Overview
This resource provides practical guidance for state Medicaid agencies developing plans to monitor and evaluate initiatives that address health-related, non-medical needs. It explains how evaluation can help agencies understand whether programs are being implemented as intended, measure their effects, and identify opportunities for improvement.
What the Resource Covers
The guide summarizes federal evaluation requirements for several Medicaid financing and policy approaches, including managed care in lieu of services and settings (ILOS), Section 1115 demonstrations, home- and community-based services authorities, and CHIP Health Services Initiatives. It distinguishes implementation evaluation, which examines program participation, service delivery, access, and operational challenges, from impact evaluation, which assesses changes in social needs, health outcomes, healthcare use, and costs. The resource also provides sample evaluation questions, potential data sources, evaluation design options, cost considerations, and examples from several states.
Key Takeaways for Implementation
For ILOS initiatives, the guide outlines federal expectations for assessing whether services are medically appropriate and cost-effective substitutes for covered Medicaid services. More broadly, it encourages agencies to establish evaluation questions early, combine quantitative and qualitative information, gather input from Medicaid members and implementation partners, and use findings to make timely program improvements.
Who May Find This Resource Useful
This resource may be especially useful for Medicaid agencies designing, monitoring, and evaluating programs that address non-medical needs, as well as for the managed care organizations responsible for implementing them.
Resource Type: Evaluation and implementation guide.
Topic Areas: Medicaid, ILOS, program evaluation, implementation monitoring
Population or Setting: State Medicaid programs and managed care organizations.
Publication Date: June 2025.
Source: Center for Health Care Strategies, in partnership with the Social Interventions Research and Evaluation Network (SIREN) and HealthBegins
