1115 Waiver
In December 2011, Texas received approval from the Centers for Medicare and Medicaid Services (CMS) for a waiver that allows the state to expand Medicaid managed care while preserving hospital funding, provide incentive payments for healthcare improvements, and direct more funding to hospitals that serve large numbers of uninsured patients.
How Funds are Distributed
Under the Texas Healthcare Transformation and Quality Improvement Program (1115 Waiver), supplemental payment funding, managed care savings, and negotiated funding will go into two statewide pools now worth $29 billion over five years. Funding from the pools will be distributed to hospitals and other providers to support the following objectives:
- an uncompensated care (UC) pool to help offset the costs of uncompensated care provided by the hospital or other providers
- a Delivery System Reform Incentive Payment (DSRIP) pool to incentivize hospitals and other providers to transform their service delivery practices to improve quality, health status, patient experience, coordination, and cost-effectiveness
Partnerships that Improve Health Services
Eligibility to get UC or DSRIP payments requires community and hospital participation in a Regional Healthcare Partnership (RHP) that supports more localized health care solutions. Within a partnership, participants include governmental entities providing public funds known as intergovernmental transfers (IGT), Medicaid providers and other stakeholders. These partnerships work together to identify ways of improving health services that address the specific needs of the region, promoting system transformation and innovative solutions to local healthcare delivery challenges.
Each partnership must have one anchoring entity, which acts as a primary point of contact for HHSC in the region and is responsible for seeking regional stakeholder engagement, coordinating development of a regional plan, and reporting the progress of the entire region to HHSC and CMS. UT Health Science Center serves as the anchor for 28 counties that make up Region 1, including:
- Anderson
- Bowie
- Camp
- Cass
- Cherokee
- Delta
- Fannin
- Franklin
- Freestone
- Gregg
- Harrison
- Henderson
- Hopkins
- Houston
- Hunt
- Lamar
- Marion
- Morris
- Panola
- Rains
- Red River
- Rusk
- Smith
- Titus
- Trinity
- Upshur
- Van Zandt
- Wood
More Information about the Waiver
Overview of Texas Healthcare Transformation Waiver