Maggie Samra
Senior Director, Federal Medicaid Practice
View Bio PageEvidence that helps policy work in practice
Public leaders are under growing pressure to act quickly in a context of budget constraints, evolving federal requirements, and incomplete information about what will work, for whom, and at what cost.
Mathematica data, evidence, and policy solutions help leaders understand how decisions will function in real systems—what trade-offs they create, how they affect access and cost, and whether they can be implemented effectively. Across the policy development cycle, we help policymakers and program leaders make more informed decisions, be more accountable, and produce better outcomes.
Understanding challenges on the ground
Agencies need more than topline data to make and implement effective policies. They need to see where systems break down in practice, the barriers participants face, and how policies shape the day-to-day experiences of participants and providers.
In many cases, gaps in access or outcomes reflect how programs are structured and delivered, not just underlying conditions. Evidence that captures these realities helps policymakers clearly define problems and focus action where it can have the greatest impact.
Selected examples
- For people with disabilities, weak employment outcomes often reflect policy and service barriers, not just labor market conditions. Mathematica has identified obstacles—such as benefit cliffs, limited employer engagement, and fragmented services—to deepen policymakers’ understanding of where systems fall short and where targeted changes could improve outcomes. Read our congressional testimony
- As policymakers assess how Medicaid payment affects access to care, they must understand where access challenges are most acute and how they vary across settings. Mathematica’s work with the Medicaid and CHIP Payment and Access Commission (MACPAC) highlighted variation across states, specialties, and provider types, informing decisions about where payment policy may need to change to maintain beneficiary access. Explore the issue brief
Designing effective solutions
Policy ideas often falter when implemented because they do not account for how programs operate in practice. The challenge is not only defining what a policy should do, but understanding how it will function in real systems. Seemingly small design choices—such as how to verify eligibility, how to specify measures, and how to collect data—can affect access to services, administrative burden, or adherence to federal requirements.
Evidence helps policymakers and program leaders test their assumptions before they implement a policy. Evidence enables them to assess feasibility, anticipate trade-offs, and find the places where design decisions may create unintended barriers or costs.
Selected examples
- When federal data systems do not capture key information, it limits agencies’ ability to monitor program performance. Mathematica analyzed data gaps in the child welfare system and recommended new data elements and reporting requirements, giving policymakers concrete options for strengthening oversight before a rule was finalized. Our recommendations
- Quality measures support program monitoring and improvements in healthcare delivery and outcomes only when they are action-ready, feasible, and meaningful for the programs they assess. Mathematica helps the Centers for Medicare and Medicaid Services maintain effective Core Sets by implementing an annual review process that convenes experts to assess measures for removal or addition using clear, consistent, and evidence-based criteria. Learn about our technical assistance and analytic support
- Before changing policy that affects public programs, federal leaders must understand how any proposed changes will affect participation, eligibility, and costs. Mathematica’s microsimulation work helps estimate these effects in advance, allowing decision makers to weigh trade-offs and refine proposals before implementation. More on microsimulation modeling
- States facing shortages in the direct care workforce must balance access, cost, and service delivery requirements. Mathematica’s qualitative research for MACPAC examines how workforce pressures affect home- and community-based services, helping policymakers assess which policy options are most likely to expand access without unintended consequences. Explore the qualitative study
Effective implementation
Even well-designed policies can fall short when they encounter the realities of implementation. Agencies must interpret federal guidance, manage administrative demands, coordinate across systems, and adapt to local conditions—all while maintaining service delivery and meeting reporting requirements. Implementation is often where policy intent and operational reality diverge.
Studying how policies operate on the ground helps leaders recognize these challenges early. Evidence on implementation can highlight the places where guidance is unclear, where processes create unnecessary burden, and where adjustments can improve delivery and outcomes.
Selected examples
- The Workforce Innovation and Opportunity Act required states and local providers to adapt programs, systems, and partnerships. Mathematica studied how these changes played out in practice, helping policymakers understand what supports effective implementation and where additional guidance or flexibility may be needed. Implementation and innovation overview
- States and districts often need to translate evidence-based practices into workable approaches within their own contexts. Through the Regional Educational Laboratories (REL), Mathematica supports partners in adapting interventions, aligning interventions with local conditions, and monitoring outcomes to help ensure effective implementation. Read More: REL Central
Read More: REL Mid-Atlantic
Evaluating what works
As fiscal pressures intensify, policymakers must decide which programs to sustain, scale, or change. These decisions should be based on credible evidence on whether policies improve outcomes and for whom—and whether the results justify the investment.
Evidence from rigorous evaluation provides the basis for those decisions about sustaining, scaling, or changing. It helps distinguish between promising ideas and measurable impact. In many cases, evaluation is also necessary to meet federal requirements and demonstrate accountability for public funds.
Selected examples
- As the Centers for Medicare and Medicaid Services continues the Money Follows the Person demonstration, policymakers need to assess whether the program is achieving its goals. Mathematica’s national evaluation examines outcomes related to service use and community integration, informing decisions about policies that apply to long-term services and supports. Our national evaluation
- Policymakers must determine whether investments in employment services are effectively addressing economic and workforce-related challenges that have arisen from the opioid crisis. Mathematica’s evaluation of Department of Labor demonstration grants examined how states used workforce systems to serve affected populations, helping assess whether funding and needs are aligned. A study of six states
Bringing evidence into decision making
Evidence can only inform policy when leaders are able to use it. Policymakers and program leaders need findings that are timely, clear, and directly connected to the decisions they face, whether they are shaping legislation, refining regulations, or managing implementation.
Translating research into decision-ready insights helps bridge the gap between analysis and action. This includes providing clear interpretations of findings, highlighting implications for policy and operations, and supporting leaders as they apply evidence in complex, real contexts.
Selected examples
- For policymakers considering how to improve care for people dually eligible for Medicare and Medicaid, evidence must inform concrete policy choices. Mathematica’s research on integrated care models helped inform MACPAC recommendations to Congress, supporting decisions about care coordination, access, and accountability. How our work informed Congress
- The child welfare system is designed to ensure children’s safety and promote child and family well-being. Effective coordination between Medicaid and child welfare agencies can help make this happen. MACPAC used Mathematica’s research to understand how state Medicaid and child welfare agencies make care available to youth in foster care and to develop recommendations to improve access to care. Access the March 2026 Report to Congress on Medicaid and CHIP
What this work shows
Better policy depends on evidence that is both rigorous and practical. When leaders understand not only what the data show, but how policy choices will affect access, operations, cost, and outcomes, they are better positioned to act responsibly and improve results.
Partners in progress
These experts help policymakers and program leaders interpret evidence, assess trade-offs, and apply findings to real-world decisions.
