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2012-2013
Fast Facts
Hospitals’ Participation In the
Texas Medicaid Program
T e x a s H o s p i ta l A s s o c i at i o n
Medicaid: Health Coverage
Program Primarily for Children,
Pregnant Women, Disabled and Elderly
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2 0 12 -1 3 T E X A S M e d i c a i d
The federal government sets minimum standards for
Medicaid eligibility, and states may choose to cover
people at higher income levels and broaden the definition of eligible populations. Texas Medicaid provides
coverage at only the minimum levels required by federal
Federal Poverty Level
200%
200%
CHIP
185%
MEDICAID
185%
133%
100%
74%
ts
ren
Pa
d
ble
d,
Dis
a
ge
SS
I, A
an
tW
om
en
-18
Pre
gn
ild
ren
Ag
Ag
ren
e6
rns
e1
-5
14%
Ch
The Children’s Health Insurance Program
was created by federal law in 1997. CHIP
allows states to cover children in families with incomes that
are modest (up to 200 percent of the federal poverty level)
but too high to qualify for Medicaid. About 577,000 Texas
children are enrolled in CHIP. The federal government pays
more than 70 cents for every 30 cents that the state spends
200%
200%
ild
Ne
CHIP
Who is Eligible for
Medicaid and CHIP?
wb
o
Percent of Federal Poverty
Family Annual Income Level
Size
100% of the FPL
1$11,170
2$15,130
3$19,090
4$23,050
5$27,010
6$30,970
on CHIP. The Children’s Health Insurance Program
Reauthorization Act of 2009 strengthened and extended
CHIP until Sept. 30, 2013. The Patient Protection and
Affordable Care Act extends federal funding for CHIP
through federal fiscal year 2015.
Ch
2012 Federal
Poverty Level Guidelines
In 1965, the U.S. Congress created the Medicaid program
to ensure access to health care for low-income Americans.
Over the years, Congress has transformed Medicaid from
a narrowly-defined program available only to individuals
eligible for cash assistance into a large health care coverage
program with complex eligibility rules. During the late 1980s
and early 1990s, Congress expanded Medicaid eligibility to
include a greater number of people with disabilities, children,
pregnant women and the elderly. These changes helped fuel
the growth of the Medicaid program, and the Texas Medicaid population tripled in just a decade, adding more than
1 million people between 1990 and 1995 alone. Currently,
about 3.5 million Texans are enrolled in the Texas Medicaid
program, and some 2.8 million of these Medicaid enrollees
are children under the age of 19. Although
non-disabled children make up the majority
of Medicaid enrollees, they account for only a
200
third of spending on direct health care services.
175
150
Medicaid is funded jointly by the
125
federal and state governments. The program
100
is operated by the states and is overseen at
75
the federal level by the Centers for Medicare
50
& Medicaid Services. The Texas Health and
25
Human Services Commission oversees the
0
operations of the Texas Medicaid program.
law for most eligible populations. The federal poverty level
is the basis on which financial eligibility is measured for
both Medicaid and CHIP. The chart above summarizes
the major categories of people eligible for Medicaid and
CHIP.
T e x a s
h o s p i t a l
a s s o c i a t i o n
In determining qualification for Texas Medicaid
coverage, THHSC screens applicants to ensure they meet
eligibility requirements, including:
Financial;
Citizenship; and
n State residency.
n
n
spending on direct health care services. By contrast,
the aged, blind and disabled population made up
about 25 percent of enrollees and accounted for almost
60 percent of expenditures.
Medicaid Program Growth
Even extremely poor Texans do not qualify for Medicaid if
they do not meet all of the necessary criteria. Non-disabled,
non-pregnant adults are generally not eligible for coverage under the Texas Medicaid program. Under the Patient
Protection and Affordable Care Act, Medicaid eligibility
expands to 133 percent of the federal poverty level for most
single adults in 2014. THHSC estimates that this expansion will result in an additional 1.2 million Texans becoming
eligible for Medicaid. Texas Medicaid grants eligibility for
six months; enrollees must reapply and THHSC must verify
that they continue to meet all of the eligibility requirements
for benefits to be maintained.
Who Is Enrolled in Medicaid?
Non-disabled children are the largest percentage of the
Medicaid population. More than 75 percent of the people
receiving Medicaid are under age 20. In 2010, while nondisabled children made up the majority of all Medicaid
enrollees (about 66 percent), they accounted for only a
relatively small portion (about one-third) of Texas Medicaid
Enrollment in the Texas Medicaid program has grown
dramatically over the past five years and is expected
to continue to increase. In addition to sheer population growth, Medicaid enrollees have increased for a
number of reasons, including the economic recession,
the rising cost of private health care coverage, a decline
in employer-sponsored health insurance and an increase
in the number of part-time employees who usually
are ineligible for employer-sponsored coverage. The
THHSC estimates that the monthly average number
of Medicaid enrollees, also known as Medicaid caseload,
will increase by more than a third between 2008 and 2013.
Historically, the Texas Legislature has failed to fund the full
projected Medicaid caseload, resulting in a shortfall that
must be funded in the next biennium.
Because of lower-than-anticipated revenue collection and the impact of the national economic crisis
on the state, when the Texas Legislature convened in
January 2011, members were looking for additional
ways to contain costs and create budget certainty. Some
32 percent of the state budget is spent on health and
Texas Medicaid Beneficiaries and Expenditures
State Fiscal Year 2010
100%
90%
Non -Disabled
Children
80%
Non-Disabled
Children
70%
66%
60%
32%
Non - Disabled Adults
10%
50%
40%
30%
20%
10%
0%
Non - Disabled Adults
9%
Aged & Disability
Related
Aged & Disability
Related
58%
25%
Caseload
Cost
Source: HHS Financial Services, 2010 Medicaid Expenditures, including Acute Care, Vendor Drug, and Long-Term Care. Costs and
caseload for all Medicaid payments for full beneficiaries and non-full beneficiaries (Women’s Health Waiver, Emergency Services for Non Citizens, Medicare payments) are included. Children include all Poverty-Level Children, including TANF. Disability Related Children are in
the Disability-Related group, not in the Children group.
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2 0 12 -1 3 T E X A S M e d i c a i d
f a c t s
o n
t e x a s
m e d i c a i d
p r o g r a m
Medicaid Caseload 2008 - 2013
FY 2008
FY 2009
FY 2010
FY 2011
FY 2012
FY 2013
THHSC Actual and
2,877,203 3,004,380 3,296,358 *3,547,717 *3,712,237 *3,834,684
*Projected Caseloads State
3,105,445 3,168,320 3,620,829 3,709,990
Budget
Variance Over Budget
human services, second only to public and higher education at 42 percent, so both were targets for the budget
committees. One response to the shortfall was to expand
Medicaid managed care because it provides more budget
certainty for the state, since the financial risk is assumed
by managed care organizations. Another benefit of managed care for the state is that it generates additional state
general revenue. All insurance companies in Texas – including managed care organizations – pay a state premium
tax. HMOs’ premium tax is based on HMO revenues
received from the sale of health maintenance certificates
or contracts.
6%
12%
3%
3%
In the chart below, the blue line represents THHSC’s
estimated and actual caseloads from 2008 to 2013. The
dotted red line represents the amount included in the
2010-11 and 2012-13 appropriations made by the Texas
Legislature. As the chart demonstrates, over the past several
sessions, the Texas Legislature has not funded the full caseload projected by the THHSC and has made other funding
reductions to Medicaid to achieve a balanced budget. In each
of these sessions, this underfunding has been at least partly
responsible for the need for supplemental appropriations.
THHSC has determined that the Legislature underfunded
Medicaid for the 2011-2012 biennium by an estimated
$4.8 billion, which will need to be addressed when the
Legislature convenes in 2013.
Medicaid Caseload
4,000,000
*3,834,684
3,800,000
3,709,990
*3,712,237
3,620,829
3,600,000
*3,547,717
3,400,000
3,296,358
3,200,000
3,000,000
3,168,320
3,004,380
3,105,445
2,877,203
THHSC Actual and *Estimates
2010-11 and 2012-13 Budgets
2,800,000
FY 2008
FY 2009
FY 2010
FY 2011
FY 2012
FY 2013
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T e x a s
h o s p i t a l
a s s o c i a t i o n
How Are Medicaid Services
Provided to Enrollees?
THHSC contracts with managed care organizations
that in turn contract with providers, including physicians
and hospitals, to create a network of providers to deliver
health care services to Medicaid enrollees. The MCO
bears the financial risk for the individuals enrolled in its
Medicaid plan, meaning that regardless of how much
the MCO pays for health care services provided to its
enrollees, the state pays a fixed premium to the MCO
each month based on the number of Medicaid enrollees
the MCO has. This per-member per-month premium is
called a capitation rate. MCOs negotiate discounted rates
with providers, including hospitals.
Each MCO emphasizes prevention and primary
care for its enrollees. Access to specialty care – such
as expensive diagnostic tests and consultation with a
medical specialist – is managed by the MCO both to
ensure that the services are medically necessary and to
control costs.
Medicaid enrollees have the opportunity to select
their MCO and their primary care physician. Many MCOs
Medicaid provides services to enrollees through four different
delivery models. The majority of Medicaid enrollees – more
than 3 million people or 77 percent of Medicaid enrollees –
receive their care through Medicaid managed care organizations because the Texas Legislature expanded Medicaid
managed care to all areas of the state in 2011 as part of its
cost containment initiatives. The two main managed care programs are: (1) STAR (State of Texas Access Reform), which
provides services to pregnant women, children, newborns and
low-income families, with an enrollment of approximately
2.5 million; and (2) STAR+PLUS, which provides services to
the aged, disabled and chronically ill, with an enrollment of
about 396,000. A small managed care program, STAR Health,
covers about 31,500 children in foster care. In the Dallas/
Fort Worth service area, the NorthSTAR program integrates
mental health care and chemical dependency services provided
to about 424,000 Medicaid enrollees using a behavioral health
Medicaid Managed Care Programs
As of March 2012
STAR
2.5 million
North STAR
424,000
STAR+PLUS
396,000
STAR Health
Enrollees
31,500
0
125,000
250,000
500,000
1 million
1.5 million
2 million 2.5 million 3 million
Source: Texas Health and Human Services Commission
organization, which is a managed care organization providing
only behavioral health services.
Through managed care, the state seeks to:
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establish a medical home for Medicaid enrollees
through a primary care provider (PCP);
n emphasize preventive care;
n improve access to care;
n ensure appropriate use of services;
n improve health outcomes and quality of care;
n improve enrollee and provider satisfaction; and
n
n
improve cost effectiveness.
offer “value-added” services as recruitment incentives for
enrollees. For example, some MCOs offer transportation
to medical appointments, which improves compliance
with follow-up care and leads to cost savings because
illnesses are treated quickly and effectively. If the
enrollee fails to select an MCO, the state makes an
assignment based on the enrollee’s history with a plan
or primary care provider and location.
Some individuals are not enrolled in STAR or
STAR+PLUS because they do not meet one of the
eligibility categories. For them, the state contracts
directly with physicians, hospitals and other providers
and pays them directly under a fee schedule. Among
f a c t s
those Medicaid enrollees served in the fee-for-service
program are clients eligible for both Medicare and Medicaid and individuals in institutions – like a state school or
nursing home.
What Services Does
Medicaid Cover?
Medicaid covers basic physical and behavioral health
services, as well as chronic care and nursing home care for
low-income Texans. Covered services include inpatient
and outpatient hospital services, physician services, pharmacy services, and laboratory and X-ray services.
Federal law allows states to determine the reasonably sufficient amount, duration and scope of Medicaid
benefits. For example, state Medicaid programs can limit
the number of visits per year for a certain service or limit
a service to delivery in an outpatient setting. In traditional
fee-for-service Medicaid, Texas limits adult inpatient
hospitalizations to 30 days per spell-of-illness. For adults
enrolled in Medicaid fee-for-service, only three prescriptions per month are covered in Texas. This limitation does
not apply to people enrolled in managed care or Medicaid
enrollees in nursing homes.
How Is Medicaid Financed?
The Texas Legislature appropriates money to fund Texas
Medicaid each biennium based on projected caseloads and
the cost of services. The amount of state dollars budgeted
and local funds transferred to the state impact the amount
contributed by the federal government.
The Federal Medical Assistance Percentage (FMAP)
determines the amount of federal payments to the state
for Medicaid medical services. The FMAP formula
compares each state’s average per capita income with the
national average. The minimum FMAP is 50 percent, the
maximum is 83 percent and the average is 59 percent.
States with lower per capita incomes receive more federal
assistance. The FMAP calculation changes every year, and
the calculation impacts the federal funds available to the
state for Medicaid.
Historically, Texas’ FMAP has averaged about 60 percent. Texas’ FMAP has been higher than average because of
the state’s large lower-than-average per capita income. However, Texas’ current FMAP is 58 percent, slightly below the
average, meaning that for every 42 cents the state spends on
Medicaid services, the federal government contributes 58
cents. In 2011, the Texas Legislature required the THHSC
to actively pursue a modification to the FMAP formula
that would reflect the state’s total population, growth rate
and the percentage of the population with incomes below
the federal poverty level. The Legislature reasoned that
o n
t e x a s
m e d i c a i d
p r o g r a m
these factors more appropriately reflect the state’s need for
federal matching funds than the current formula.
States may use local government funding for up to 60
percent of the state’s share of Medicaid monies eligible for
federal matching dollars. Texas uses local government funding for the disproportionate share hospital program and other,
smaller Texas Medicaid programs. A Medicaid transformation
and quality improvement 1115 waiver program, approved by
the Centers for Medicare & Medicaid Services in December
2011, allows the state to use public funds from local governmental entities willing to make a transfer to draw down
federal matching funds. The additional matching funds that
Texas expects under the waiver will provide supplemental
payments for uncompensated care and incentive payments
for making the health care delivery system more effective
and efficient. The state’s large hospital districts provide
most of the share of local government funding.
How Does Medicaid
Reimburse Hospitals?
Medicaid reimburses hospitals for providing covered inpatient and outpatient services to enrollees. Federal law allows
state Medicaid programs flexibility in the amount they
reimburse health care providers, although rates may not exceed the amount paid by Medicare for the same treatment.
In 2012, Medicaid will pay most hospitals slightly more
than 50 percent of their allowed costs for inpatient services,
and outpatient rates are at less than 75 percent of allowed
costs. Allowable costs are determined by a THHSC audit
process. In 2013, Medicaid will pay most hospitals less than 50
In 2013, Medicaid
will pay most
hospitals less than
50 percent of their
audited allowed
costs for inpatient
services.
percent of their audited allowed costs for inpatient services.
These payment rates apply only to fee-for-service Medicaid.
With most Medicaid enrollees covered through managed
care plans, provider reimbursement rates are negotiated
between the hospital or doctor and the MCO. The state
Medicaid fee-for-service rates are usually the starting point
for negotiations between the parties. Texas Medicaid has
special cost-based payment rules for children’s hospitals and
hospitals in rural counties with a population of less than
50,000, because these hospitals treat a very high percentage
of Medicaid patients.
Hospitals that meet certain eligibility criteria may
receive Medicaid Disproportionate Share Hospital funds.
Hospitals also may be able to receive Medicaid transformation and quality improvement 1115 waiver payments,
beginning in state fiscal year 2012.
While supplemental payments help offset the below
cost reimbursement in Medicaid and losses on uninsured
patients, hospitals still are forced to underwrite a portion of
the cost of caring for Medicaid patients. To help offset the
unpaid costs of care, hospitals shift a portion of the uncovered Medicaid costs to insured and private-pay patients.
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T e x a s
h o s p i t a l
a s s o c i a t i o n
Inpatient Hospital
Reimbursement Rates
Effective Sept. 1, 2012, general acute-care hospital reimbursement rates for fee-for-service Medicaid enrollees are
set using a prospective payment system (PPS) based on an
All Patient Refined Diagnosis Related Group methodology
(APR-DRG). This approach replaces the previous Medicare
diagnosis grouping approach. However, most hospitals will be
paid a negotiated rate by MCOs, as most Medicaid enrollees
will be covered through managed care and not the original
fee-for-service program. The state sets the capitation rate that
it pays to the MCOs, in part, on the Medicaid fee-for-service
reimbursement rate. However, the decision of how much the
MCO will pay a hospital, and whether a hospital will participate in that MCO’s provider network, is negotiated between
the two entities. Because MCOs bear the risk of financial
loss on care provided to Medicaid enrollees, the MCOs may
Medicaid Hospital Reimbursement Shortfall
100%
Audited
Allowed Costs
100%
Outpatient Hospital
Reimbursement Rates
75%
52%
Actual Inpatient
Reimbursement
Actual Outpatient
Reimbursement
pay hospitals less than the fee-for-service rate. A natural
tension exists in these negotiations because MCOs need
an adequate network of providers, and hospitals see large
numbers of Medicaid patients, but want to be paid fairly.
Under the fee-for-service PPS, each admission is
classified into an APR-DRG on the basis of clinical information. Hospitals then are paid a predetermined rate
for each admission, based on the APR-DRG, regardless of the actual services provided. The payment rate
is calculated using a formula based on a statewide rate
– called a Standard Dollar Amount – that is adjusted for
each hospital’s geographic location, teaching status and
trauma designation. For state fiscal year 2013, the state-
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2 0 12 -1 3 T E X A S M e d i c a i d
to the base APR-DRG payment for enrollees under
age 21 whose treatments are exceptionally costly or who
have unusually long lengths-of-stay.
Rates paid to children’s and rural hospitals are set
using a different methodology. Children’s and rural hospitals are reimbursed for their actual audited reasonable
cost of providing care to Medicaid enrollees using the
Tax Equity and Fiscal Responsibility Act of 1982 cost
principles. Children’s hospitals will be reimbursed under
an APR-DRG methodology effective Sept. 1, 2013.
Free-standing psychiatric hospitals also are paid on
a prospective basis but they are paid a hospital-specific
per diem, meaning a specified amount for each day a
Medicaid enrollee is in a psychiatric hospital. These rates
apply to services provided to Medicaid enrollees who are
21 years old or younger. The per diem is calculated based
on a Medicare federal base rate with hospital-specific
adjustments for wages, rural location and length-of-stay.
On Sept. 1, 2011, these per diem rates were reduced by
10 percent, in compliance with a $400 million package
of broad-based hospital cost containment measures approved by the Texas Legislature in 2011.
wide APR-DRG rates likely will be set at levels that reimburse
hospitals, in the aggregate, less than 50 percent of their
allowable audited costs. “Outlier” payments are added
Outpatient hospital services provided to fee-for-service
Medicaid enrollees are reimbursed at a portion of the
hospital’s audited reasonable cost. Reimbursement for
outpatient hospital services for high-volume providers is paid at approximately 76 percent of the hospital’s
allowable audited costs, with lower-volume hospitals
paid about 72 percent of their allowable audited costs.
As with inpatient reimbursement rates, the amounts that
MCOs pay hospitals are negotiated between the two
entities and may be less than the fee-for-service rate.
Supplemental
Medicaid Payments
To compensate hospitals for below-cost Medicaid
reimbursement by the state and to help fund care for
low-income patients not eligible for Medicaid, the
federal government created the Disproportionate Share
Hospital program to provide additional Medicaid funds
to hospitals. A second program, the Upper Payment
Limit Program, provided about $2.7 billion per year in
funding to hospitals through state fiscal year 2011. The
state’s expansion of Medicaid managed care required
significant changes to preserve the UPL funding for
Texas hospitals.
f a c t s
Disproportionate Share
Hospital Funding
In the Omnibus Budget Reconciliation Act of 1981,
Congress required state Medicaid programs to make special
payments to hospitals that serve a disproportionately large
number of Medicaid and uninsured patients. Such hospitals
are called disproportionate share hospitals and receive DSH
funding. DSH funds differ from all other Medicaid payments because DSH is tied to both Medicaid and uninsured
patients. DSH payments help hospitals finance the unpaid
and under-funded care delivered in the emergency room as
a result of the federal Emergency Medical Treatment and
Labor Act (EMTALA), which requires hospitals to screen
and stabilize everyone who comes to the emergency room,
regardless of the person’s ability to pay. While this unfunded
mandate assures access to care, EMTALA does not address
how to pay for the related health care services.
DSH payments have been an important source of
revenue for hospitals to expand health care services to the
uninsured, defray the cost of treating indigent patients,
and recruit physicians and other health care professionals
to treat patients. The THHSC is considering a change in
the distribution of DSH funds. Since the amount of DSH
funding is fixed, changes will impact all hospitals that
receive these additional payments.
Medicaid patients often use the hospital emergency
room to access health care services, especially after hours or
on weekends. Because there typically is no enrollee-required
financial participation for these ER visits, Medicaid patients have no incentive to use alternate, more appropriate
sources of health care. In 2011, the Legislature approved a
40 percent reduction in Medicaid hospital and physician
reimbursement for non-emergency care visits, penalizing
providers for patient behavior they cannot control.
Who Gets DSH?
Three University of Texas teaching hospitals and all children’s hospitals in Texas receive DSH payments if they meet
federal and state qualification criteria. All other hospitals
must qualify annually for DSH funds by providing care to
large numbers of Medicaid and uninsured patients.
The amount Texas hospitals receive from DSH varies
annually, based on a formula set by Congress. The state
combines its funds related to state-owned hospitals with
local tax monies transferred to the state by the large hospital
districts to create a pool of state dollars eligible to obtain
federal matching dollars. These funds then are distributed to
Texas hospitals that meet the threshold to qualify for DSH
funds. Each hospital has a specific DSH cap, which is the
total of the hospital’s Medicaid and uninsured shortfalls,
which are the differences between what it costs a hospital
o n
t e x a s
m e d i c a i d
p r o g r a m
to provide services to that population and the payment
received for those services. The lower the state Medicaid
reimbursement to hospitals becomes, the more reliant
hospitals become on DSH funds to mitigate the shortfall.
Medicaid 1115 Transformation
and Quality Improvement Waiver
As allowed by federal law, in the mid-2000s, Texas created
an Upper Payment Limit program that provided supplemental Medicaid payments to hospitals to mitigate the
difference between Medicaid reimbursement levels and
what Medicare would pay for the same services. The UPL
program allowed public hospitals and county governments
to transfer dollars to the state to obtain federal matching
funds. However, the legislatively-mandated expansion of
managed care in March 2012 effectively resulted in its
discontinuation because UPL dollars cannot be used to
mitigate shortfalls on Medicaid patients enrolled in managed
care. The end of the UPL program could have resulted in a
loss of about $2.7 billion a year in supplemental payments to
hospitals.
To save these supplemental payments, as well as
incentivize changes in how services are delivered to improve
the population’s health, enhance the patient experience of
care (including quality, access and reliability), and reduce or
control the cost of care, THHSC obtained federal approval
of a Medicaid transformation and quality improvement
1115 waiver. THHSC estimates that up to $29 billion will
be available to hospitals over the five-year waiver period
through two pools, an uncompensated care subpool and
a delivery system reform incentive payment subpool. To
receive payments from either subpool, a hospital must join
with other hospitals and public entities in a geographic
region to form a Regional Healthcare Partnership. Each
RHP will create a plan under which its members will
implement projects that will achieve waiver goals.
To receive payments from the UC subpool, a hospital
will fill out an application listing its uncompensated costs
for services provided to Medicaid and uninsured individuals. A hospital may claim uncompensated costs for
inpatient and outpatient services, as well as related costs
for physician, clinic and pharmacy services. To receive
payments from the DSRIP subpool, a hospital must meet
specific metrics for each project selected by the RHP
members and detailed in the plan. The projects will fall
into four categories: infrastructure development, program innovation and redesign, quality improvements and
population-focused improvements.
As in the Medicaid DSH program, Texas will
use intergovernmental transfers from state-owned and
local governmental entities to draw down federal funds
to finance both subpools. In addition to the same local
Did you know?
Texas Medicaid:
n
Subsidizes care
for 70 percent of
Texans in nursing
homes
Pays for more than
57 percent of all
births in Texas
n
With the Children’s
Health Insurance
Program, provides
health insurance
to 3.7 million
low-income Texans
each month
n
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2 0 12 -1 3 T E X A S M e d i c a i d
T e x as
h o spital
ass o ciati o n
Medicaid 1115 Waiver Pool
Uncompensated Care Subpool
Hospitals eligible for funding
must commit to investing in
system transformation.
Delivery System Reform Incentive
Payment Subpool
Hospitals must participate
in a Regional Healthcare
Partnership to receive funds
from either pool.
Pays hospitals
for cost of
care not
compensated
by Medicaid
directly or
through DSH
Category 1 – Infrastructure Development
Inpatient
Outpatient
Pays hospitals
for achieving
metrics that
move toward
the triple aim
Category 2 – Program Innovation & Redesign
Pharmacy
Category 3 – Quality Improvements
Clinic
Physician
Category 4 – Population Focused Improvements
entities that fund Medicaid DSH, counties, local mental
health authorities and state academic medical centers
also will fund the waiver. All hospitals are eligible to
participate in the waiver, but each must be a member of
a Regional Healthcare Partnership which must include
public entities to provide the intergovernmental transfer
of funds to finance the state match.
THHSC is implementing the waiver on a very
aggressive timeline. The federal government approved the
waiver in December 2011, and THHSC must have
everything implemented and approved by the Centers
for Medicare & Medicaid Services by Oct. 31, 2012.
Among the many items to be accomplished are:
According to Texas
Government Code
305.027, portions
of this material
may be considered
“legislative advertising.”
Authorization for its
publication is made by
John Hawkins, Texas
Hospital Association,
P.O. Box 679010, Austin,
TX 78767-9010.
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2 0 12 -1 3 T E X A S M e d i c a i d
n
Agreement on regions for RHPs;
n
Agreement on an anchor entity in each RHP;
n
n
n
n
n
Identification of sources of public funds to make up the
state match used to draw down the federal matching dollars
to fund both subpools;
Determination of the governance of each RHP;
Agreement by RHP members on projects that will form the
basis of an RHP plan;
Determination of the valuation of each project in the plan; and
Determination of a payment process, perhaps graduated,
based on the level of success in achieving projects in the plan.
Not only are these very large, complex issues that
must be resolved within a short timeframe, but they also
are complicated by politics and competition.
About the Texas Hospital Association
Founded in 1930, the Texas Hospital Association is the leadership organization and principal advocate for the state’s hospitals and health care
systems. Based in Austin, THA enhances its members’ abilities to improve accessibility, quality and cost-effectiveness of health care for all Texans.
One of the largest hospital associations in the country, THA represents more than 85 percent of the state’s acute-care hospitals and health
care systems, which employ more than 369,000 health care professionals statewide. Learn more about THA at www.tha.org or follow THA
on Twitter at http://twitter.com/texashospitals. For more information, contact THA’s Advocacy staff at 512/465-1507.