The COVID-19 pandemic continues to evolve and bring about significant–and rapidly occurring–changes in care delivery. As a result, states are examining their Medicaid managed care incentive arrangements to evaluate the impact of COVID-19 on their health care quality and cost performance requirements. This expert perspective identifies actions federal and state policymakers have taken to address the impact of COVID-19 on their managed care performance incentive programs, and 2020 quality and total cost of care performance. The examples detailed in the expert perspective can be used to inform state decisions on whether and how to modify Medicaid managed care reporting and performance incentives as a result of COVID-19.