States can learn from Medicaid experiments in other areas of the country, but there must be an effective way to measure how well those innovations work.
These experiments require "rigorous, timely evaluations" that can dig deep into what's effective and what's not, Anne F. Weiss, a managing director at the Robert Wood Johnson Foundation who oversees its Culture of Health initiative, wrote in a blog post for Health Affairs.
The Centers for Medicare & Medicaid Services has made it clear that it's open to more state innovation in Medicaid—issuing new guidelines that would allow states to test work requirements, for example. But it's crucial to have a rubric for measuring them, Weiss wrote.
She offered several principles that should be central to these evaluations, including:
- Transparency: States should be clear about how they're evaluating their programs and share negative outcomes as well as the positive ones. Indiana's Medicaid program, Healthy Indiana Plan, got positive results in its pilot, for example. But some said the contribution requirement was too confusing and deterred some individuals from enrolling. Other states need the full picture.
- Inclusivity: Anyone who's evaluating these demonstrations must have access to all data available and have the ability to publicly release their own findings.
- Timeliness: For other states to benefit from the analysis, the results from evaluations of Medicaid experiments should be released in a timely manner, and may even benefit from updates on a rolling basis.
- Robustness: Evaluations should include more than just a rundown of the results of the demonstration, Weiss said, but should also analyze their implementation. This is especially crucial in tests that may be administratively complex to put in place.
Allowing for more experiments and demonstrations within states' Medicaid programs is a key part of CMS Administrator Seema Verma's vision for Medicaid.
CMS has rolled out policies that would allow states to request section 1115 waivers that would last for 10 years, and also to streamline the process around plan amendments and 1915 waivers.
CMS has approved Indiana's request to test work requirements, and nine other states have submitted applications to try such requirements.