Association for Public Policy Analysis & Management

Many proposed health insurance reforms suggest devolving control of Medicaid to the state level, in the hopes that granting states more autonomy will drive innovation and improve the value of services delivered. There is widespread interest in expanding the role of health insurance to allow investment in community and population health, for example, in the hopes that investments in services that go beyond the walls of the health care system will ultimately improve health and potentially save money. With the effectiveness of such innovations uncertain, however, coupling flexibility with accountability is crucial. New "pay for success" funding models offer a potential mechanism for such accountability, but have rarely been used in Medicaid. South Carolina has an innovative waiver to deliver "Nurse Family Partnership" home visiting services through Medicaid, using a pay for success model coupled with a randomized controlled evaluation. There is past evidence of the success of NFP in improving maternal and child health, but these services have never been delivered through Medicaid, and their effectiveness in reducing health costs and improving health for this population is unknown. This session will describe this innovative evaluation, including the novel financial model, the metrics of success, and the evaluation methods, along with implications for Medicaid policy.