Projects
Supporting CMS Oversight of Medicaid 1115 Demonstrations
2019-2030
Project Overview
Objective
Mathematica develops Medicaid 1115 demonstration implementation, monitoring, and evaluation tools to support oversight by the Centers for Medicare & Medicaid Services (CMS) and assist states in building data-driven approaches to demonstration operation. We also support CMS is synthesizing data across demonstrations and facilitating learning activities to accelerate promising practices.
Project Motivation
Implementation, monitoring, and evaluation tools will help states and the policy community assess the performance of demonstrations. Ultimately, the insights generated by rigorous state-led monitoring and evaluation contribute to a larger body of knowledge about how to best provide health care to individuals and families through the Medicaid program.
Partners in Progress
- Social Interventions Research and Evaluation Network (SIREN)
- Health and Reentry Project (HARP)
Prepared For
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services
Mathematica provides technical assistance to CMS and states in implementing, monitoring, and evaluating the full range of Medicaid 1115 demonstrations.
Demonstration types include those with policies affecting eligibility and coverage as well as those addressing substance use disorder (SUD), serious mental illness/serious emotional disturbance (SMI/SED), value-based care (VBC), health-related social needs (HRSN), justice-involved populations, traditional health care practices, and family planning. Under this contract, we create and maintain standardized templates for applications, implementation plans, monitoring metrics and reports, and evaluation design guidance. Many of these products are publicly available on Medicaid.gov. We also synthesize monitoring data as states submit it to CMS, and we have created interactive analytic tools to enable CMS to track demonstration progress, as well as public reports. The project also helped CMS develop and now supports implementation of an updated approach to budget neutrality for 1115 demonstrations, allowing investments in innovation across states with both new and longstanding demonstrations.
Project Impact
We are proud to be supporting CMS oversight and state innovation across a wide range of policies, including newly approved demonstrations that support transitions back to the community for formerly incarcerated individuals, creative approaches to address HRSNs, and demonstrations addressing substance use disorder and serious mental illness, now approved in more than two-thirds of states. Our work to support CMS in updating budget neutrality policies will ultimately enable investments in innovation across states with both new and longstanding demonstrations.
Evidence & Insights From This Project
Publication
Cross-State Analysis of Section 1115 Serious Mental Illness and Serious Emotional Disturbance Demonstration Monitoring Data
This report examines the performance of Medicaid section 1115 waiver demonstrations for adults with serious mental illness and children with serious emotional disturbance. CMS and states can use this to monitor progress, explore strategies for meeting goals and milestones, and inform policy decisions.
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