Medicaid provides coverage to approximately 60 million individuals and is the largest single payer of healthcare for children. Given this scope of the program and the concentration of low-income and minority recipients, improvements to the quality of care delivered to Medicaid members represents a significant opportunity to reduce health care disparities and improve the overall delivery and quality of healthcare within the U.S. The current study sought to evaluate the various approaches that state Medicaid agencies are taking to assess and improve the quality of care to their managed care enrollees and the degree to which they have implemented recommendations of various policy experts. A survey was distributed to the Medicaid Directors of all 50 states. A total of 23 states with risk based managed care programs responded, representing 62% of the states that have managed care programs. The results indicated that nearly all states are utilizing standard performance measures as one method to assess quality, with virtually all relying on HEDIS measures for this purpose. Additional strategies that are being used include public reporting of quality data and the use of pay-for-performance incentives; few states are currently focusing on health information technology. Recommendations are made for steps that the Medicaid program could take at both the state and federal level to further develop quality improvement programs.