Last updated: April 2026
URAC vs. NCQA Medicaid Health Plan Accreditation — Which Is Right for Your MCO?
Medicaid managed care organizations pursuing independent accreditation typically evaluate two nationally recognized programs: URAC Medicaid Health Plan Accreditation and NCQA Health Plan Accreditation. Both are credible, widely recognized, and accepted by state Medicaid agencies across the country — but they differ meaningfully in standards focus, performance measurement requirements, state-specific recognition, and operational fit. This comparison is designed to help Medicaid MCOs understand the key differences and make an informed program selection decision.
IHS consults on both URAC and NCQA accreditation programs. Thomas G. Goddard, JD, PhD served as Chief Operating Officer and General Counsel of URAC before founding IHS, giving IHS unmatched familiarity with how URAC standards are written, interpreted, and evaluated.
The Two Programs at a Glance
URAC Medicaid Health Plan Accreditation
URAC Medicaid Health Plan Accreditation is a program designed specifically for Medicaid managed care organizations. It incorporates URAC's core Health Plan standards — covering governance, consumer protection, quality management, network management, utilization management, and health information — plus a Medicaid-specific module that addresses state contract compliance, Medicaid member protections, care coordination for complex populations, and Medicaid quality metrics. URAC allows organizations to establish their own performance metrics aligned to organizational goals. An optional LTSS module is available for plans that administer long-term services and supports.
NCQA Health Plan Accreditation
NCQA Health Plan Accreditation (HPA) is the most widely used health plan accreditation program in the United States, covering commercial, Medicaid, and Medicare health plans. It integrates clinical performance measurement through HEDIS (Healthcare Effectiveness Data and Information Set) and CAHPS (Consumer Assessment of Healthcare Providers and Systems) as mandatory components of the accreditation evaluation. NCQA scores accreditation outcomes on a tiered scale — Excellent, Commendable, Accredited, Provisional — with the level tied directly to clinical performance scores alongside structural standards compliance.
Side-by-Side Comparison
| Dimension | URAC Medicaid Health Plan | NCQA Health Plan Accreditation |
|---|---|---|
| Primary Focus | Operational structures, processes, and state Medicaid contract compliance | Clinical performance measurement integrated with structural standards |
| Performance Measurement | Organization sets its own meaningful metrics; HEDIS not required | Audited HEDIS results and CAHPS ratings required; scores affect accreditation level |
| Medicaid-Specific Module | Yes — dedicated Medicaid module addressing state contract compliance and Medicaid member protections | Medicaid content integrated into core standards; no separate Medicaid module |
| LTSS Option | Yes — Medicaid Health Plan with LTSS add-on module available | No dedicated LTSS accreditation module |
| State Mandate Recognition | Accepted in 15 states including TX, FL, NJ, MN, CT, IA, UT, NV, NM, ND, MT, MI, VT, OK, AR | Required or strongly preferred in many Medicaid markets; recognized across most states |
| Accreditation Outcome Scale | Full Accreditation, Provisional Accreditation, or Denial | Excellent, Commendable, Accredited, Provisional, or Denied — level tied to clinical performance |
| Typical Timeline | 6–18 months depending on starting point | 6–9 months review process; HEDIS data cycles affect readiness timeline |
| Renewal Cycle | Typically 2–3 years (verify with URAC) | 3-year renewal cycle |
| Standards Update Cadence | Recent update reduced document uploads by 50%+; AI/ML standards added | Annual HEDIS measure updates; periodic structural standards revisions |
| Small Plan Pricing | Special pricing available for smaller health plans | Tiered pricing based on enrollment size |
| Fee Transparency | Not publicly disclosed; contact URAC directly | Not publicly disclosed; contact NCQA directly |
Key Differences in Depth
Performance Measurement: Flexible vs. Prescribed
The most significant structural difference between the two programs is how they handle performance measurement. NCQA requires organizations to submit audited HEDIS results for designated Medicaid measures and CAHPS ratings — and these scores directly affect the accreditation level awarded. An organization with strong structural compliance but weak HEDIS scores cannot achieve NCQA's highest accreditation tiers.
URAC takes a different approach. Organizations are expected to have a quality management program with defined metrics and continuous improvement processes, but they establish their own performance metrics rather than reporting against a prescribed national measure set. This gives organizations more flexibility to align quality measurement with their specific population and contract requirements — and removes the HEDIS data readiness prerequisite from the accreditation timeline.
Medicaid-Specific Standards
URAC built its Medicaid Health Plan program as a distinct accreditation with a dedicated Medicaid module. This module explicitly addresses state contract compliance, Medicaid member rights, care coordination for the Medicaid population, and Medicaid-specific quality reporting obligations. The program was designed for organizations whose primary or exclusive line of business is Medicaid managed care.
NCQA integrates Medicaid-relevant content into its core Health Plan Accreditation standards rather than maintaining a separate Medicaid module. Many state Medicaid agencies have developed specific NCQA-aligned evaluation frameworks, and NCQA's HEDIS Medicaid measure set is widely used in state external quality review processes. The NCQA program is not Medicaid-exclusive — it applies equally to commercial plans — but it is deeply embedded in Medicaid quality infrastructure at the federal and state levels.
LTSS Coverage
URAC offers a dedicated Medicaid Health Plan with LTSS module for organizations that administer home- and community-based services, institutional long-term care, or other LTSS benefits under their Medicaid contracts. This covers person-centered assessment, care planning, care coordination, and LTSS-specific quality management. NCQA does not offer a comparable LTSS-specific accreditation module — making URAC the stronger fit for Medicaid MCOs with significant LTSS populations.
State Mandate Specificity
Both programs are accepted as satisfying Medicaid MCO accreditation mandates across most states that have enacted such requirements. However, specific state contracts sometimes name a preferred or required accreditor. Organizations operating in multiple states with different requirements should map their specific state contract terms before selecting a program — some states accept either URAC or NCQA, while others specify one or the other.
Decision Framework: How to Choose
Neither program is universally superior. The right choice depends on your organization's specific situation across five factors:
1. State Contract Requirements
Start here. If your state Medicaid contract specifies URAC, NCQA, or both as accepted accreditors, that constrains the decision. If the contract accepts either, move to the remaining factors.
2. HEDIS Data Readiness
If your organization already produces audited HEDIS data — or has the infrastructure to do so — NCQA's performance-integrated model is manageable. If you do not have a HEDIS reporting infrastructure and building one would extend your accreditation timeline significantly, URAC's flexible measurement approach may be the faster path to initial accreditation.
3. LTSS Program Administration
If your Medicaid contract includes significant LTSS benefit administration, URAC's Medicaid Health Plan with LTSS module is purpose-built for that operating environment. There is no NCQA equivalent. This is a strong differentiating factor for LTSS-intensive Medicaid MCOs.
4. Competitive Positioning
In some markets, NCQA accreditation carries stronger brand recognition with employers and consumer audiences due to its HEDIS reporting integration. For Medicaid-only plans whose primary audience is state Medicaid agencies and CMS, this distinction matters less — both programs carry equivalent credibility with government purchasers.
5. Multi-Accreditation Strategy
Organizations are not required to choose only one program. Some Medicaid MCOs hold both URAC and NCQA accreditations — using URAC for its Medicaid-specific module and LTSS coverage, and NCQA to satisfy markets where NCQA is the preferred standard. IHS can help organizations structure a multi-accreditation strategy that minimizes redundant effort and maximizes state compliance coverage.
IHS Can Guide Either Path
IHS consults on both URAC and NCQA accreditation programs for Medicaid managed care organizations. Thomas G. Goddard, JD, PhD served as Chief Operating Officer and General Counsel of URAC, giving IHS unmatched depth on URAC standards interpretation and reviewer expectations. IHS also brings NCQA Health Plan Accreditation experience from engagements across both programs.
If you are evaluating which program to pursue — or whether to pursue both — IHS can provide a structured program selection analysis based on your state contract requirements, organizational starting point, HEDIS data readiness, and LTSS program structure.