AcademyHealth staff continues to monitor and analyze the national landscape of states’ experiences with Section 1115 waivers, which provide states the opportunity to pilot new demonstrations that are designed to test innovative alterations to their existing Medicaid program. Today’s post builds on prior updates on federal government action to deny funding for partial Medicaid expansion, as well as actions in the states around innovative funding approaches

Considered to be one of the most prevalent 1115 waivers in recent months, SUD demonstrations are continuing to be approved and adopted at a rapid rate. As states are working to leverage waivers to provide expansive treatment access and coverage, researchers have worked to quantify the success of these demonstrations. For example, an issue brief was recently published evaluating the role of Section 1115 waivers on Medicaid coverage and utilization of opioid agonist therapy (i.e. MAT) among substance use treatment admissions. The researchers found that “1115 waiver implementation was associated with an average of a 6 percentage point increase in proportion of all admissions with Medicaid, and 4 percentage point increase among opioid outpatient admissions.”

In related news, the Centers for Medicare and Medicaid Services (CMS) recently approved Idaho’s and Indiana’s “institutions of mental disease” (IMD) demonstration requests to provide further behavioral health service coverage options for low-income beneficiaries. These recent approvals illustrate the national attention set on addressing mental health and SUD among Medicaid beneficiaries. A related blog post on this issue from recent AcademyHealth webinar presenters reported on patterns of Medicaid enrollee use of SUD services and additional state waiver activities aimed at expanding services.

Other reports have been published in the recent months that help states qualify and measure the impact of 1115 waivers. A recent report explores the best practices and applications for producing, synthesizing, visualizing, using, and disseminating health care evaluation research and reports.” Furthermore, the University of Michigan found that “Medicaid expansion doubled access to primary care and increased attention to health risks in low-income Michiganders.” Finally, a new study found that “states with approved Medicaid work requirements have higher overall opioid overdose death rates and lower availability of substance use disorder (SUD) treatment facilities with opioid treatment programs, compared to states without Medicaid work requirements.”

In addressing other demonstrations, there have been notable updates in regards to 1115 work requirements. Michigan’s Governor Gretchen Whitmer recently called for the pause of the state’s 1115 work requirement waiver, just as Virginia is taking legislative steps towards removing the state’s work requirement demonstration. Most recently, the newly elected Kentucky Democratic Governor Andy Besheard publicly denounced former Republican Governor’s Medicaid expansion plan, and officially withdrew the state’s 1115 work requirement waiver. While it’s evident that many states are attempting to limit the scope of this demonstration, other states are working to increase the program. As such, CMS recently approved Utah’s request for full Medicaid expansion, which included an 1115 work requirement waiver. South Carolina followed suit, becoming the first non-expansion state to receive approval from CMS for an 1115 work requirement waiver. Finally, Nebraska recently submitted an 1115 community engagement waiver to CMS to implement their proposed plan to create a two-tier benefit system for expanding Medicaid to about 94,000 more low-income Nebraskans. As proposed, newly eligible Medicaid patients would get dental, vision and over-the-counter medication benefits only if they complied with work requirements among other requirements.

These and other issues continue to be an area of focus for the AcademyHealth-led Medicaid Demonstration Evaluation Learning Collaborative. These evaluation researchers examine the critical policy questions, as well as study designs, methodologies, data sources and metrics used in Medicaid waiver initiatives to demonstrate the effectiveness of the waiver programs as designed. Learn more about the collaborative here.

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