Medicaid expansion waivers: what will we learn?
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (Henry J. Kaiser Family Foundation)
- Author(s):
- Rudowitz, Robin, author Musumeci, MaryBeth, author Gates, Alexandra, author
- Contributor(s):
- Henry J. Kaiser Family Foundation, issuing body. Kaiser Commission on Medicaid and the Uninsured, issuing body.
- Publication:
- Menlo Park, CA : Henry J. Kaiser Family Foundation, March 2016
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Health Care Reform Medicaid -- organization & administration Pilot Projects United States United States. Department of Health and Human Services. United States.
- Genre(s):
- Technical Report
- Abstract:
- Six of the 32 states implementing the Affordable Care Act's (ACA) Medicaid expansion to date have done so through Section 1115 waivers. Using these waivers, the Centers for Medicare and Medicaid Services (CMS) has approved terms that extend beyond the flexibility provided by federal law. Section 1115 waivers authorize research and demonstration projects that, in the view of the Health and Human Services (HHS) Secretary, further the purposes of the Medicaid program. The ACA implemented new requirements for these waivers, including that states must have a publicly available, approved evaluation strategy. States also must submit an annual report to HHS that describes the changes occurring under the waiver and their impact on access, quality, and outcomes. Additionally, a federal contract has been awarded to evaluate different types of Section 1115 waivers, including those related to the ACA's Medicaid expansion. This brief examines some of the major research questions and hypotheses relevant to the federal and state evaluations of Medicaid expansion Section 1115 waivers and explores key challenges that may hamper research and evaluation efforts. The federal evaluation of Section 1115 waivers is designed to consider the experiences of multiple states in implementing policy changes related to Medicaid expansion, including Marketplace premium assistance programs, premiums beyond the limits set in federal law, and healthy behavior incentive programs. While the state evaluations are unique to each state's waiver, the evaluation questions identified by the states relevant to Medicaid expansion waivers can be grouped into five key areas: coverage, access to care and utilization, premiums, healthy behavior incentives, and program costs. As additional states seek waivers, evaluations are key to understanding Medicaid expansion experiences under existing waivers. Evaluation plans include comprehensive research questions, but a number of challenges may hamper research efforts including: limited access to timely data; difficulty selecting outcome measures; difficulty generalizing the results; administrative complexity; and implementation of waivers in dynamic, continuously evolving environments. Despite the challenges in conducting waiver evaluations, timely and publicly available results are important. In the near term, availability of data can help states and CMS to understand issues and make mid-course corrections in the implementation of current waivers. In the near and longer term, data and analysis of existing waivers also begins to inform policy makers about which policies are effective and could be replicated or implemented more broadly as well as what approaches to avoid.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (20 pages, 1 unnumbered page)).
- NLM Unique ID:
- 101678631 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101678631