What’s up with Medicaid Waivers? Why Should I Care, and How to Keep Up?

In December, federal Medicaid officials approved a Texas request for a Medicaid waiver officially named “Texas Healthcare Transformation and Quality Improvement Program.”  This waiver lets Texas Medicaid expand HMO-style care to more Texans without losing large federal payments to hospitals.  In return for keeping those federal dollars, Texas will re-purpose them into a fund to help pay hospitals for care for the uninsured, and help launch health reforms that move away from paying hospitals simply for volume of care, and toward payment that depends on better outcomes and safety, and more cost-effective care. You can find all the official state and federal documents here and here.  Read the Center for Public Policy Priorities analysis of the waiver and key concerns here (page 10).

Consumer Eyes and Ears for this Waiver.  Texas HHSC (that's Health and Human Services Commission for all non-wonks) has a working group of mostly hospital representatives meeting monthly, and CPPP was asked to send a staff member as a sort of informal consumer representative.  We will update fellow consumers on key information and issues from these meetings through regular emails and blog posts in the months to come.  Check back for a report on the 2/2/2012 meeting in the next few days.

BUT, another 1115 Waiver May be On the Way.  The 2011 Legislature also authorized a different 1115 waiver (article 13 of SB 7, special session), directing HHSC to seek exemption from federal minimum Medicaid eligibility, benefits, and co-pay standards.

Read CPPP analysis of this second proposed waiver and key concerns here (page 12).  See also testimony on HB 13.


A legislative oversight committee required in the SB 7 was just named and a hearing has just been posted for 9:00 AM, Wednesday, February 29, 2012.  See the Agenda and the Schedule.

Joint Committee on Oversight of Medicaid Reform Waiver (C885):

Chair: Sen. Jane Nelson

Members: Rep. Garnet Coleman Rep. Brandon Creighton Sen. Bob Deuell Rep. Lois W. Kolkhorst Sen. Dan Patrick Sen. Royce West Rep. John Zerwas

Texans who care about kids health and the health care safety net in general will need to stay tuned for opportunities to get involved in this committee’s work and not-yet-known process Texas HHSC will take to develop a second 1115 waiver proposal. Meanwhile, we promise to come up with shorthand names to help us keep these two different waivers apart—by next week!

Contributed by: Anne Dunkelberg, Center for Public Policy Priorities