Last updated: April 2026

URAC Medicaid Health Plan Accreditation — Frequently Asked Questions

Common questions about URAC Medicaid Health Plan Accreditation — what it is, who needs it, how the process works, and how IHS supports Medicaid managed care organizations through every phase. Answers are based on direct experience with URAC standards and processes. Thomas G. Goddard, JD, PhD served as Chief Operating Officer and General Counsel of URAC before founding IHS.

What is URAC Medicaid Health Plan Accreditation?

URAC Medicaid Health Plan Accreditation is an independent, third-party assessment of a Medicaid managed care organization's quality structures, operational processes, and member protection practices. It combines URAC's core Health Plan standards with a Medicaid-specific module addressing state contract compliance, Medicaid member protections, care coordination for complex populations, and Medicaid quality metrics. It is issued by URAC following a comprehensive review of documentation, operational evidence, and staff interviews.

Which states require Medicaid MCOs to hold URAC accreditation?

URAC Medicaid Health Plan Accreditation satisfies state mandatory accreditation requirements in 15 jurisdictions: Arkansas, Connecticut, Florida, Iowa, Michigan, Minnesota, Montana, Nevada, New Jersey, New Mexico, North Dakota, Oklahoma, Texas, Utah, and Vermont. Texas enacted SB 2138, making it the 30th state to require accreditation for managed care organizations. Requirements vary by state — some mandate accreditation for all Medicaid MCOs while others apply the requirement to specific contract types or plan sizes. Organizations should verify current requirements with their state Medicaid agency and legal counsel.

What is the difference between URAC Health Plan Accreditation and URAC Medicaid Health Plan Accreditation?

URAC Health Plan Accreditation applies to commercial health plans — HMOs, PPOs, and self-insured arrangements. URAC Medicaid Health Plan Accreditation incorporates those same core standards and adds a Medicaid-specific module that addresses state contract compliance requirements, Medicaid member protection obligations, Medicaid-specific quality metrics, and care coordination standards for the Medicaid population. Organizations with both commercial and Medicaid lines of business may hold both accreditations or structure their accreditation portfolio to match their specific lines of business.

How long does URAC Medicaid Health Plan Accreditation take?

The full process typically ranges from 6 to 18 months from the decision to pursue accreditation through the final award. Timeline depends heavily on the organization's starting point — specifically, how much of the required policy infrastructure, operational track record, and quality documentation already exists. Organizations operating under a state compliance deadline require a compressed-timeline engagement plan that prioritizes the highest-risk gaps first. Engaging a consultant early is the single most reliable way to shorten the timeline — late-stage gap discoveries can extend the process significantly.

What does the URAC Medicaid Health Plan accreditation process involve?

The process involves several stages:

  1. Pre-application preparation — gap analysis against all applicable standards
  2. Documentation development — policies, procedures, program descriptions, and delegation agreements
  3. Evidence building — operational records, committee minutes, quality dashboards, and case management logs demonstrating implementation over the required track record period
  4. Application submission — uploading documentation to URAC's accreditation portal
  5. Desktop review — URAC reviewers evaluate submitted materials and may request clarifications
  6. Validation review / survey — structured interviews with organizational leaders and operational staff
  7. Accreditation Committee decision — full accreditation, provisional accreditation, or denial
  8. Post-survey RFI response — if URAC identifies deficiencies requiring remediation documentation

What is the Medicaid-specific module in URAC's accreditation program?

The Medicaid-specific module addresses the operational and regulatory requirements that distinguish Medicaid managed care from commercial health plan operations. It covers:

  • Alignment with state Medicaid contract requirements and state-specific reporting obligations
  • Medicaid member rights and protection obligations under federal Medicaid regulations
  • Care coordination structures for high-need Medicaid members, including those with complex behavioral health, chronic disease, or social need profiles
  • Medicaid quality metrics and performance improvement project requirements
  • Oversight of subcontractors performing Medicaid-covered services, including behavioral health carve-outs and pharmacy benefit managers

Does URAC Medicaid Health Plan Accreditation satisfy CMS external quality review requirements?

Under federal Medicaid managed care regulations, states must require MCOs to report whether they hold accreditation from a private independent accrediting entity and provide the most recent accreditation review results. Independent URAC accreditation can satisfy elements of state external quality review obligations and may reduce the scope of separate state-directed audits, depending on the state's specific EQR protocol and the accrediting body recognition framework in place. Organizations should confirm with their state Medicaid agency which accreditation programs are recognized under their specific EQR framework.

Is URAC Medicaid Health Plan Accreditation available for dual-eligible plans?

Yes. Dual-eligible special needs plans (D-SNPs) that coordinate Medicaid and Medicare benefits can pursue URAC Medicaid Health Plan Accreditation to satisfy Medicaid-side quality requirements. Organizations with integrated Medicaid and Medicare operations may also hold URAC Health Plan Accreditation alongside Medicaid Health Plan Accreditation to address quality standards across both program lines.

What is URAC Medicaid Health Plan with LTSS Accreditation?

URAC offers a companion program — Medicaid Health Plan with Long-Term Services and Supports (LTSS) Accreditation — for Medicaid MCOs that also coordinate home- and community-based services, institutional long-term care, or other LTSS benefits under their Medicaid contracts. This program adds an LTSS-specific module covering person-centered assessment, care planning, care coordination, and LTSS quality management on top of the core Medicaid Health Plan standards. Organizations can pursue this combined program as a standalone or as part of a broader accreditation portfolio.

How does URAC Medicaid Health Plan Accreditation compare to NCQA Health Plan Accreditation?

Both URAC and NCQA are nationally recognized accrediting bodies for health plans. NCQA's program integrates clinical performance measurement through HEDIS and CAHPS and is required or preferred in many state Medicaid markets. URAC's Medicaid Health Plan program allows organizations to establish their own performance metrics aligned to organizational goals rather than mandating HEDIS reporting, and covers a broader range of healthcare business functions including utilization management and network management in depth. Some states accept either accreditor; others specify one. Organizations operating across multiple states often evaluate both programs against their specific state contract portfolio and compliance obligations before selecting an accreditor.

What documents does URAC typically review during Medicaid Health Plan Accreditation?

URAC reviews a comprehensive evidence package including:

  • Quality management program descriptions and committee meeting minutes
  • Utilization management policies, clinical criteria, and UM decision logs
  • Network adequacy analyses and provider credentialing documentation
  • Member handbook, notice templates, and grievance and appeals records
  • Delegation agreements and delegation monitoring reports
  • Care management program descriptions and case management records
  • Compliance program documentation
  • Medicaid-specific operational records including state reporting submissions and state contract compliance documentation

URAC's recent program updates reduced required document uploads by more than 50% compared to earlier versions of the standards.

What happens if URAC identifies deficiencies during the survey?

If URAC's survey identifies deficiencies, the Accreditation Committee may issue a Request for Information (RFI) requiring the organization to submit additional documentation, corrective action evidence, or clarifying materials within a defined deadline. Organizations that receive an RFI must respond with documentation demonstrating that the deficiency has been remediated or that existing practices satisfy the standard. IHS manages full RFI responses — drafting corrective documentation, organizing evidence, and preparing the written submission. In most cases, a well-managed RFI response can convert a deficiency finding to a satisfactory outcome without extending the overall accreditation timeline significantly.

How does IHS support organizations through URAC Medicaid Health Plan Accreditation?

IHS provides end-to-end consulting support across every phase: gap analysis against all applicable standards, policy and program development, evidence building and operational track record planning, application preparation and desktop review coordination, staff interview preparation and survey support, and post-survey RFI response if needed. Every engagement is principal-led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC — who oversaw the development and administration of these standards from inside the organization.

What does URAC Medicaid Health Plan Accreditation cost?

URAC does not publicly disclose its fee schedule. URAC does offer special pricing for smaller health plans. Contact URAC directly at businessdevelopment@urac.org for current application and accreditation fees applicable to your organization's size and structure.

IHS consulting engagement fees are scoped per engagement — contact us for a proposal tailored to your organization's starting point, timeline, and scope.

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