As states continue to experiment in Medicaid, look to section 1115 waiver evaluations to understand what works

Flexibility and innovation have long been central tenets of Medicaid, the state-federal program that provides health care coverage to more than 77 million Americans. Through Section 1115 Medicaid demonstration waivers, states are allowed to make programmatic changes that are not otherwise permitted under federal law, provided the changes promote the goals of the Medicaid program and are budget neutral. Over the years, states have used 1115 waivers in many different ways, reflecting changing priorities of states and presidential administrations.

With this flexibility comes the requirement that 1115 waiver demonstrations be monitored and evaluated so that evidence on these experiments can inform future Medicaid policy. Yet, waiver evaluations have sometimes received short shrift, prompting some to raise concerns about the quality, timeliness, and usefulness of evaluation results. In recent years, the Centers for Medicare and Medicaid Services (CMS) has sought to strengthen waiver evaluations by providing guidance and technical assistance to states and their independent evaluators, including tools and guidance on evaluation design released last year.