In December 2011, Texas received approval from the Centers for Medicare and Medicaid Services (CMS) for a waiver to upcoming changes in federal support for state Medicaid programs. Texas Health and Human Services Commisson (HHSC) applied for the waiver, at the direction of the Texas Legislature, to identify innovative, state-based solutions to Texas' health care needs.
Under the waiver, communities and hospitals will form regional health partnerships that support more localized health care solutions. The partnerships will identify ways to improve health services that address the specific needs of their region in order to qualify for incentive payments. [Learn more with our Quick Guide to the 1115 Waiver]
Under managed care, the state pays a set fee each month to a health plan to provide care for a Medicaid client, who selects a primary doctor from the plan's network to coordinate his or her care. This emphasizes more coordinated and efficient patient treatment. Federal rules generally mean that states that expand managed care will see a reduction in funding to hospitals under the Medicaid Upper Payment Limit program. This five-year waiver will allow for both, enabling Texas to continue receiving these federal funds while allowing for an expansion of managed care. Hospitals providing care to uninsured patients will continue to receive funding to care for them, as well as physician, clinic and other services, and traditional inpatient costs. [Read the full THHS Release]
In December 2011, Texas received approval of a demonstration project that, in part, allows health care providers to work collaboratively on innovative solutions to local healthcare delivery system challenges. The Regional Health Plan (RHP) development occurred in two (2) phases, with a completed plan due to Health and Human Services Commission (HHSC) on/before December 31, 2012.
The University of Texas Medical Branch at Galveston (UTMB) serves as anchor for 16 counties that make up Region 2: Angelina, Brazoria, Galveston, Hardin, Jasper, Jefferson, Liberty, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby and Tyler Counties. Region 2’s submitted plan is online: