2025

Background

The child and adult core health care quality measurement sets, developed by the Centers for Medicare & Medicaid Services (CMS), are standardized collections of quality measures used to monitor and improve health care provided to Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. These measures span multiple domains—including preventive care, maternal and perinatal health, behavioral health, and oral health—and are updated annually based on evolving clinical guidelines, stakeholder input, and changes to a quality measure’s technical specifications. CMS uses the core sets to facilitate national benchmarking and inform program improvements, while also supporting state efforts to identify disparities and enhance quality of health care.

In 2023, CMS finalized a federal rule mandating phased-in reporting of these measures. Beginning in fiscal year (FY)’24, all states must report on the full child core set and the behavioral health measures in the adult core set. Starting in FY’25, states are also required to report on the remaining adult core set measures. This mandate applies to all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands, while American Samoa and the Northern Mariana Islands are encouraged to report voluntarily. Data submissions are due annually by December 31, covering services delivered during the previous FY.

To support states in meeting these reporting requirements, CMS provides technical assistance, resource manuals, detailed technical specifications, and training webinars. These tools are designed to help states accurately collect, analyze, and report data while enhancing care quality and addressing health disparities across populations.

In a letter sent to state health officials in 2024, CMS announced updates to the 2025 child and adult core health care quality measurement sets, with significant changes aimed at enhancing quality of care for Medicaid and CHIP beneficiaries. These updates include the addition of new measures, modifications to existing measures, and guidance on mandatory reporting. Notably, several updates focus on improving oral health outcomes across population groups.

Impact

The updates to the 2025 child and adult core sets place a strong emphasis on oral health, recognizing its critical role in overall health and well-being. Key oral-health-related measures in the core sets include:

• Oral Evaluation, Dental Services: This measure assesses the percentage of children and adolescents under age 21 who received at least one preventive dental service during the reporting year. It continues to be a mandatory measure in the child core set.

• Oral Evaluation During Pregnancy: This measure assesses the percentage of pregnant women who had a dental visit during pregnancy. The measure was introduced as a voluntary measure in the 2025 child and adult core sets and is a mandatory measure in the 2026 child and adult core sets.
• Topical Fluoride for Children: This measure evaluates the percentage of children who received at least two topical fluoride applications within the reporting year. It continues to be a mandatory measure in the child core set.
• Sealant Receipt on Permanent First Molars: This measure tracks the percentage of children ages 6–9 who received dental sealants on their first permanent molars. It continues as a mandatory measure in the child core set.
• Ambulatory Care Sensitive Emergency Department Visits for Non-Traumatic Dental Conditions in Adults: This measure assesses the rate of emergency department visits for non-traumatic dental conditions, aiming to identify and reduce preventable dental emergencies. The measure was added to the 2025 adult core set for voluntary reporting.

These measures are designed to promote preventive oral health care and early detection of oral health issues and to reduce unnecessary emergency department visits related to dental conditions. By incorporating these measures into the core sets, CMS aims to improve oral health outcomes and reduce disparities among Medicaid and CHIP beneficiaries.

Sources

Centers for Medicare & Medicaid Services. No date. Child and Adult Health Care Quality Measures: Child and Adult Core Sets [webpage].

Centers for Medicare & Medicaid Services. 2024. 2025 Updates to the Child and Adult Core Health Care Quality Measurement Sets and Mandatory Reporting Guidance [letter from CMS to state health officials].

Centers for Medicare & Medicaid Services. 2025. Overview of the Dental and Oral Health Services Measures in the 2025 Child, Adult, and 1945A Health Home Core Sets. Baltimore, MD: Centers for Medicare & Medicaid Services.

 

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