Mathematica's evaluation of Medicaid Section 1115 waiver demonstrations, approximately 40 in number, seeks to assess the implementation and outcomes of four different types of innovations and help CMCS shift toward data-driven decision making for future waiver approvals.
- Medicaid data sources
- Program and policy evaluation
- Technical assistance
- Measurement for program monitoring
- Learning collaboratives
- Care Delivery Systems
- Medicaid and CHIP
- State Health Programs
Margaret (Maggie) Samra focuses on Medicaid, state, and local health policy, and she is an expert in the policy intersections between Medicaid and health insurance marketplaces. Samra has led major technical assistance projects as well as several multimethod evaluations that combine rigorous quantitative analyses with case studies, examining changes in enrollment, retention, access, and service utilization caused by changes in provider or beneficiary incentives.
Samra currently directs the Centers for Medicare & Medicaid Services’ (CMS’s) national 1115 demonstration, which examines the cross-state impacts of four different types of demonstrations: (1) Delivery System Reform Incentive Payment programs; (2) Managed Long-Term Services and Supports; (3) premium assistance for marketplace plans; and (4) beneficiary engagement and incentives. The contract also supports CMS in enhancing the quality of state-led evaluations and monitoring plans for these demonstrations; provides project management and technical assistance to CMS in standing up new demonstrations to address substance use disorders; and manages internal and external stakeholder input to develop content for the Medicaid and CHIP (Children’s Health Insurance Program) Scorecard, a major initiative to enhance transparency and accountability in these programs. Samra is also evaluating a California-based intervention that delivers scheduled and urgent house calls on a 24/7 basis to Medicaid beneficiaries with complex chronic conditions using an integrated care team that includes medical, behavioral, and social service providers.
Samra previously directed the Medicaid and CHIP Learning Collaboratives, which bring together state and federal officials to support the development of integrated and high-performing Medicaid and state marketplace systems that fulfill the requirements of the Affordable Care Act. She supported California in developing public reports that present application, eligibility, and enrollment data for both Medi-Cal and Covered California. She has served as a task leader and researcher on evaluation studies for the Assistant Secretary for Planning and Evaluation, the California Health Care Foundation, and state and local governments, including evaluations of Express Lane Eligibility, the Healthy Indiana Plan, California’s Health-e-App Public Access system, Healthy San Francisco, and the alignment of Medicaid and Medicare enrollment for dual-eligible beneficiaries in Arizona.
Samra, who joined Mathematica in 2007, has published work in Health Services Research, the Maternal and Child Health Journal, Medical Care Research and Review, and the American Journal of Pharmacy Benefits. She holds an M.P.P. from Georgetown University.
New Approaches for Medicaid: The 1115 Demonstration Evaluation
Adapting a Model of Integrated and In-Home Care for Safety-Net Patients with Multiple Chronic Conditions
This project is examining an innovative care delivery model built on a partnership between Landmark Health and the Inland Empire Health Plan to deliver coordinated services to eligible Medi-Cal managed care members with multiple medical and behavioral health needs.
Helping States Monitor and Evaluate Medicaid 1115 Demonstrations
Mathematica’s health experts recently helped develop new state implementation and monitoring tools, as well as guidance on evaluation methods, for section 1115 Medicaid demonstrations.