The Centers for Medicare & Medicaid on April 16 rescinded the 10-year extension of Texas’ Medicaid 1115 Waiver that the previous administration approved on Jan. 15. The current waiver and its uncompensated care pool will continue through Sept. 30, 2022. The extension would have provided approximately $11.4 billion a year through Sept. 30, 2030. In addition to helping stabilize the health care safety net through the pandemic and beyond, the extension would have:
THA is working with the Texas Health and Human Services Commission and state leadership to understand the impact and identify next steps. THA also is in close communication, educating state and federal lawmakers about the impact. THA notified member hospitals of the waiver decision via an
information alert and issued a statement to statewide and national media on April 16.
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.”
Texas’ Medicaid 1115 Transformation Waiver represents a major resource in reshaping the delivery of health care in communities across the state. Hospitals are collaborating with providers of all types to implement ways to make health care more effective and efficient. To demonstrate the local impact of the waiver for members of Congress and highlight the innovative work hospitals and their partners are pursuing, THA produced a series of one-pagers highlighting the unique needs and challenges of each region, and the projects developed to meet those needs ...
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
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.