Under a five-year Medicaid transformation waiver, 20 regional healthcare partnerships in Texas are developing local, innovative plans to help reduce costs for uncompensated care while improving health care. This demonstration project, the Texas Healthcare Transformation and Quality Improvement Program, was approved by the federal government in December 2011. It allowed Texas to expand Medicaid managed care statewide in March 2012 while preserving funding for hospitals, providing incentive payments for improving health care and directing more money to hospitals that serve large numbers of uninsured patients.
Regional Healthcare Partnerships
The regional healthcare partnerships are locally developed groups of stakeholders — including hospitals, providers, academic health science centers, county medical societies, local governments and consumers. Each regional healthcare partnership is developing a five-year plan based on local needs, which includes strategies to address uncompensated care and to reform the delivery system. This can include enhancing access to health care, increasing the quality of care or improving the cost-effectiveness of care.
The regional healthcare partnerships will pay for these projects by combining a variety of matching, public funds that will be sent to the federal government in the form of an intergovernmental transfer through the Texas Health and Human Services. These matching funds will be used to increase the amount of federal Medicaid dollars the state gets, based on a $1 total return for every 42 cents submitted.
Local authorities recently were given the go ahead to use their intellectual and developmental disability (IDD) state general revenue as matching funds, in addition to their local tax dollars. Local authorities still would have to use the funds for the purposes they were originally allocated, but could use the enhanced funds to demonstrate projects with predefined outcomes. They had previously received authority to use their mental health general revenue funds.
For example, a local mental health authority could choose to use the general revenue funds to develop or enhance its mobile crisis units. The predefined outcome would be that the number of emergency room visits associated with mental health emergencies would be decreased. This could also cut back on the overuse of emergency rooms by individuals, including waiver recipients and people living in group homes.
The transformation waiver is authorized through Sept. 30, 2016, under Section 1115 of the Social Security Act, to give more flexibility in how benefits are provided and health care delivery. Local plans must be submitted by the regional healthcare partnerships by October 31, 2012, for approval by the Texas Health and Human Services Commission and the federal Centers for Medicare and Medicaid Services.
The Texas Health and Human Services Commission will hold a public hearing on proposed new rules on the healthcare transformation program on September 18, 2012 in Austin.