IRVING, TX – “On Friday, April 16, 2021, The Centers for Medicare & Medicaid Services (CMS) sent a letter to the Texas Health and Human Services Commission (HHSC) rescinding the 10-year waiver renewal that was approved in December 2020. Thus, our current Medicaid 1115 Waiver will be in effect until September 30, 2022 with the Delivery System Reform Incentive Payment (DSRIP) program ending September 30, 2021.
The letter was eight pages long and detailed the Texas request for an exemption from the federal public notice and comment process. The letter stated that CMS determined the state’s exemption request did not articulate a sufficient basis for CMS to conclude that an exemption was needed. The exemption and lack of federal public notice and comment seemed to be the most relevant points from a CMS perspective.
We need to develop a strategy to remedy these issues so we can continue with a Medicaid 1115 Waiver renewal. The letter did offer some hope to mitigate the issues because CMS noted the 1115 demonstration is currently authorized through September 30, 2022.
Should the state still wish to extend the demonstration past that date, we stand ready to work with the state to accomplish state submission and CMS review of a complete extension application during the next 18 months the demonstration continues to be authorized.
We are fortunate to have Cecile Young as the executive commissioner for the HHSC as she and her team can negotiate and work through these CMS concerns. Young has a positive approach to solving problems and does so with no emotional or adverse reactions. I am confident through her leadership we can collaborate with CMS and remedy this rescinded renewal of the Medicaid 1115 Waiver.
Two questions loom as a result of the rescinded waiver. What financial assumptions or projections from the waiver renewal have been incorporated into the current budget process our state legislature has been working on this session? Do those financial assumptions need to be modified?
The second question relates to coverage expansion. It is apparent the CMS leadership frowns on granting waivers with large uncompensated care pools to essentially substitute for coverage in non-expansion states that have high uninsured populations. Some experts say this approach increases overall federal spending. Should we now have a bi-partisan approach to explore Medicaid expansion in Texas in a very collaborative and meaningful way without any preconceived notions?”
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April 19, 2021
Chris Wilson, DFWHC