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 ended in 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 focused 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 incentivesLong term services and supports to people who are frail or disabled (MLTSS) under managed careDelivery system reform incentive payment (DSRIP) programsFederal Evaluation and Meta-Analysis DesignsFederal Meta-Evaluation Design for Serious Mental Illness/Serious Emotional DisturbanceFederal Meta-Evaluation Design for Substance Use DisorderMedicaid 1115 Demonstration Evaluation Design Plan July 2015Interim Evaluation Plan – Managed Long-Term Services and SupportsInterim Evaluation Plan – Delivery System Reform IncentivesInterim Evaluation Plan – Premium Assistance, Monthly Payments, and Beneficiary EngagementDesign Supplement, Final Evaluation—Managed Long-Term Services and SupportsDesign Supplement, Final Evaluation—Delivery System Reform IncentivesDesign Supplement, Summative Evaluation—Premium Assistance, Monthly Payments, and Beneficiary EngagementEvaluation Design – Indiana HIPEvaluation Design – Montana HELPFederal Evaluation Rapid-Cycle and Evaluation Reports1115 Substance Use Disorder DemonstrationsSUD and SMI Demonstrations Chartbook: Findings from Monitoring Data (September 2026)Summary at a Glance: Findings from Monitoring Data (September 2026)State Experiences of Managed Care and SUD Provider Organizations with Changes in Care Coordination (May 2025)State Experiences of Managed Care and Provider Organizations with Expansion of Coverage of SUD Services (May 2025)Experiences of Managed Care and SUD Provider Organizations with Changes in Patient Placement Criteria and Utilization Management (May 2025)Impacts on SUD Service Access in 17 Demonstration States (May 2025)Initial Impacts on Medicaid Acceptance and MOUD Provision Among SUD Treatment Facilities in 5 Early Implementing States (May 2025)Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Cross State Analysis (November 2023)Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: An In-Depth Look Into Pre demonstration Measures of SUD Need, Treatment Use, Availability, and Outcomes Across States (February 2023)Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Features of State Approaches to Improve Medicaid SUD Treatment Delivery Systems (February 2023)Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: State Experiences Expanding Availability of Medication Assisted Treatment for Patients in Residential Settings (February 2023)Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Implementation Challenges Across States (February 2023)1115 Serious Mental Illness and Serious Emotional Disturbance DemonstrationsSUD and SMI Demonstrations Chartbook: Findings from Monitoring Data (September 2026)Summary at a Glance: Findings from Monitoring Data (September 2026)SMI Cross-State Analysis (May 2025)Use of Mental Health Services in Seven Early Implementing States (May 2025)State Actions to Support Early Identification of Mental Health Disorders and Maintain Engagement in Treatment (May 2025)State Actions to Integrate Supportive Housing and Supported Employment Services into Treatment (May 2025)State Actions to Deliver Crisis Stabilization Services (May 2025)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. Social and Scientific Systems (SSS), Inc. and the Urban Institute conducted these evaluations. The evaluations focused 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 will serve as a source of information to conduct these analyses. These data and reports include quality and other program performance metrics. Transformed Medicaid Statistical Information System and national survey data will also 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 experience with implementing policies.To identify innovative approaches to address high-priority challenges, RTI will draw from the assembled analyses to create rapid-cycle reports, interim and summative evaluation reports, and learning collaborative materials for CMS to review and distribute.Alternatives to Medicaid ExpansionNational Cross-State Evaluation ReportNational Cross-State Evaluation AppendixWraparound Benefits in Premium Assistance DemonstrationsBeneficiary Engagement Strategies in Medicaid DemonstrationsPaying for Medicaid Coverage: An Overview of Monthly Payments in Section 1115 DemonstrationsPremium Assistance Demonstrations: The Challenges of Interagency and Public/Private CoordinationIncentives to Change Health Behaviors: Beneficiary Engagement Strategies in Indiana, Iowa, and MichiganEducating Beneficiaries About the Cost of Care: Health Accounts in Arkansas, Indiana, and MichiganBeneficiary Understanding of Incentives: Evidence from Interim Demonstration Evaluation Reports in Indiana, Iowa, and MichiganContinuing with the Same Issuer in Transitions Between Medicaid and the Marketplace: Premium Assistance Models in Arkansas, Iowa, and New HampshireMLTSS ProgramsMLTSS Summative Evaluation ReportInterim Evaluation Report on MLTSS Section 1115 DemonstrationsThe Impact of MLTSS on Access to LTSSManaged Care Programs Covering Long-Term Services and Supports and Impact on Reducing Waiting Lists for Home and Community-Based ServicesWho Enrolls in Medicaid Managed Care Programs that Cover Long-Term Services and Supports?How MLTSS Programs Interact With Federal LTSS-Related InitiativesWorking with Medicaid Managed Long Term Services and Supports (MLTSS) Data: Challenges and Solutions for State and National DataWhen Medicare is unaligned: How Medicaid Managed Long-Term Services and Supports (MLTSS) Programs in Non-Integrated Models Coordinate Medicare Services for Dually Eligible BeneficiariesCritical Incidents, Grievances, and Appeals: Data to Support Monitoring and Evaluation of Medicaid Managed Long-Term Services and Supports (MLTSS) ProgramsDSRIP ProgramsSummative Evaluation on Section 1115 DSRIP DemonstrationsAccelerating the Adoption of Value-Based PaymentPromoting Physical and Behavioral Health IntegrationNew York's Section 1115 Delivery System Incentive Reform Payments Demonstration Case StudyInterim Evaluation Report on DSRIP Section 1115 DemonstrationsAchieving Coordination of Care to Improve Population Health: Provider Collaboration in Delivery System Reform Incentive Payment ProgramsAttribution in DSRIP Demonstration Programs: A Spotlight on New Jersey and New YorkImplementing Measurement Requirements in DSRIP Demonstration ProgramsDesigning Medicaid Delivery System Reform Incentive Payment Demonstrations to Reward Better PerformanceAdvancing Value-Based Payment in Medicaid Section 1115 Delivery System Reform Demonstrations: The Role of Hospital Supplemental PaymentsThe Building Provider Capacity for Delivery System Transformation: The Role of Section 1115 Delivery System Reform Incentive Payment DemonstrationsIn 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 EffortsCMS 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 NameYearEvaluation of the Oregon Medicaid Reform Demonstration1995Evaluation of the BadgerCare Medicaid Demonstration2000Second Five-State Medicaid Reform Evaluation2004Medicaid Emergency Psychiatric Demonstration2011
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