By Valerie Reddell
After months of negotiation, the Centers for Medicare & Medicaid Services and Texas Health and Human Services Commission have reached an agreement to approve a new five-year Medicaid 1115 Transformation Waiver.
In 2016, the 1115 Waiver generated about $1 million in revenue for Tyler County Hospital, said Dr. Sandra Wright, CEO of Tyler County Hospital.
"Failure to approve the 1115 Waiver would have resulted in near catastrophic consequences for the state's most vulnerable populations," said Ted Shaw, president/CEO of the Texas Hospital Association. "The waiver has been absolutely critical for increasing access to quality health care. And it has done so with an efficiency that has saved Texas and the federal government more than $8 billion."
This is an extremely important part of the state's Medicaid program that provides funding to hospitals that treat and serve Texans who are in need of quality healthcare.
"Additionally, this $25 billion in Medicaid funding that will be distributed over the next five
years is tax money that hardworking Texans and Texas small businesses are already sending to
the federal government. This waiver will keep these tax dollars in Texas continuing efficient and
innovative approaches to providing healthcare to millions of Texas Medicaid clients," said Rep.
James White (R-Hillister).
The waiver funds uncompensated care for Texas hospitals and other Medicaid providers and
maintains level funding for Texas at $3.1 billion each year for the first and second year of the
"State leaders have worked together over the past two years to craft a waiver that works for all
Texans. HHSC and Commissioner Smith have done a remarkable job in obtaining the federal
funds needed," White said.
Here in Tyler County waiver funds help offset the cost of providing care to those who cannot afford it.
Waiver funds are used to put a nurse practitioner in the family health clinic and fund a diabetes educator, according to Wright. The diabetes educator program alone has helped reduce blood sugars across the county, she added.
Waiver funds help the hospital district meet expenses in the emergency room and help fund the hospitalists who direct care for patients admitted to the hospital, Wright said. "Those funds allow us to keep the clinic open later Monday through Thursday and on Saturdays."
"All of those services help improve access to primary care for Tyler County residents and improve patient satisfaction at the hospital," Wright added. "Thirty percent of our patients have no insurance."
The agreement reflects months of negotiation and advocacy to ensure that Texas hospitals and other health care providers can continue to provide the highest quality of care to publicly insured and low-income Texans. With the agreement, Texas Medicaid beneficiaries will continue receiving health care services through managed care plans, and Texas hospitals and other health care providers will continue receiving vital supplemental payments.
Details on the exact terms and conditions of the new waiver are forthcoming.
"Texas hospitals extend their sincerest thanks to Gov. Greg Abbott, THHSC Executive Commissioner Charles Smith, CMS Administrator Seema Verma, the Texas Congressional delegation and all their staffs for their hard work and commitment to securing this agreement," said Shaw. "The importance of the Waiver to Texas health care providers and the patients we are privileged to care for cannot be overstated."