The Texas Health and Human Services Commission (HHSC) has reached an agreement with the Centers for Medicare & Medicaid Services (CMS) on a 15-month extension of the state's 1115 Medicaid waiver. The waiver funds uncompensated care and the Delivery System Reform Incentive Payment Program (DSRIP) through December 2017 and will maintain its current funding. While physicians applaud the move, they say it doesn't alleviate their concerns about a long-term solution to sustain funding for uncompensated care.
HHSC says it will work with CMS over the next 15 months to negotiate a longer term extension.
John Holcomb, MD, chair of the TMA Select Committee on Medicaid, CHIP, and the Uninsured, said in a statement the "extension is critical to Texas' health care safety net" and "will allow the state of Texas to maintain uncompensated care pools for safety-net hospitals and providers and fund innovative projects to improve availability and quality of services to Medicaid and uninsured Texans."
He added that the extension of federal money, combined with local funds, totals $3.1 billion for 12 months for uncompensated care and another $3.1 billion to continue innovative projects to improve care delivery. There will also be an additional estimated prorated amount of $1.55 billion for the remaining three months of the extension. In total, the continuation of the five-year funding will provide $7.75 billion dollars for uncompensated care and DSRIP. The waiver extension also allows Texas to continue the managed care model.
"However, given CMS' prior statements indicating enhancing access to care is a better long-term solution to reducing uncompensated care costs, Texas physicians are concerned about the enduring stability of the health care safety net without a long-term agreement in place to sustain it. This is just one step: We strongly encourage the Texas Legislature to devise a strategy to develop long-term direction that focuses on appropriate payments and use of health care resources on the front end rather than the back of the health care system," Dr. Holcomb said. He added he's hopeful the extension "will lay the groundwork for future expansion of access to care for Texans."
Negotiating the waiver extension will be one of the last major acts for HHSC Commissioner Chris Traylor, who announced he is retiring on June 1. Gov. Greg Abbott appointed Charles Young, the current No. 2 at the agency, to succeed him.
DSRIP consists of local programs working to improve health care delivery costs and outcomes.
There are 1,451 DSRIP projects across 20 regions in the state. In each region, a coalition of governments, hospitals, and other health professionals develops novel solutions for containing health care costs while preserving access and quality. HHSC says most projects focus on increasing primary and preventive care. The waiver program also helps hospitals with uncompensated care costs.
For more information about the 1115 Medicaid waiver, read "1115 Medicaid Waiver Up for Renewal" in the October 2015 issue of Texas Medicine.
Action, May 16, 2016