Texas 1115 Waiver Request Falls Short of State’s Health and Budget Needs, Skips Public Comment Period
Since 2012, Texas has relied on an important 1115 Healthcare Transformation Waiver for federal funding to invest in innovative local “DSRIP” health projects and to cover the uncompensated care that hospitals provide to Texans who lack health insurance. The Waiver was explicitly intended to serve as a temporary bridge until the state implemented an insurance option — with federal funds — for low-wage workers whose jobs don’t provide health coverage.
With that Waiver winding down, Texas submitted a request to the Trump administration on November 30, 2020 to extend the uncompensated care funding component of the Waiver for five years, continuing that funding from September 30, 2022 through September 30, 2027.
The Trump administration is likely to approve that extension before its term ends a few days from now on January 20th. If the Trump administration approves the extension, the Biden administration will be under no obligation to uphold it as submitted.
There is widespread agreement that continuing to bring federal health care dollars to Texas and providing uncompensated care funding to Texas hospitals is critically important.
However, simply extending the uncompensated care funding as requested by Texas, without taking any additional steps, falls far short of the state’s health and budget needs.
Moving forward only with an extension of uncompensated care funding:
Allows DSRIP projects to expire as soon as September 30th of this year without replacing the health care they provide. (Texas submitted a separate one-year extension request for DSRIP.)
Fails to connect uninsured Texans with an affordable health insurance option at a time when the COVID pandemic has pushed the state’s uninsured rate even higher.
Fails to help Texas’ doctors, clinics, and health centers on the front line of the COVID response as they try to recover from the losses of the pandemic and fails to address the economic strain that has contributed to the closure of rural Texas hospitals.
Leaves billions of federal health care dollars on the table — $2.5 billion per year for DSRIP and up to $10 billion per year for Medicaid expansion — at a time when Texas needs the funding to address the state’s revenue shortfall and grow the economy.
Additionally, the Texas request for the Waiver extension skipped over federal requirements for public notice and public comments, limiting opportunities for stakeholders to weigh in and ensure that the request meets the state’s needs.
So where do we go from here?
If the Trump administration approves the partial extension, the Texas Legislature must still develop a plan to draw down Medicaid expansion funding to address the state’s urgent health care and health funding needs.
To learn more about these and other concerns, read the following letter to the Trump administration from Texas organizations regarding the extension request.