Kentucky HEALTH Medicaid 1115 Waiver Evaluation

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NORC at the University of Chicago served as the data collection contractor for the University of Pennsylvania’s independent evaluation of the Kentucky HEALTH Medicaid 1115 Waiver. Kentucky HEALTH is a Medicaid Section 1115 waiver that was approved by the Centers for Medicare & Medicaid Services (CMS) in January 2018. The planned five-year demonstration waiver aimed to modify the traditional Medicaid program to improve health behaviors, health outcomes, and socioeconomic outcomes in the waiver-eligible population through several innovations. Prior to the cancellation of the demonstration waiver in early 2020, this project aimed to examine the waiver’s impact on members’ health care utilization, health status and outcomes, employment and community involvement, insurance status, finances, attitudes and beliefs about the program, and member demographics.

The Commonwealth of Kentucky implemented this program in a randomized fashion, where 10 percent of the target population were randomly assigned to continue receiving traditional Medicaid while 90 percent were selected to participate in the Kentucky HEALTH program. NORC selected participants from Kentucky’s Medicaid member database and conducted the randomization. Primary data collection consisted of a series of surveys, bio-measure collection, and qualitative in-depth interviews.

NORC fielded the first of five planned annual surveys in May 2018. The multi-modal survey of Medicaid members included a self-administered online questionnaire and computer-assisted telephone interviews. Respondents’ basic health measures were also collected using an in-person protocol with the aim of tracking a panel of members over a five-year period. NORC conducted a series of in-depth interviews with Medicaid enrollees, including a cohort to be followed and interviewed annually during the life of the contract, as well as separate interviews with individuals impacted by substance use disorders, smokers, those who were locked out of coverage or who experienced disenrollment, and beneficiaries who actively participated in the state's My Rewards incentive program. NORC also conducted interviews with health care providers and Medicaid staff.