Since implementation of the Affordable Care Act, 7 million+ individuals are newly covered on state-managed Medicaid programs and millions more on subsidized commercial insurance plans. We describe Oregon's experience in including colorectal cancer (CRC) screening as a measure for the state's new pay-for-performance Medicaid program. Using Oregon Health Authority data, we present 1) frequencies of Medicaid enrollees age-eligible for CRC screening, before and after Medicaid expansion; 2) CRC screening rates for 2011 and 2013; and 3) stakeholder perceptions about incentivizing CRC screening. Between December 2013 and June 2014, the size of the Medicaid-enrolled population age-eligible for CRC screening increased by 55% (104,920 to 163,078). Between 2011 and 2013, CRC screening rates improved by more than three percent for 6/15 (40%) CCOs; the majority of stakeholders surveyed (70%) supported the CRC screening metric. Inclusion of CRC screening as a Medicaid quality metric may present a unique opportunity to raise rates among historically underserved populations.