Measuring impact: Designing an evaluation for Oregon's 1115(a) Medicaid Waiver

January 23, 2025

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  • In 2024, Providence CORE developed a formal plan to evaluate the impact of four policies that Oregon is testing through its 2022-2027 Medicaid 1115(a) Demonstration Waiver.
  • Federally-issued 1115(a) Demonstration Waivers allow states to test new approaches to improving their Medicaid programs.
  • The CMS-approved plan will help Oregon assess the impacts and implementation of its latest Medicaid innovations on the populations served through the new policies.

Building on the Center for Outcomes Research & Education’s (CORE) 30-year history of studying Medicaid, the CORE team developed an in-depth plan in 2024 to evaluate the impact of four new policies that Oregon is testing through its 2022-2027 Medicaid 1115(a) demonstration. The evaluation plan, approved by the Center for Medicaid and Medicare Services (CMS) in late 2024, will help Oregon assess the new policies’ implementation and measure their impacts on the health and well-being of the communities and populations served.

Read on to learn about our efforts to review evidence, gather ideas from interested parties, and design a robust independent evaluation of Oregon’s latest Medicaid innovations. Or read the CMS-approved evaluation design for more details.

About the waiver: Testing Medicaid innovations

Demonstration waivers are issued by CMS to allow states to test new approaches to improving their Medicaid programs. Through Oregon’s 2022-2027 demonstration, the state aims to address some of the complex challenges facing underserved residents and beneficiaries of Oregon’s Medicaid program, the Oregon Health Plan (OHP). Specific policies approved for the 2022-2027 demonstration include:

  • Continuous eligibility (CE) for children up to age 6 and 24-month eligibility periods for adults to increase access to care and to promote better health.
  • Coverage of new health-related social needs (HRSN) benefits for certain members facing critical life transitions.
  • More access to health care and HRSN services for young adults with special health care needs (YSHCN)
  • An April 2023 amendment to the waiver authorizing a temporary Medicaid expansion to certain adults until the OHP Bridge program started in July 2024. 

Learn more about the 2022-2027 demonstration policies at OHA’s website.

Gathering input and insights

To shape a robust evaluation design informed by Medicaid beneficiaries, providers, and organizations, we worked with the Oregon Health Authority (OHA) to identify and conduct outreach to a wide range of community-based organizations and other interested parties. Examples include the Oregon Medicaid Advisory Committee, the Community Advisory Councils of Oregon’s coordinated Care Organizations (CCOs), and OHP members on these committees. We also conducted outreach to councils, advocacy groups, parents of young adults with special health care needs, and more.

Our team used input from interested parties to shape evaluation questions and approaches, identify focus populations, and prioritize specific outcome measures. Feedback that could not be implemented for budgetary or other reasons was also captured and shared with OHA for future consideration.

“At CORE, we’re committed to supporting projects that shape more effective programs and policies that improve health and equity. Our work designing an evaluation plan for Oregon’s current Medicaid waiver is a great example of this commitment in action.” – Hannah Cohen-Cline, Program Director, Research & Evaluation, CORE

Designing the evaluation

We then brought together the insights gathered from interested parties, evidence, and best practices to develop a comprehensive evaluation plan for the 2022-2027 demonstration. 

Each of the proposed waiver policies will be evaluated using a mix of qualitative and quantitative methods. Key to this work is an emphasis on understanding OHP members’ experiences with these new policies. The plan calls for hundreds of in-depth member interviews to capture their personal experiences and the impacts of the new policies, as well as interviews with the organizations carrying out the new policies, including state agencies, CCOs, and community-based organizations. The evaluation will also use an OHP member survey and analyses of administrative data sources, including Medicaid claims data.

This targeted examination of the waiver’s policies will provide crucial information on the implementation and impact of coverage for HRSN, continuous eligibility and temporary Medicaid expansion, and new provisions for YSHCN. It will also reveal impacts on healthcare expenditures and the demonstration’s implications for cost and sustainability. 

Most importantly, the plan will examine whether the waiver successfully supports better health equity in Oregon by examining experiences and impacts across different demographics and assessing any influence on disparities in outcomes.

Next steps

Following a CMS review of the evaluation design, Oregon received federal approval in late 2024 to implement it. We’re also pleased to share that OHA selected CORE to conduct the evaluation in partnership with the OHSU Center for Health Systems Effectiveness and in consultation with the  Oregon Center for Children and Youth with Special Health Needs. Stay tuned for more news on CORE's next steps!

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