Paying for Success in Medicaid: Evaluation of Nurse Family Partnership Services in South Carolina

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.