Evaluating Vermont’s Medicaid Global Commitment to Health Waiver
Problem
CMS requires Vermont to monitor progress toward Demonstration goals.
Since 2005, Vermont has used the Global Commitment to Health Demonstration (“Demonstration”) to implement large-scale Medicaid transformation and payment reform. The current Demonstration focuses on services to address substance use disorders (SUD), serious mental illness (SMI), serious emotional disturbance (SED), and services related to transitions of Medicaid-eligible individuals from carceral facilities to the community (reentry initiative).
The Centers for Medicare & Medicaid Services (CMS) extended Vermont’s 1115 Waiver from July 2022 through December 2027. Vermont identified the following Demonstration goals:
- Advance the state toward population-wide comprehensive coverage
- Implement innovative care models across the continuum that produce value
- Engage Vermonters in transforming their health
- Strengthen care coordination and population health management capabilities to encompass the full spectrum of health-related services and supports
- Accelerate payment reform
In the extension period, Vermont will continue to focus on improving coverage, access, and quality of care for Medicaid beneficiaries and Vermonters by strengthening its Demonstration programs. AHS also obtained federal Medicaid matching funds for 66 investments focused on public health, health care, and health-related investments in Vermont.
Solution
NORC is using primary and secondary data to understand the Demonstration’s impact.
NORC is leading a mixed-methods evaluation to capture insights about the implementation process and overall impact of the Demonstration and associated investments. This approach uses primary and secondary data to describe trends in utilization, quality and cost and how the Demonstration has transformed care for Vermonters with Medicaid coverage over the five-year period.
- The SUD, SMI, and reentry initiative mid-point assessments examine progress, capacity, access, and challenges achieving service milestones. Data sources include document review, claims-based metrics, key informant interviews, focus groups, and provider surveys.
Additionally, in partnership with John Snow Research and Training Institute, Inc. (JSI), we are conducting brief assessments of 40 related investments focused on public health, health care, and health-related investments.
Result
Our findings will inform Vermont’s ongoing health reform efforts.
The evaluation design began in 2023, and the evaluation will continue through December 2030. We will conduct mid-point assessments for Demonstration services focused on Medicaid members with SMI/SED (June 2024), SUD (June 2025), and Medicaid-eligible individuals transitioning from a carceral facility to the community (December 2029). We will also develop interim and summative evaluation reports for CMS in 2026 and 2029. We collaborate with AHS and relevant department leadership to design and produce brief assessments for each investment. Findings will inform progress on Demonstration milestones, future Demonstration investments, and health reform efforts in Vermont.
Project Director
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Project Leads
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Jenna T. Sirkin
Principal Research ScientistProject Director -
Karen Swietek
Principal Health EconomistEvaluation Lead -
Jennifer Norris
Research ScientistQualitative Research Lead -
Alexandra F. Kritikos
Research Scientist & Health EconomistQuantitative Research Lead -
Erin Ewald
Principal Research ScientistSenior Advisor
Other Project Leads
Simran Chugani
Project Manager
