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Past Event

State Flexibility in a New Era: What are the Research Priorities for §1115 Demonstration and §1332 Waiver Evaluations?

With funding from the Robert Wood Johnson Foundation, AcademyHealth hosted this expert meeting to explore research priorities related to the evaluation of Section 1115 Medicaid demonstrations and Section 1332 state innovation waivers.

State health care environments have been undergoing major changes due to Affordable Care Act implementation and will likely see additional modifications under the policy environment of the Trump Administration. It will be important to understand the implications that current and future federal statutory and regulatory requirements and opportunities - particularly through the waiver process) have on states' capacity to support the delivery of high-quality, comprehensive care through their Medicaid program and their commercial insurance markets. 

With support from the Robert Wood Johnson Foundation, AcademyHealth convened health services and policy researchers, national and state-level evaluators and policymakers, philanthropic organizations and other experts to discuss the critical issues that need to be addressed in evaluating the impact of waivers on coverage, access to care, effective use of health services and public financing, health outcomes, financial well-being, and employment. 

The full agenda and select presentation slides are below.


Welcome and Introductions

Mona Shah

Mona Shah, Ph.D., M.P.H.

Senior Program Officer - The Robert Wood Johnson Foundation

Mona Shah, Ph.D., M.P.H., a senior program officer in the Research-Evaluation-Learning unit, joined the Robert... Read Bio

Envisioning Medicaid’s Future and the Role of §1115 Waivers to Get Us There

  • Moderator: Joel Cantor, Rutgers University
  • Discussants:
    • John McCarthy, Speire Consulting
    • Cindy Mann, Manatt, Phelps & Phillips

What Policies and Strategies are Federal and State Policymakers Seeking to Test for the Future of Medicaid using §1115 Waivers?

What goals are these strategies and policies seeking to achieve? What outcomes should be evaluated? Is there a useful way to categorize/group policy goals (e.g., health savings accounts, health behavior incentives, cost sharing requirements; tying benefits/eligibility to work requirements; making Medicaid look more like commercial insurance [open enrollment periods]; drug testing as a condition of eligibility, benefit modifications; changes in the ways that states determine/implement eligibility)?

  • Moderator/Commenters: Joseph Antos, American Enterprise Institute and Sara Rosenbaum, The George Washington University
  • Speakers:
    • Judith Cash, Centers for Medicare and Medicaid Services
    • Rose Naff, Arkansas Department of Human Services
    • Michael Heifetz, Wisconsin Department of Health Services
    • Stephen Miller, Kentucky Department for Medicaid Services

Lessons from Current §1115 Coverage Expansion Waiver Evaluations that Can Inform Future Efforts

What are some of the key findings from current §1115 waiver evaluations.

Data and Methodological Challenges for §1115 Waiver Evaluations

Issues related to data sources, best types of evaluations to suit circumstances/goals, methodologies, standardizations across evaluations, etc.

Examining the Legislative Framework for §1332 Waivers, the Current State of Affairs, and Goals for Federal and State Policymakers for §1332 Waivers

“State Innovation Waivers allow states to implement innovative ways to provide access to quality health care that is at least as comprehensive and affordable as would be provided absent the waiver, provides coverage to a comparable number of residents of the state as would be provided coverage absent a waiver, and does not increase the federal deficit.” (CCIIO Website)

This session will examine the approach taken to §1332 waivers under the prior and current administrations and provide a landscape of the current state of affairs. In addition, it will explore the goals that federal and state policymakers are trying to achieve through these waivers and understand what outcomes should be evaluated.

  • Moderator: Enrique Martinez-Vidal, AcademyHealth
  • Speakers:
    • Sabrina Corlette, Georgetown University
    • Stuart Butler, The Brookings Institution
    • Dan Meuse, Princeton University
    • Emily Brice, Massachusetts Health Connector
    • Peter Brickwedde, Minnesota Department of Commerce

Data and Methodological Challenges for §1332 Waiver Evaluations

Given the stated parameters for developing §1332 waivers, are there some common approaches to evaluating any waivers being proposed to CCIIO as well as for evaluating implemented waivers? What data are needed? What are the challenges in measuring the parameters related to: 1) access to quality care at least as comprehensive and affordable; 2) comparable number of residents provided coverage; and 3) does not contribute to deficit? Are there lessons from §1115 evaluations that can inform §1332 waiver evaluations?

  • Moderator: Linda Blumberg, Urban Institute
  • Speakers:
    • Jason Levitis, Yale Law School
    • Joel Ario, Manatt, Phelps & Phillips
    • Michael Cohen, Wakely Consulting Group

Reflections on the Day and Next Steps

  • Moderator: Enrique Martinez-Vidal, AcademyHealth
  • Speakers:
    • Anne Schwartz, Medicaid and CHIP Payment and Access Commission
    • Anne Weiss, Robert Wood Johnson Foundation