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Medicaid readability rules: federal floor and state grades

Federal law sets the floor for Medicaid plan materials. It does not set a reading grade. Your state contract may. Here is the federal floor, the grade 6 states set for plan materials, and how to find yours.

Owner: Compliance · Federal rule checked · State rules checked

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  • The federal rule, 42 CFR 438.10, says plan materials must be easy to understand, in at least 12-point font.
  • It sets no reading grade. Grade levels come from each state’s contracts and guidance.
  • Check your current state contract before you set a target grade.

The federal baseline: 42 CFR 438.10

Every Medicaid managed care plan must follow these rules. States add their own on top.

Your member noticeHas to meet both layers below.
Your state's contractMay set a reading grade and model notices.
The federal floor: 42 CFR 438.10Easily understood language and format, type of at least 12 points, other formats and languages. No reading grade.
  • Use words and layouts that are easy to understand.
  • Print written materials in 12-point font or larger.
  • Offer other formats, and aids and services, for people who need them.
  • Offer key materials, such as handbooks and denial notices, in the main non-English languages in your area.
  • Add taglines in those languages that say how to get translation or interpretation.
  • Use your state’s terms and its model handbooks and notices.

The federal rule sets no reading grade. Grade levels, where they exist, come from each state’s contracts and guidance.

Source: 42 CFR 438.10 (Medicaid managed care information requirements). Read the rule in our 42 CFR 438.10 guide

How to find your state's grade

  1. Find your contract

    Get your current managed care contract and any member-materials guide from your state.

  2. Look for the grade

    Search them for “reading level” or “grade.” Note which formula they name, if any.

  3. Score a notice

    Score one notice against that grade. Fix the hardest passages first.

State rules

Each row is checked against the state's own managed care contract or member-materials guide, linked with its year. It covers Medicaid managed care member materials only, not fee-for-service, CHIP-only or Medicare plans. Where a source names no formula, ask the state which one it scores with. Contracts change at each amendment, so check yours before you set a target.

State Medicaid readability requirements, checked against each state's source
StateRequirement
GeorgiaWritten materials understandable at a fifth-grade reading level. Fry, PROSE, Gunning FOG, SMOG and Flesch-Kincaid are suggested.

Source: Georgia Families Amended and Restated Contract (generic, June 2022 restatement), RFP DCH0000100, Georgia Department of Community Health. Checked

LouisianaGenerally no higher than a 6.9 grade level, allowing for technical terms that must be explained (state companion guide).

Source: Marketing and Member Education Companion Guide (updated December 5, 2025), Louisiana Department of Health. Checked

OhioMember materials at or below a sixth-grade reading level, unless ODM approves otherwise. No formula named.

Source: Ohio Medicaid Provider Agreement for Managed Care Organization (12/2025 version), Ohio Department of Medicaid. Checked

PennsylvaniaThe member handbook no higher than a sixth-grade reading level, and denial notices at a sixth-grade level. No formula named.

Source: 2025 PH HealthChoices Agreement including Exhibits and Non-Rate Financial Appendices, PA Department of Human Services. Checked

TennesseeMember materials at a sixth-grade reading level, unless TennCare approves otherwise. No formula named.

Source: TennCare Statewide Contract with Amendment 25 (July 1, 2026), Division of TennCare. Checked

WashingtonWritten enrollee information at the sixth-grade reading level, in 12-point type or larger. HCA may grant written exceptions, and educational materials the plan did not develop are exempt.

Source: Apple Health Integrated Managed Care Contract (incl. amendments through #4, effective July 1, 2026), Washington State Health Care Authority. Checked

We're checking each state's contract. Tell us yours.

We list a state's rule only after we check it against the state's own contract or guidance. Still being checked:

Alabama · Alaska · Arizona · Arkansas · California · Colorado · Connecticut · Delaware · District of Columbia · Florida · Hawaii · Idaho · Illinois · Indiana · Iowa · Kansas · Kentucky · Maine · Maryland · Massachusetts · Michigan · Minnesota · Mississippi · Missouri · Montana · Nebraska · Nevada · New Hampshire · New Jersey · New Mexico · New York · North Carolina · North Dakota · Oklahoma · Oregon · Rhode Island · South Carolina · South Dakota · Texas · Utah · Vermont · Virginia · West Virginia · Wisconsin · Wyoming

Know your state's rule? Tell us

Not sure what grade your state contract sets?

Get one notice scored free. Upload one Word document or PDF, up to 5 pages. It is scored against N-PLAT and rewritten in plain language, with the reason for each change.

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