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CMS Approves Waiver Allowing Texas to Expand Managed Care

By Rick Thompson
TAC Legislative Staff


The Centers for Medicare and Medicaid Services (CMS) approved a Section 1115 Demonstration Waiver to expand managed care statewide in an effort to achieve state budget savings and preserve hospital access to funding consistent with Upper Payment Limit funds (UPL).

The 82nd Legislature directed the Texas Health and Human Services Commission (HHSC) to expand managed care statewide to accomplish these goals. In order to achieve this, HHSC submitted a proposal to the CMS in July of 2011, which was approved Monday, Dec. 12. 

With the approval of this waiver, the role counties with indigent health care programs will take is not clarified. 

“This (waiver) does not fundamentally change the structure of the Medicaid program or impose any unfunded mandates on counties,” testified Billy Millwee, associate commissioner for Medicaid and CHIP, in a Sept. 15 hearing of the House Committee on County Affairs. “All it does is take those UPL dollars and put them into the Opportunity Pool so if a county wants to participate and has the Intergovernmental Transfer (IGT) to participate and draw down those dollars, [it can].”

TAC and the County Judges and Commissioners Association have been monitoring the progression of this initiative closely, and to date, the HHSC has only provided anecdotal information on how counties will be affected. Moving forward, many of the policy decisions have not been made, so it will be important for counties to be aware of the initiative’s progress and provide input when necessary. 

TAC will provide more information as it becomes available.