2025 Medicaid Annual Evaluation Summary

Annual Evaluation Overview

Meridian’s Quality Improvement Program (QIP) is designed to continuously improve the quality, safety, and experience of care for members. The program reviews health outcomes, access to care, member and provider feedback, and performance measures throughout the year to identify opportunities for improvement and implement targeted interventions. It includes medical, behavioral health, dental, and preventive services and focuses on delivering equitable, culturally responsive care to all members.

In 2025, Meridian maintained strong program oversight, met regulatory requirements, and demonstrated ongoing collaboration across departments to improve care delivery and member outcomes.

 

Population Summary

•  Medicaid enrollment decreased in 2025 due to program changes, including loss of approximately 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 composition:
  • White: 57.6%
  • Black or African American: 28.9%
  • Other groups represent smaller proportions
• Primary 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%)
• Achieved 100% SDOH screening for newly managed members
• Improved engagement rate to 20.6%
• Identified gap in health care transition assessments, targeted for improvement

Clinical Quality & PIPs

• Lead Screening PIP: Increased screening rates; barriers remain in outreach and caregiver education
• Health-Related Social Needs PIP: Improved screening rates; variability in provider adoption persists
• Maternal Health Outcomes:
  • Prenatal care improved by +7.8 points, postpartum by +2.9 points
  • Low Birth Weight (LBW) rate met overall target but disparities persist for Black/African American populations
• Expanded telehealth, doula services, and community partnerships to support outcomes

HEDIS® Performance

• 8 of 26 measures met/exceeded benchmarks; 12 improved year-over-year
• Key gaps remain in:
  • Immunizations
  • Asthma management
  • Lead screening
  • Maternal care measures
• Implemented interventions including home testing kits, incentives, CHW outreach, and telehealth

Dental Program

• Significant increases in adult dental utilization (preventive, diagnostic, restorative)
• Exceeded state benchmarks for pregnancy and diabetes dental care
• Barriers identified: transportation, awareness, and provider coding
• Ongoing improvements through Delta Dental partnership and outreach strategies

Patient Safety

• 191 Quality of Care events reviewed, majority low-risk
• Most common categories: infections and skin/ulcer issues
• All cases addressed through established QOC and credentialing processes

Access & Availability

• Call center performance met service and response targets; reduced abandonment rates
• Network adequacy standards met for geography and ratios
• Gaps identified in urgent and after-hours access for certain specialties
• Barriers include provider shortages 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 Takeaways:

• 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% [2025 Medic...orking Doc | Word]

 

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 Takeaways:

• Performance met or exceeded state averages across all measures
• Significant improvement in “Would Recommend Dental Plan”
• Continued opportunity to improve survey participation rates

Appeals & Grievances

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

Behavioral Health

• Strong performance in provider communication and goal-setting
• Barriers include appointment access and affordability
• Expanded access through telehealth, digital tools, and partnerships (e.g., Teladoc, Pyx Health)

Care Management & Population Health

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

Community Health Workers (CHWs)

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

Foster Care Program

• Established dedicated program model
• Achieved 93% timely initial screenings (within 30 days)
• Expanded services supporting behavioral health and transition to adulthood (a2A)

 

What This Means

 

For Members

• Meridian continues to improve access to care, preventive services, and support programs.
• Your feedback through surveys (like CAHPS) directly shapes improvements.
• Expanded services include transportation, dental care, behavioral health support, and community resources.
• Meridian is focused on ensuring that care is equitable, accessible, and culturally responsive.

For Providers

• Provider collaboration remains critical to improving quality outcomes and member experience.
• Opportunities exist to improve CAHPS performance 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

• Improve member engagement and survey response rates
• Strengthen care coordination and provider communication
• Address health disparities through targeted interventions
• Expand access to preventive, behavioral, and maternity care services