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TEAMKY Demonstration

Approval Period: January 1, 2025 through December 31, 2029

Page 113 of 155 In addition, we will be analyzing changes in total costs (expenditures) associated with care provided to Medicaid beneficiaries diagnosed with substance use disorders. Because almost all Kentucky Medicaid beneficiaries are enrolled in managed care plans, expenditures will be calculated from encounter data reported by managed care organizations and regularly compiled by the Kentucky Cabinet for Health and Family Services. We will use descriptive statistics and the interrupted-time-series-without-comparison-group method to estimate the effect of the demonstration on care expenditures.

C. METHODOLOGY

C.1. Overview

Although the broader objective of Kentucky's opioid strategy is to reduce the number of opioid- related injuries and deaths, the sheer magnitude of SUD challenges in the state and the many ongoing federal, state, and privately funded initiatives directed towards the state's SUD crisis mean that the incremental effect of the 1115 SUD demonstration will be challenging to detect using population-level health measures such as opioid-related deaths. This is because these injuries and deaths are the result of complex and overlapping demographic, social, economic, disease, health care, public health, and institutional factors. For this reason, the evaluation will focus on monitoring and evaluating outcome measures that are most directly affected by the central features of the demonstration, which are the enhancement of the Medicaid SUD provider capacity, waiver of the IMD exclusion, and expansion of MAT coverage for SUD.

Because the SUD demonstration will be implemented statewide, there is no obvious contemporaneous internal comparison group. The evaluation team considered comparison states with similar demographic profiles as Kentucky, but these candidate states were launching similar SUD initiatives and therefore could not serve as comparison populations for evaluating the key features of Kentucky's SUD demonstration. For this reason, we will use an interrupted time series analysis without comparison group approach to evaluate the effect of the SUD demonstration.

C.2. Target and Comparison Population

The target population for the evaluation will be Kentucky Medicaid beneficiaries with a substance use disorder. More specifically, following CMS guidance, beneficiaries observed to have been diagnosed with an SUD or who have used SUD treatment services in a given month will be considered to have an active substance use disorder (and included in the target population) that month as well as for an additional 11 months after the initial diagnosis or care episode. Individuals without an SUD diagnosis or record of SUD treatment after this 12-month period will be considered to not have an active SUD and will be excluded from the target population in subsequent months unless there is another triggering SUD diagnosis or care visit. For the reasons noted above, there is no comparison population available.

C.3. Evaluation Period