With Medicare and Medicaid providing more than half of most hospitals’ patient revenue, any changes to these government-sponsored programs have a significant impact on hospitals. Federal health care reform will change these programs significantly over the next decade, as well as make dramatic modifications to private insurance practices. The Texas Legislature sets the Medicaid program budget for each biennium, and also oversees the regulation of the state’s insurance industry through the Texas Department of Insurance. THA works with the Texas Legislature on legislation that affects health care financing. Through involvement with specific Medicaid advisory committees, the Texas Health and Human Services Commission and the Texas Department of State Health Services, THA helps shape the regulatory environment.
General/Directed Payment Programs
Comprehensive Hospital Increased Reimbursement Program
Texas Incentives for Physician and Professional Services Program
Rural Access to Primary and Preventative Services Program
Disproportionate Share Hospital Payments & Uncompensated Care
Medicaid 1115 Waiver
The Centers for Medicare & Medicaid on April 16 rescinded the 10-year extension of Texas’ Medicaid 1115 Waiver that the previous administration approved in January 2021. While the current waiver and its uncompensated care pool will continue through Sept. 30, 2022, THA continues its advocacy with state and congressional leaders in support of another extension.
Texas hospitals urge CMS to work with the state to reapprove its waiver extension and achieve the following outcomes:
- Grant an equivalent or better budget neutrality determination.
- Sustain a strong hospital uncompensated care pool.
- Reinforce the behavioral heath safety net.
- Recognize the waiver as a building block to comprehensive health care coverage.
10-Year Extension (DYs 10-19/Jan 2021 – Sept. 2030)
DYs 7-10 (Dec. 2017-Jan. 2021)
CMS Disallowance of Uncompensated Care Payments
DY 6 (Sept. 2016-Dec. 2017)
Supporting Web pages
Visit THA’s supporting Web pages for additional information on certain Medicaid and Medicare issues as well as hospital financing.
- Medicaid Disproportionate Share Hospital Payment Cuts
- 340B Drug Pricing Program
- Hospital Financing 101
According to Texas Government Code 305.027, portions of this material may be considered “legislative advertising.” Authorization for its publication is made by Jennifer Banda, J.D., Texas Hospital Association, 1108 Lavaca, Suite 700, Austin, TX 78701-2180.