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TEAMKY Demonstration

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

Page 116 of 155 and expanded coverage of MAT to include methadone. For these reasons, we will use the interrupted time series without comparison group method to evaluate the demonstration.

For each of the outcomes identified in Table 2 (provider capacity, utilization, health, substance use, mortality), we will provide descriptive summary statistics for the two pre-demonstration years, as well as each successive year of the evaluation.

For the outcomes identified in Table 1 that are available monthly (provider capacity, utilization, mortality), we will estimate the following model:

Ym,c = β0 + β1 timem + β2 I[post]m,c + β3 timem × I[post] m,c + β' controlsm,c + 'c + m,c

where Y is the outcome of interest; time is a linear time trend; I[post] is a binary indicator of demonstration implementation (1 if yes, 0 otherwise); controls are a vector of covariates (e.g., provider and population characteristics); c is a vector of county fixed effects; ε is the disturbance term; m indexes the month; and c indexes the county.

The coefficient β2 reflects the shift in outcome levels in the post-demonstration period (after accounting for secular time trends), while β3 reflects the effect of the demonstration. Both coefficients will be of interest in the evaluation.

Our power analyses suggest that we will be able to detect moderate changes in the utilization of treatment services. We were not able to obtain data from all proposed measures for which to conduct power analyses, but as an illustration, we will be able to detect, at =0.05 with 80% power:  a change of 1.14 in the monthly number of inpatient stays for SUD per 1,000 beneficiaries (monthly average: 6.01)  a change of 15.3 in the monthly number of beneficiaries who have a claim for MAT (monthly average: 594).

C.5.2. Qualitative analyses

The purpose of the qualitative interviews is to describe the Medicaid experiences of individuals affected by SUD, including access to care and uptake of treatment. Qualitative interviews will address questions such as how well Medicaid members understand new treatment options, how people learned about these services, and what engagement in these services has been like in comparison to past services. Interviews will also explore a narrative of the person’s SUD, the impact on daily life, current medical needs and health status, past and current experiences with Medicaid, both for overall health and SUD, access to SUD treatment through any means of payment as well as Medicaid, barriers to SUD treatment services, and any SUD treatment needs not currently covered by Medicaid or other insurance.

The interviews will be semi-structured, using written agendas with flexibility to explore unexpected responses. Interviews will be conducted by phone, and voice recorded and transcribed for analysis. We will aim for approximately 25 beneficiaries in each interview cycle—a sample size consistent with best practices for qualitative interviews—monitoring for data saturation. Data