Another 10 years for the Texas 1115 waiver? Experts say it’s unlikely – State of Reform
Eli Kirshbaum | June 2, 2021
The Texas Health and Human Services Commission (HHSC) inclusion of another 10-year extension in its Medicaid 1115 request for an extension of the exemption is unlikely to receive approval from the Centers for Medicare and Medicaid Services (CMS), some experts say following the waiver. If CMS approves the extension, it is likely that they will only grant it for 5 years.
The HHSC only asked for a five-year extension in its original request to extend the waiver in January 2020, but the Trump administration increased the period to ten years in its approval.
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Anne Dunkelberg, associate director of Every Texan, explained how atypical the increase in the Trump administration’s extension in 2020 was:
“This is one of only three examples in history of a state’s Medicaid waivers being granted a ten-year extension, and all three were made in the final months of the Trump administration.”
Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council, agreed. He said that while 10 years would be “fantastic”, a five-year extension is more likely.
Subsections (e) and (f) of Article 1115 of the Social Security Act stipulate that the two initial waiver approvals 1115 and subsequent extensions should last three years – five at most. Despite this federal law, the CMS of the Trump administration published guide in 2017, stating that it could grant extensions of up to 10 years to “routine, successful and uncomplicated” extension requests.
Dunkelberg said such a long extension is particularly rare because 1,115 waivers are designed to be temporary demonstration projects. In fact, the Obama administration original approval Texas’ 1115 waiver request in 2011 was intended to serve as a bridge for the state to eventually expand Medicaid.
“I don’t expect the new administration to take the 10-year jump, but it’s just a guess. 1115 exemptions are supposed to be demonstration projects.
“… The 10-year extension request is inconsistent with federal law, and the Texas extension request for spending authorizations is far from ‘non-complex’.
Although the state’s current waiver does not expire until September 2022, federal funding for its Delivery System Reform Incentive Program (DSRIP) will run out at the end of September of this year – giving considerable urgency to a plan to replace or renew the waiver.
DSRIP provides essential funding for the state’s unpaid care pool, hospital reimbursements, and services for its Medicaid population. Dunkelberg said the funding of care without compensation is the only “immediately pressing issue” about the waiver.
“The only thing that was in the Trump administration’s approval that is now lost until there is a new deal is the HHSC’s demand for a whole new $ 1.5 billion a year for a brand new unpaid care pool for local health services and local mental health authorities. “
The public comment period for HHSC’s new extension request began on May 28 and will last until June 31. Individuals can submit comments on the proposed nomination by email or US mail, or by attending one of the three public meetings organized by HHSC. The lack of a public comment period was CMS’s reasoning for to cancel The previous Texas waiver extension in April.
Dunkelberg believes some of the comments during the public comment period will relate to the unusually long duration of the extension request. Given the overwhelming Support for the Medicaid expansion, she also believes HHSC will receive a large number of calls to expand Medicaid instead of extending the waiver.
“It is important and meaningful for the people of Texas to be able to voice this to both the HHSC and the federal government, and to say,” Unpaid care pools are great when you have the worst uninsured rate in the country. , and we don’t have any problem paying better Medicaid rates either.
After HHSC’s public comment period and its submission of the extension request to the federal government, CMS will hold a second federal public comment period before its decision.
“Under federal law, there is a minimum thirty-day period during which states can collect public comments. So it’s a comment from people – mostly in Texas, presumably – to the agency, which is supposed to be considered by the agency before submitting their extension request to federal Medicaid. And then there will be another federal public comment period before the federal government makes its decision whether or not to approve it. “
The timeline for CMS’s waiver decision is not set in stone, Dunkelberg said.
“As a general rule, for anything related to waivers, there is usually a lot of informal back and forth, questions and things like that. So how long it takes, in part, depends on how complex or controversial things are. “