1115 Demonstration Evaluations

The Centers for Medicare & Medicaid Services (CMS) uses several waiver authorities, including the section 1115 demonstration waiver authority, to permit and support innovation in Medicaid and the Children's Health Insurance Program (CHIP). These innovations concern service delivery, alternatives to eligibility and coverage including for expansion populations, and payment approaches intended to align financial incentives with program improvement goals. CMS conducts federal reviews to monitor implementation progress and conducts evaluations on a selection of these demonstrations to examine the impacts of these demonstrations on beneficiaries, providers, health plans, states, including on access, quality of care and costs.

In September 2014, 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

See related reports from the national evaluation:

Alternatives to Medicaid Expansion

• Wraparound Benefits in Premium Assistance Demonstrations
• Beneficiary Engagement Strategies in Medicaid Demonstrations
• Paying for Medicaid Coverage: An Overview of Monthly Payments in Section 1115 Demonstrations
• Premium Assistance Demonstrations: The Challenges of Interagency and Public/Private Coordination
• Incentives to Change Health Behaviors: Beneficiary Engagement Strategies in Indiana, Iowa, and Michigan
• Educating Beneficiaries About the Cost of Care: Health Accounts in Arkansas, Indiana, and Michigan
• Beneficiary Understanding of Incentives: Evidence from Interim Demonstration Evaluation Reports in Indiana, Iowa, and Michigan
• Continuing with the Same Issuer in Transitions Between Medicaid and the Marketplace: Premium Assistance Models in Arkansas, Iowa, and New Hampshire

Managed Long-Term Services and Supports (MLTSS) Programs

• Interim Evaluation Report on MLTSS Section 1115 Demonstrations
• The Impact of MLTSS on Access to LTSS
• Managed Care Programs Covering Long-Term Services and Supports & Impact on Reducing Waiting Lists for Home and Community-Based Services
• Who Enrolls in Medicaid Managed Care Programs that Cover Long-Term Services and Supports?
• How MLTSS Programs Interact With Federal LTSS-Related Initiatives

Delivery System Reform Incentive Payment (DSRIP) Programs

• NYs Section 1115 Delivery System Incentive Reform Payments Demonstration Case Study
• Interim Evaluation Report on DSRIP Section 1115 Demonstrations
• Achieving Coordination of Care to Improve Population Health: Provider Collaboration in Delivery System Reform Incentive Payment Programs
• Attribution in DSRIP Demonstration Programs: A Spotlight on New Jersey and New York
• Implementing Measurement Requirements in DSRIP Demonstration Programs
• Designing Medicaid Delivery System Reform Incentive Payment Demonstrations to Reward Better Performance

In September 2015, CMS initiated a federal evaluation of Indiana’s HELP 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 yet been tested or only tested on a limited basis. The focus of the evaluations is to understand beneficiary experience and outcomes, including beneficiary impact analyses using comparisons drawn from national survey data. Please review the evaluation design reports for Indiana and Montana. The Montana Focus Group Site Visit Report for the first wave is also available for review.

Prior Evaluation Efforts

CMS has sponsored other state-specific and cross-state evaluations, available below. More information about state sponsored evaluations is available in the Administrative Records of demonstrations on the Waiver and Demonstration List.

Demonstration Project Name	Year
Evaluation of the Oregon Medicaid Reform Demonstration	1995
Evaluation of the BadgerCare Medicaid Demonstration	2000
Second Five-State Medicaid Reform Evaluation	2004
Medicaid Emergency Psychiatric Demonstration	2011