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The state should include in the Final Report a background description of the scope and objectives of the demonstration amendment’s expenditure authority. The Final Report should be structured such that the section describing the Evaluation Design of this amendment outlines the evaluation questions the state will examine as part of its evaluation, a description of the data sources the state will leverage to both contextualize and respond to these questions, and the methodologies and approaches used in the evaluation.

For this demonstration amendment, the state will test whether and how the approved expenditure authority facilitated the state’s response to the COVID-19 PHE, and helped promote the objectives of Medicaid. To that end, the evaluation for this amendment will address thoughtful evaluation questions that support understanding the successes and challenges in implementing the expenditure authority. The state may use evaluation questions that will provide insight into: the populations affected by the expenditure authority under this amendment; specific policies and procedures that reduced barriers to care (e.g., the steps taken to ensure access to COVID-19 vaccines); challenges associated with implementing the amendment and engaging with beneficiaries, as well as how the state overcame these challenges, as applicable; and principal lessons learned for any future PHEs. Additionally, the state should track demonstration expenditures under this amendment, including – as appropriate – administrative and program costs and health services expenditures under the amendment, and assess how these outlays were effective at achieving the objectives of the demonstration amendment. The Final Report should also outline any challenges and limitations encountered in the planning and conduct of the monitoring and evaluation activities.

To address the evaluation questions as well as for providing contextual information to better understand the extent of the challenges presented by the COVID-19 PHE, and any unresolved or ongoing challenges the state continues to face, the state should identify and use suitable qualitative and quantitative data. The state may also use publicly available benchmark data from other federal agencies, such as the Centers for Disease Control and Prevention (CDC), on rates of COVID-19 cases and associated vaccinations, hospitalizations and deaths.3 Overall, the Final Report should provide an understanding of the successes, challenges, and lessons learned in implementing the demonstration amendment.

In accordance with the Wisconsin SeniorCare section 1115 demonstration’s STC #58 on Public Access pertaining to demonstration deliverables, the state is required to post the CMS-approved Final Report for this amendment to its Medicaid agency website within 30 days of CMS approval. In addition, per 42 CFR § 431.420(f), the state must comply with any requests for data from CMS and/or its federal evaluation contractors.

3 For example, see https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html, https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm, and https://covid.cdc.gov/covid-data- tracker/#vaccinations_vacc-total-admin-rate-total.