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Health Affairs: Three Lessons From A Philanthropic Partnership To Expand Evaluation Of The Kentucky HEALTH Medicaid Waiver

Over two months in 2018, the Donaghue Foundation and the Rx Foundation assessed and responded to a request from a group of researchers based at the University of Pennsylvania Center for Health Incentives and Behavioral Economics (CHIBE) and Columbia Law School to fund two population-level surveys that would complement their independent evaluation of the 1115 Medicaid waiver (the one including “community engagement” such as work) in Kentucky. While the results of the first survey, which seeks to understand the knowledge and beliefs of the general population in Kentucky about the state’s new and controversial Medicaid waiver program, will not be available until later in 2019, the decision to support two surveys that will enhance the results of the state-funded evaluation reinforced several lessons for us as grantmakers.

Lesson No. 1: Relationships Are Important

The Donaghue Foundation had previously worked with Kevin Volpp and the CHIBE team members in several contexts, and we knew the high caliber of their work. So when they came to us with a request for support to expand the scope of their evaluation of Kentucky’s Medicaid waiver policy, we were willing to give it serious consideration even though it was outside of our major grant programs and required an expedited proposal review process. Volpp’s team (Atheendar Venkataramani and Kristen Underhill) had already been asked by Kentucky to serve as the independent evaluators for the package of reforms they were testing, including a “community engagement” requirement (that is, eighty hours of work, school, or volunteer activity a month); premium payments at all income levels; and tightened requirements for re-enrolling if a beneficiary falls out of the program. However, knowing there was widespread confusion about the program and understanding its potential impact on lower-income people, the researchers sought to measure baseline knowledge of the new policies, as well as opinions about how these requirements affect people’s lives. Knowing that similar Centers for Medicare and Medicaid Services (CMS) waivers are being considered for roll-out in other states, the CHIBE team recognized this as one of the most important policy issues currently affecting vulnerable populations and the urgent need to document and understand the nuances of these policies as they unfold. Read more at Health Affairs