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. In a Medicare or Medicaid fee-for-service model, payment rates to hospitals are administratively set instead of negotiated between providers and payers. Medicare and Medicaid both also feature supplemental payment opportunities, which boost low hospital base payments in these programs, which typically do not cover enrollees’ costs of care.
The Texas Legislature sets the Medicaid program budget for each biennium, and the Texas Health and Human Services Commission (HHSC) administers the base and supplemental payment programs that reimburse hospital care for low-income and uninsured Texans. THA works with the Texas Legislature on legislation that affects health care financing and helps shape the regulatory environment through involvement with specific Medicaid advisory committees, HHSC and the Texas Department of State Health Services.
In Medicare, the amount and manner of payments are governed by acts of Congress and the Centers for Medicare and Medicaid Services (CMS). THA engages the Texas congressional delegation on key Medicare issues and takes part in public comment opportunities put forth by CMS to safeguard hospitals’ Medicare payments.
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 and Uncompensated Care
Medicaid DSH Payment Cuts
The Texas Hospital Association is asking Congress to address Medicaid disproportionate share hospital (DSH) cuts to help protect patient care. THA has calculated the number of DSH hospitals and reduction amounts for each of the 38 U.S. House districts for FY 2024. More information is available here.
Medicaid 1115 Waiver
The Centers for Medicare & Medicaid Services has renewed Texas’ Medicaid 1115 Waiver through September 2030. The waiver authorizes the state to operate Medicaid managed care and sets budgetary limits for several key supplemental payment programs, including state directed payment programs and Texas’ uncompensated care pool.
Although the waiver itself received 10-year approval, payment programs within the waiver must be reapproved or resized periodically. THA continues its advocacy with state and congressional leaders to preserve the state’s health care safety net.
Texas hospitals urge CMS to continue working with the state to achieve the following outcomes:
- Preserve a budget neutrality determination that permits sufficient safety-net hospital funding.
- 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)
Supporting Web pages
Visit THA’s supporting Web pages for additional information on certain Medicaid and Medicare issues as well as hospital financing.
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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.