2025 Medicaid Annual Evaluation Summary

Overview

Meridian’s Quality Improvement Program (QIP) is designed to keep making quality and safety better. It also works to help how members experience care. The program reviews health results, access to care, member and provider feedback. Performance measures throughout the year to find ways to improve and start focused interventions. The program involves medical, behavioral health, dental, and preventive services. The goal is to give equitable, culturally aware care to all members.

In 2025, Meridian maintained strong program oversight. It met regulatory rules, and worked together across many teams. This helped care delivery and member results.

Population Summary

• Medicaid enrollment went down in 2025 due to program changes. This contains the loss of around 43,000 members across Regions 2, 3, and 7.
• Total Medicaid membership in 2025 was 219,741 members, with 55% female and 45% male.
• The largest population group is ages 0–19, followed by ages 20–44.
• Racial make up:
  • White: 57.6%
  • Black or African American: 28.9%
  • Other groups have smaller amounts
• Main language: 96.9% English, followed by Arabic (1.06%) and Spanish (0.95%).

Children’s Special Health Care Services (CSHCS)

• Increased referral rates for chronic conditions (asthma +43%, diabetes +56%)
• Reached 100% SDOH screening for newly managed members
• Increased engagement rate to 20.6%
• Found gap in health care transition assessments, targeted for improvement

Clinical Quality & PIPs

• Lead Screening PIP: Raised screening rates; blocks are still there for outreach and caregiver education
• Health-Related Social Needs PIP: Better screening rates; variability in provider adoption is still there
• Maternal Health Results:
  • Prenatal care went up by +7.8 points, postpartum by +2.9 points
  • Low Birth Weight (LBW) rate met overall goal but disparities are still there for Black/African American populations
• More telehealth, doula care, and community partners to support outcomes

HEDIS® Performance

• 8 of 26 measures met/were higher than goal number; 12 went up year-over-year
• There are still key gaps in:
  • Immunizations
  • Asthma management
  • Lead screening
  • Maternal care measures
• Began interventions including home testing kits, incentives, CHW outreach, and telehealth

Dental Program

• Adult dental use (preventive, diagnostic, restorative) went up
• Went past state goals for pregnancy and diabetes dental care
• Blocks found: transportation, awareness, and provider coding
• Ongoing improvements through Delta Dental partnership and outreach plans

Patient Safety

• 191 Quality of Care (QOC) events reviewed, most low-risk
• Most common types: infections and skin/ulcer issues
• All cases reviewed through usual QOC and credentialing methods

Access & Availability

• Call center performance met service and response goals; reduced abandonment rates
• Network adequacy standards met for geography and provider-enrollee ratios
• Gaps found in urgent and after-hours access for certain specialties
• Barriers include lack of provider and member engagement challenges

Member Experience (CAHPS®)

Adult CAHPS® (2025)

Sample: 2,160 | Responses: 228 | Response Rate: 10.7%

Measure	2023	2024	2025	Benchmark
Rating of Health Plan	63.8%	60.1%	58.4%	63.8%
Rating of Health Care	55.6%	49.6%	58.2%	58.0%
Getting Needed Care	81.8%	78.6%	83.0%	82.4%
Getting Care Quickly	82.7%	81.7%	83.8%	82.0%
Customer Service	90.5%	85.2%	86.4%	89.9%
Coordination of Care	87.4%	80.0%	84.6%	86.3%
Personal Doctor Rating	65.2%	70.0%	70.1%	71.4%
Specialist Rating	64.6%	63.4%	58.0%	83.5%
Doctor Communication	91.4%	95.4%	90.6%	93.6%

 

Adult CAHPS® Key Findings:

• Strengths: access to care and timeliness
• Opportunities: overall plan rating, specialist experience, and communication consistency

Child CAHPS® (2025)

Sample: 1,650 | Responses: 239 | Response Rate: 14.6%

Measure	2023	2024	2025
Rating of Health Plan	70.3%	69.0%	67.9%
Rating of Health Care	68.6%	59.9%	71.2%
Rating of Personal Doctor	73.6%	72.3%	74.1%
Rating of Specialist	75.8%	80.0%	68.4%
Customer Service	91.7%	79.9%	85.2%
Getting Needed Care	87.2%	82.5%	88.3%
Getting Care Quickly	89.7%	89.7%	90.3%
Doctor Communication	95.6%	94.0%	93.4%
Coordination of Care	94.2%	87.3%	86.3%

 

Child CAHPS® Key Takeaways:

• Strengths: access and timeliness of care
• Opportunities: specialist ratings and customer service experience

Dental CAHPS® (2025)

Sample: 1,350 | Responses: 242 | Response Rate: 18.29%

 

Global Ratings

Measure	2023	2024	2025	State Avg
Rating of Regular Dentist	70.79%	60.51%	67.63%	63.81%
Rating of All Dental Care	59.39%	55.14%	65.00%	62.87%
Finding a Dentist	48.86%	33.33%	47.62%	43.00%

 

Composite Measures

Measure	2023	2024	2025	State Avg
Care from Dentist & Staff	93.76%	93.21%	92.41%	92.22%
Access to Dental Care	66.76%	63.80%	69.94%	67.9%
Dental Plan Info & Services	73.53%	80.63%	80.23%	79.55%
Would Recommend Plan	85.27%	90.16%	93.21%	91.86%

 

Dental CAHPS® Key Findings:

• Performance met or exceeded state averages across all measures
• Significant improvement in “Would Recommend Dental Plan”
• We can still make survey participation rates better

Appeals & Grievances

• Increased appeals volume (5.83 per 1,000 members)
• High overturn rate driven by additional documentation
• Grievances decreased, particularly about service and provider behavior

Behavioral Health

• Strong performance in provider communication and goal-setting
• Blocks include appointment access and affordability
• Expanded access through telehealth, digital tools, and partners (such as, Teladoc, Pyx Health)

Care Management & Population Health

• 30% member engagement rate in care coordination
• Improvements in:
  • Prenatal gap closure
  • Member satisfaction
  • Completed SDOH screenings
• Reduced inpatient, ED, and readmission usage through targeted interventions

Community Health Workers (CHWs)

• Increased referrals and engagement rates
• Expanded role in helping with SDOH, housing, food, and complex needs
• Showed strong impact in high-risk populations

Foster Care Program

• Established dedicated program model
• Achieved 93% timely initial screenings (within 30 days)
• Added more support for behavioral health and transition to adulthood (a2A)

 

What This Means

 

For Members

• Meridian keeps making access to care, preventive services, and support programs better
• Your feedback through surveys (like CAHPS) helps make things better.
• Expanded services include transportation, dental care, behavioral health support, and community resources.
• Meridian is focused on making sure that care is equitable, accessible, and culturally responsive.

For Providers

• Working with providers is still a vital part of making quality results and member experience better.
• We can still make CAHPS performance better in:
  • Member communication
  • Specialist experience
  • Care coordination
• Meridian continues to support providers through:
  • Education and resources
  • Data and performance reporting
  • Incentive programs for quality improvement

Focus Areas for 2026

• Make member engagement and survey response rates better
• Make care coordination and provider communication stronger
• Work to help with health disparities through targeted interventions
• Expand access to preventive, behavioral, and maternity care services