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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:

  1. Alternatives to Medicaid expansion, including Medicaid program-sponsored premium assistance, and premium contributions and healthy behavior incentives
  2. Long term services and supports to people who are frail or disabled (MLTSS) under managed care
  3. Delivery system reform incentive payment (DSRIP) programs

Federal Evaluation and Meta-Analysis Designs

Federal Evaluation Rapid-Cycle and Evaluation Reports

1115 Substance Use Disorder Demonstrations
Alternatives to Medicaid Expansion
MLTSS Programs
DSRIP Programs

In September 2015, CMS initiated a federal evaluation of Indiana’s HIP 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. Social and Scientific Systems (SSS), Inc. and the Urban Institute are conducting these evaluations. 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, and the Draft Interim Evaluation Report for the Montana HELP Federal Evaluation.

The summative evaluation reports for Indiana and Montana.

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, such as substance use disorder demonstrations, for example. 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 NameYear
Evaluation of the Oregon Medicaid Reform Demonstration1995
Evaluation of the BadgerCare Medicaid Demonstration2000
Second Five-State Medicaid Reform Evaluation2004
Medicaid Emergency Psychiatric Demonstration2011