TX – Medicaid Demonstration Renewal Requested

June 2017 ~

Texas is asking CMS to extend its DSRIP-based 1115 Medicaid waiver program despite findings from its own evaluation which showed little change towards improved access.

According to the report, healthcare organizations found the process for staff providers approved as network providers for Medicaid plans to be difficult and slow. Providers said this was due to high turnover and understaffed Medicaid plans, which in turn led to longer waiting periods for payment by the plans.

The evaluation also discovered that providers find the program to be administratively cumbersome – expressing particular frustration around an uncompensated-care pool involving significant paperwork and spreadsheets and has resulted in uncertain payment dates and amounts.

“This was particularly problematic because of the demand placed on smaller hospitals with less staff capacity to accommodate the increased paperwork,” Texas Health and Human Services Commission said in its evaluation report.

The state is seeking an extension of the waiver, initially approved in 2011, which includes:

• The Delivery System Reform Incentive Payment (DSRIP) to encourage providers to adopt Innovative programs that boost quality and cost-effectiveness of care;
• The expansion of managed Medicaid to more than 160 counties; and
• Funding of $4 billion per year for the Texas Healthcare Transformation and Quality Improvement Program to cover providers’ uncompensated-care bills.

Texas was granted a short-term waiver extension last spring which is currently set to expire December 31. State officials are seeking a 21-month extension waiver to assist in the re-payment of unpaid bills of Medicaid-eligible and uninsured patients.

Source(s): Modern Healthcare; Texas Health and Human Services; Kaiser Health News;