The Centers for Medicare & Medicaid on April 16 rescinded the 10-year extension of Texas’ Medicaid 1115 Waiver that the previous administration approved in January 2021.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:
1. Grant an equivalent or better budget neutrality determination.
2. Sustain a strong hospital uncompensated care pool.
3. Reinforce the behavioral heath safety net.
4. Recognize the waiver as a building block to comprehensive health care coverage.
The Departmental Appeals Board at the U.S. Department of Health and Human Services decided in early August 2018 to uphold CMS' earlier decision to disallow approximately $25 million in federal uncompensated care payments to private hospitals in the Dallas-Fort Worth area. At this time, the state Medicaid agency is considering its options and could accept the decision or appeal.
In September 2014, CMS notified HHSC that it was deferring $74 million in federal Medicaid funds tied to private hospital uncompensated care payments from 2013 under the waiver. While it did not accept the financial arrangement, CMS ultimately released the deferral in January 2015 and stated its willingness to work with HHSC before making a final determination.
In May 2015, HHSC and CMS revisited the issue. Shortly thereafter, CMS agreed that if changes to private hospital funding were required following the discussions, Texas would have until Sept. 1, 2017 to transition to other funding mechanisms without risk of disallowance on the same grounds as the 2014 deferral. Discussions concluded in September 2015 without CMS’ authorization of the private hospital funding arrangement in question.
In September 2016, CMS issued another disallowance notice to HHSC stating that $27 million in federal uncompensated care payments were being disallowed because they constituted “impermissible provider donations.”
1115 Waiver Payments by Congressional District, DSH, UC and DSRIP Payments by House District and DSH, UC and DSRIP Payments by Senate District.
John Hawkins, senior vice president, government relations, 512/465-1505
Jennifer Banda, vice president, advocacy, public policy & political strategy, 512/465-1046
Richard Schirmer, vice president, policy analysis, 512/465-1056
Anna Stelter, senior director of policy analysis, 512/465-1556
Federal Comments on Texas’ 1115 Waiver Extension Application (8/25/21)
Comments on HHSC’s Medicaid 1115 Waiver Extension Application (6/24/21)
Multi Association Letter on Hospital Priorities for Potential Waiver Extension Negotiation (5/12/21)
Whitepaper: Losing Texas’ Waiver Extension Destabilizes the Health Care Safety Net (April 21, 2021)
White Paper: 1115 Waiver Is a Building Block to Health Care Coverage (Feb. 12, 2021)
Hospitals, Health Care Providers Support DSRIP Extension (Aug. 10, 2020)
1115 Waiver Is Critical for Texas’ Health Care Safety Net (November 2019)
According to Texas Government Code 305.027, portions of this material may be considered “legislative advertising.” Authorization for its publication is made by John Hawkins, Texas Hospital Association, 1108 Lavaca, Suite 700, Austin, TX 78701-2180.