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Medicaid Section 1115 Substance Use Disorder and Serious Mental Illness Demonstrations: Findings from Monitoring Data Chartbook
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Medicaid Section 1115 Substance Use Disorder and Serious Mental Illness Demonstrations: Findings from Monitoring Data Chartbook

Published: Sep 23, 2026
Publisher: CMS and Mathematica
Analytics & Operations Research & Evaluation Data Visualization Technical Assistance Policy Analysis Monitoring, Evaluation and Learning Health Clinical Quality Measures Delivery System Reforms Medicaid and CHIP Mental Health and Substance Use Quality Improvement State Health Policy Federal

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Associated Project

Supporting CMS Oversight of Medicaid 1115 Demonstrations

Time frame: 2019-2030

Prepared for:

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services

Authors

Mathematica

Key Findings

  • Most states analyzed saw an increase in provider availability for SUD and SMI.
  • SUD demonstrations were associated with increased receipt of medication-assisted treatment, along with decreases in inappropriate opioid prescribing and some hospital and emergency department use.
  • SMI demonstrations were associated with increased outpatient treatment, and about half of states showed significant improvement in blood glucose testing for children taking antipsychotic medications.
  • Some outcomes showed room for improvement, particularly follow-up care and readmissions, which increased significantly in about half of states analyzed.

This chartbook presents cross-state analyses of monitoring data from Medicaid section 1115 demonstrations related to substance use disorder (SUD) and serious mental illness (SMI)/serious emotional disturbance. It examines states’ progress toward demonstration goals using monitoring metrics and narrative data from 35 SUD and 11 SMI demonstration states, as well as Availability Assessment data from SMI states. The chartbook presents state-level trends and contextualizes findings using information from narrative monitoring and external benchmarks. Findings indicate progress on several measures, including increased provider availability and improvements in selected treatment and utilization measures, while identifying areas where further improvement is needed, particularly follow-up care and readmissions. For a visual summary of key findings, view the accompanying infographic.

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