A recent commentary in the New England Journal of Medicine suggests Section 1115 Medicaid waivers need a more robust study design for improved evaluations, FierceHealthcare reports.
The waivers, which enable states to test alternate coverage approaches that fall short of federal mandates, utilize before-and-after assessments and difference-in-difference analyses, per the report. Not only does this approach bring a number of limitations, the Government Accountability Office found that the evaluations involve small sample sizes and a lack of comparison groups.
The authors of the commentary suggest randomized controlled designs as a solution.
“Evaluations can (and should) generate an important and useful body of evidence about how waiver terms affect population health,” Kristen Underhill, Columbia University associate law professor and lead author of the article, told FierceHealthcare.