Minnesota needs to monitor progress on its efforts to improve access to substance use disorder treatment for Medicaid enrollees. 

Under its 1115 Substance Use Disorder (SUD) System Reform Demonstration, Minnesota is piloting a new approach to strengthen the state’s behavioral health care system by improving access to substance use disorder treatment for Medicaid enrollees. The Centers for Medicare & Medicaid Services (CMS) authorizes these waiver demonstrations to expand access to high quality, clinically appropriate SUD treatment using American Society for Addition Medicine (ASAM) levels of care.

Under this waiver, Minnesota is pursuing a multi-agency strategy to make SUD treatment more accessible and integrated with the larger health care system. Minnesota’s demonstration focuses on increasing the use of ASAM criteria in SUD treatment and placement and expanding state medical assistance coverage to institutions for mental disease and residential facilities with more than 16 beds.

Under the current waiver (approved for the period between July 2019 and June 2025), Minnesota identified the following goals:  

• Increased rates of identification, initiation, and engagement in treatment for SUD
• Increased adherence to and retention in treatment
• Fewer readmissions to the same or higher level of care where the readmission is preventable or medically inappropriate
• Improved access to care for physical health conditions
• Reduced number of opioid-related overdoses and deaths
• Increased efforts to allow patients to receive a wider array of evidence-based services
• Reduced utilization of emergency departments and inpatient hospital settings for treatment where the utilization is preventable or medically inappropriate through improved access to other continuum of care services

NORC is using primary and secondary data to understand the demonstration’s impact.

NORC is conducting a mixed-methods evaluation to capture insights about the implementation process and overall impacts of the demonstration. This approach uses primary and secondary data to describe trends in utilization, cost, and quality of care and how the demonstration has transformed SUD treatment for Minnesotans with Medicaid coverage.

NORC conducted a provider capacity assessment, a mid-point assessment, and an interim evaluation report, and will complete a summative evaluation report. Data sources include Minnesota's Medicaid claims and encounter data; administrative, enrollment, and other non-claims data; and in-depth interviews with beneficiaries and key stakeholders.  

Our findings will inform Minnesota’s ongoing SUD system reform efforts.

The evaluation began in 2020 and will continue through June 2026. In 2022, we produced a baseline provider capacity assessment and mid-point assessment that examined progress on each of the state goals, assessed any risk of not meeting specific performance targets, and assessed the state’s capacity to provide SUD services. We developed an Interim Evaluation Report for CMS in 2024, which detailed mixed progress across all seven demonstration goals between the three-year baseline period before the demonstration and the three-year period during the demonstration. We will develop a summative evaluation report in 2026.

Throughout the contract period, we will also collaborate with the Minnesota Department of Human Services (DHS) to design and produce brief assessments and presentations on waiver implementation and progress toward state goals. Findings will inform future demonstration investments and health reform efforts in Minnesota.