Planning Section 1115 Demonstration Implementation to Enable Strong Evaluation Designs

This guide describes how states can plan the implementation of their section 1115 Medicaid demonstrations to enable rigorous evaluations. Though the strategies discussed here can apply to a broad range of demonstrations, we focus on evaluating eligibility and coverage (E&C) policies. Recent policies of this type include community engagement requirements, premiums or monthly contributions to beneficiary health accounts, non-eligibility periods as a consequence for noncompliance with program requirements, healthy behavior incentives, and retroactive eligibility waivers.1 E&C demonstrations often apply more than one of these policies to the target population. They also influence beneficiaries’ likelihood of separating from Medicaid. This means E&C evaluations must examine beneficiaries’ outcomes after they disenroll or are removed from Medicaid rolls, which in turn creates a need for longitudinal beneficiary surveys. For these reasons, E&C demonstrations are particularly relevant to a discussion of how implementation can strengthen evaluation design.