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State of Texas awarded five-year Medicaid waiver

The state of Texas was awarded a five-year Medicaid waiver by the Secretary of Health and Human Services in December, 2011. Texas is the second state to receive such a waiver; California has been operating under a similar waiver since 2010.

What does this mean for the state? Essentially, more money, but accessing this money will require innovation and collaboration. The current system will have to move from a focus on ill-care and fee for service system to a prevention orientation and shift Medicaid patients to Accountable Care Organizations (ACOs). There will be an increase in federally qualified health centers (FQHCs) and partnerships between the FQHCs and hospital systems to coordinate primary, specialty and hospital care. Patients will be encouraged to make regular use of these clinics as a “Medical Home” rather than allow illnesses to advance to a state requiring an emergency room visit.

Implementation of the waiver has already begun: the state has been divided into Regional Healthcare Partnerships (RHPs) as administrative districts for the waiver. Within the Houston area, the Harris County Hospital District has been designated as the anchor organization for the RHP that encompasses Harris county and adjacent counties (at this time the group includes Austin, Colorado, Fort Bend, Harris, Matagorda, Montgomery, Waller and Wharton).

Waiver funding will be allocated through two sources: the Uncompensated Care Pool (UCP), which will reimburse providers who provide care to individuals with no third party coverage, and the Delivery System Reform Incentive Payments (DSRIP), which will fund coordinated care and quality improvements through the RHPs. The DSRIP funds will also serve as incentive for hospitals to change care delivery systems.

Want to be involved? Work groups are forming! Interested parties should check out www.setexasrhp.com to view meeting minutes and group member lists.

There are two main ways to become actively involved in this process:
Submit a needs assessment to HCHD.

Participate in one or more DSRIP work groups. Check the schedule and find a time you can attend. Take the time to review the ideas already generated by the topical groups. Don’t delay: the deadline to submit plans for our RHP is June 1, 2012.

Visit www.setexasrhp.com to learn more about the waiver and what it means for the state.

Through research-informed grantmaking to Texas nonprofits, St. Luke's Episcopal Health Charities, a separate component of St. Luke’s Episcopal Health System, improves community health and reduces health disparities.  Our Center for Community-Based Research is dedicated to community-based participatory research practices that foster informed action, collaboration and empowerment for the medically underserved and other vulnerable populations.

© 2012  St. Luke's Episcopal Health Charities