It Looks Like Maintaining the Health Care Status Quo is "Not in the Cards" for Texas

It looks like Texas leaders might be on the clock to get the state's health care system in line with the new way of doing business across the country.

For several years, the federal government has sent billions of dollars to Texas and other states to help with the unpaid hospital bills left behind by uninsured patients. But federal policy has shifted away from providing this "Uncompensated Care" or "UC" funding. Instead, the federal government is offering states Medicaid expansion funding to reduce their uninsured rate and avoid many of these unpaid hospital bills in the first place.

Texas leaders, hoping they could keep doing things the old way, asked the federal government for a five-year extension of the 1115 Medicaid Waiver that provides the funding for Uncompensated Care. (The 1115 Waiver also provides "DSRIP" funding for innovative local health projects, which appears likely to continue).

But the chief of the state's Health and Human Services Commission (HHSC) recently testified that a five-year renewal is "not in the cards." Then news broke that the state has now asked the federal government for a stopgap 15-month extension to kick in before the current hospital funding runs out on September 30.

If the extension is provided -- and we certainly hope it is -- it could signal that the Legislature and Governor have 15 months, until the end of 2017, to get Texas in sync with the new way that health care funding works. At that time, the federal government could fully implement the new approach of drastically scaling back UC funding to offset unpaid hospital bills for those uninsured low-income adults that were supposed to have a health insurance option.

If the state still hasn't connected those Texans with insurance, it would be a devastating hit for hospitals, the patients who rely on them, and the taxpayers who support them. But let's think positively. State leaders still have time to accept the Medicaid expansion funding (which is far greater than the UC funding, anyway), develop a plan to cover low-wage adults, and secure the UC funding available to offset the hospital bills of any remaining uninsured Texans.