A Tale of Two Medicaid 1115 Waivers: “Hospital” and “SB 7”

Contributed by: Anne Dunkelberg, Center for Public Policy Priorities Last week, I promised to come up with shorthand names to help us distinguish between the two different Medicaid 1115 waivers. To avoid wonky acronyms, I've decided to call the new waiver that the feds approved in December 2011—formally named, “Texas Healthcare Transformation and Quality Improvement Program”—the “Hospital Waiver.”

Now, the OTHER 1115 waiver:

• was authorized in article 13 of Senate Bill 7 of the 82nd special session of the Texas legislature; • directs Texas Medicaid to seek exemption from federal minimum Medicaid eligibility, benefits, and co-pay standards; • at present, is only a concept, but has a newly-named Legislative Oversight committee with a first public hearing set for Wednesday February 29!

I will be calling this the “SB 7 waiver.”  This avoids calling it anything that indicates either opposition (like “block grant waiver”) OR support (like “reform waiver”).  At least for now, that seems the reasonable thing to do.

Consumer Eyes on the Hospital Waiver

As I reported last week, Texas HHSC asked staff of the CPPP to act as a consumer representative in their working group of mostly hospital representatives that meets monthly. Here are some newsworthy notes from the February 2 meeting:

• Stanley Stewart, who some people may know from his successful oversight of the TIERS roll-out and the rescue of the HHSC eligibility system after its 2006-2009 melt-down, has been designated the project implementation director for the hospital 1115. Waiver policy development leads will still be Maureen Milligan and Bill Rago, under Texas Medicaid Director & Deputy Executive Commissioner Billy Millwee.
• Timelines: HHSC wants to send a “menu” of reform project choices for Regional Health Partnerships (RHPs) to pick from to federal Medicaid authorities at the end of August 2012, and a list of the RHPs (what counties, which hospitals) by the end of October 2012.
• HHSC has a group of “clinical champions” advising them on SERVICE/QUALITY/SAFETY/PAYMENT reform ideas and benchmarks that may go into the menu of options.
• An important discussion seemed to clarify that the “anchor” hospitals – the ones that have local tax dollars to contribute to the waiver funding pool – will NOT be in the role of auditing or “policing” services by and payments to the partner hospitals. It is not yet clear who WILL audit to ensure partner hospitals really meet their goals.
• Another discussion considered whether a private-for-profit hospital could participate and ONLY do Medicaid care and free care to the uninsured; that is NOT participate in the health delivery reforms. HHSC indicated that policy was not defined, but that clearly the anchor hospitals would have to agree.
• HHSC said they will provide an option to sign up for email alerts when there is Hospital 1115 waiver news, but as of 2/20/2012 this does not appear to have been added to the HHSC web site. You can check here for HHSC updates.
• Read a quick CPPP analysis of the waiver and key concerns here (page 4).

The Take-Away: Communities around Texas are holding stakeholder meetings about their ideas for their local Regional Health Partnership.

On behalf of the CPPP, I will be sending a recommendation to HHSC that all local RHP planning meeting announcements be shared with HHSC and posted at the HHSC website. If you or your organization agrees, you may wish to make a similar comment.

Contributed by: Anne Dunkelberg, Center for Public Policy Priorities