertain.