1115 Demonstration Federal Evaluation & Meta-Analysis
In September 2014, the Centers for Medicare & Medicaid Services (CMS) initiated a national, cross-state evaluation for each of several different types of Medicaid section 1115 demonstration waivers (including an evaluation of managed long-term supports and services (MLTSS) that addresses programs beyond section 1115 demonstrations). This evaluation effort will be ongoing through federal fiscal year 2019. It will both track the general performance of the demonstrations of interest and evaluate demonstration impacts and outcomes. Results will be presented in a series of periodic rapid-cycle reports, as well as interim and final evaluation reports. The work will also include detailed assessments of data sources and state-led monitoring, evaluation, and diffusion or replication activities.
The national evaluations of these demonstrations focus on three broad categories or types of demonstrations, and each demonstration type is being evaluated separately. Specifically, these evaluations focus on demonstrations that test:
- Alternatives to Medicaid expansion, including Medicaid program-sponsored premium assistance, and premium contributions and healthy behavior incentives
- Long term services and supports to people who are frail or disabled (MLTSS) under managed care
- Delivery system reform incentive payment (DSRIP) programs
Federal Evaluation and Meta-Analysis Designs
- Medicaid 1115 Demonstration Evaluation Design Plan July 2015
- Evaluation Plan – Managed Long-Term Services and Supports
- Evaluation Plan – Delivery System Reform Incentives
- Evaluation Plan – Beneficiary Engagement Programs
- Evaluation Design – Indiana HIP
- Evaluation Design – Montana HELP
Federal Evaluation Rapid-Cycle and Evaluation Reports
- Alternatives to Medicaid Expansion
- Wraparound Benefits in Premium Assistance Demonstrations
- Beneficiary Engagement Strategies in Medicaid Demonstrations
- Paying for Medicaid Coverage: An Overview of Monthly Payments in Section 1115 Demonstrations
- Premium Assistance Demonstrations: The Challenges of Interagency and Public/Private Coordination
- Incentives to Change Health Behaviors: Beneficiary Engagement Strategies in Indiana, Iowa, and Michigan
- Educating Beneficiaries About the Cost of Care: Health Accounts in Arkansas, Indiana, and Michigan
- Beneficiary Understanding of Incentives: Evidence from Interim Demonstration Evaluation Reports in Indiana, Iowa, and Michigan
- Continuing with the Same Issuer in Transitions Between Medicaid and the Marketplace: Premium Assistance Models in Arkansas, Iowa, and New Hampshire
- MLTSS Programs
- Interim Evaluation Report on MLTSS Section 1115 Demonstrations
- The Impact of MLTSS on Access to LTSS
- Managed Care Programs Covering Long-Term Services and Supports and Impact on Reducing Waiting Lists for Home and Community-Based Services
- Who Enrolls in Medicaid Managed Care Programs that Cover Long-Term Services and Supports?
- How MLTSS Programs Interact With Federal LTSS-Related Initiatives
- DSRIP Programs
- New York's Section 1115 Delivery System Incentive Reform Payments Demonstration Case Study
- Interim Evaluation Report on DSRIP Section 1115 Demonstrations
- Achieving Coordination of Care to Improve Population Health: Provider Collaboration in Delivery System Reform Incentive Payment Programs
- Attribution in DSRIP Demonstration Programs: A Spotlight on New Jersey and New York
- Implementing Measurement Requirements in DSRIP Demonstration Programs
- Designing Medicaid Delivery System Reform Incentive Payment Demonstrations to Reward Better Performance
In September 2015, CMS initiated a federal evaluation of Indiana’s HELP 2.0 demonstration and subsequently added Montana’s HELP demonstration to understand the effects of beneficiary premiums/contributions and other policies affecting coverage that have not been tested yet or have been tested only on a limited basis. The evaluations focus on understanding beneficiary experience and outcomes, including beneficiary impact analyses using comparisons drawn from national survey data. Review the Montana Focus Group Site Visit Report for the first wave.
In September 2018, CMS also contracted with Research Triangle Institute (RTI) to design and conduct federal evaluations through meta-analyses of selected types of Medicaid section 1115 demonstrations, including, but not limited to, community engagement and substance use disorder demonstrations. A meta-analytic approach that draws on experiences across multiple states implementing the same type of demonstration will provide CMS with a deeper understanding of the variables that impact successful implementation and outcomes of demonstrations, and whether these initiatives should be replicated in other states.
Data reported by states in the monitoring and evaluation reports on a quarterly and annual basis will serve as primary sources of information to conduct these analyses. These data and reports include performance on quality and other program performance metrics. Some raw data may be obtained from states, if needed, and RTI will work with states to ensure use and representation of states’ reported data. Transformed Medicaid Statistical Information System and national survey data also may be leveraged, as well as other available relevant research. Some limited key informant interviews and case studies may be warranted to help illuminate best practices and understand particularly challenging policies to implementation.
To identify innovative approaches to address high-priority challenges, RTI will draw from the assembled analyses to create rapid-cycle reports, interactive dashboards, interim and summative evaluation reports, and learning collaborative materials for CMS to review and distribute.
Prior Evaluation Efforts
CMS has sponsored other state-specific and cross-state evaluations. View more information about state-sponsored evaluations in the administrative records of demonstrations on the State Waivers List.
|Demonstration Project Name||Year|
|Evaluation of the Oregon Medicaid Reform Demonstration||1995|
|Evaluation of the BadgerCare Medicaid Demonstration||2000|
|Second Five-State Medicaid Reform Evaluation||2004|
|Medicaid Emergency Psychiatric Demonstration||2011|