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 in 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
- Health and Reentry Project (HARP)
- Social Interventions Research and Evaluation Network (SIREN)
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), social determinants of health/health-related social needs (SDOH/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 guidance. Many of these products are publicly available on Medicaid.gov. We also synthesize monitoring data as states submit it to CMS, and create interactive analytic dashboards to enable CMS to track demonstration progress, as well as public reports. The project also helps CMS develop and implement its approach to budget neutrality for 1115 demonstrations, including new approaches prompted by Public Law 119-21 that requires the Office of the Actuary to certify demonstrations as budget neutral at approval.
Project Impact
We are proud to be supporting CMS oversight and state innovation across a wide range of policies, including demonstrations that support transitions back to the community for formerly incarcerated individuals and demonstrations addressing substance use disorder and serious mental illness, now approved in more than three-quarters of states. Our work to support CMS in updating budget neutrality policies enables investments in innovation across states while maintaining program fiscal integrity.
Evidence & Insights From This Project
Publication
Medicaid Section 1115 Substance Use Disorder and Serious Mental Illness Demonstrations: Findings from Monitoring Data Chartbook
This chartbook analyzes Medicaid section 1115 SUD and SMI demonstration monitoring data across states, noting progress toward demonstration goals and room for improvement. It presents state-level trends and contextualizes findings using information from narrative monitoring and external benchmarks.
Learn MoreRelated Staff
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