1115 Demonstration State Monitoring & Evaluation Resources

General Monitoring and Evaluation

The Centers for Medicare & Medicaid Services (CMS) developed tools to help states and independent evaluators guide the development of evaluation designs and to prepare evaluation reports for Medicaid section 1115(a) demonstrations. These tools provide guidance on CMS’ expectations and support for rigorous evaluation activities. States and independent evaluators should consult these tools during the various stages of the evaluation to ensure alignment with the state’s special terms and conditions and CMS’ expectations.

Additional resources for states:

Eligibility and Coverage (including Community Engagement)

CMS has provided tools and guidance to support states with meeting the requirements in special terms and conditions for eligibility and coverage in section 1115 demonstrations, including demonstrations developed according to CMS' January 11, 2018 released guidance on new section 1115 opportunities to promote work and community engagement among Medicaid beneficiaries.

  • Implementation Plan Template: This implementation plan template provides a framework for states to document its approach to implementing community engagement policies. It also helps to determine appropriate information for the state to report to CMS in the quarterly and annual monitoring reports.
  • Monitoring Report Template: The monitoring report template provides states with a framework for how to report information to CMS quarterly and annually. In addition to the template, the tool includes a list of quantitative eligibility and coverage monitoring metrics on which states will be expected to report. The metrics cover the following types of policy approaches that are being tested under eligibility and coverage demonstrations:
    • Work or community engagement as a condition of eligibility
    • Premium assistance
    • Waivers of retroactive eligibility
    • Monthly premiums
    • Imposition of non-eligibility periods for failure to meet certain requirements
  • Evaluation Design Guidance: The evaluation design guidance highlights key hypotheses, evaluation questions, measures, and evaluation approaches, which will provide for a rigorous evaluation of eligibility and coverage section 1115 demonstrations. The evaluation design guidance contains two documents:
    1. A master narrative
    2. An appendix specific to community engagement 

Also available are appendices specific to non-eligibility periods, premiums, retroactive eligibility waiver, and sustainability.

Substance Use Disorder

CMS has provided tools and guidance to support state approaches to monitoring and evaluation of substance use disorder (SUD) section 1115 demonstrations in alignment with CMS' November 1, 2017 released guidance on strategies to address the opioid epidemic. CMS has developed these tools and guidance to support states with meeting the requirements in special terms and conditions for SUD section 1115 demonstrations.

  • Implementation Plan Template: This implementation plan template provides a framework for the state to document its approach to implementing SUD policies. It also helps to determine appropriate information for the state to report to CMS in the quarterly and annual monitoring reports.
  • Monitoring Protocol Template: The monitoring protocol template and instructions provides the state the ability to document what and how it plans to report to CMS on the quarterly and annual monitoring metrics and implementation updates.
  • Monitoring Report Template: The monitoring report template and instructions provide the state with a framework for how to report information to CMS quarterly and annually. In addition to the template, the tool includes a list of quantitative 1115 SUD monitoring metrics on which states will be expected to report.
  • Evaluation Design Guidance: The evaluation design guidance highlights key hypotheses, evaluation questions, measures, and evaluation approaches, which will provide for a rigorous evaluation of a SUD section 1115 demonstration.