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Medicaid
Waiver Request Status

Waiver Request Status


On July 7, 2008, HHSC sent a letter to the Centers for Medicare & Medicaid Services (CMS) requesting immediate formal negotiation and completion of waiver within 60 days.  CMS responded August 7, 2008, and agreed to negotiations with Texas and outlined its preliminary positions on the waiver components as submitted.   

On September 3, 2008, HHSC met with U.S. Department of Health and Human Services, CMS and the Office of Management and Budget (OMB) officials to discuss high level principles and key waiver components.  Beginning September 10, 2008, HHSC and CMS began a series of weekly calls to work through critical waiver components.  As a result of these efforts, HHSC committed to implement comprehensive reform sooner – including making subsidies available by the end of the first year of the waiver.

To expedite and focus discussions, HHSC agreed to remove components from the waiver that CMS indicated it could not approve:

  • HOP funding for children of legal immigrants (program will continue as it is).

  • HOP funding for school employee children (program will continue as is).

HHSC also agreed to move the request for Medically Needy/Catastrophic Care from the waiver to the state plan amendment process. CMS encouraged the state to pursue this program through that process, and HHSC agreed to do so to move negotiations forward.  HHSC also made the following changes to expedite and focus waiver discussions on critical components:

  • Remove CHIP Premium Assistance and “blended funding” from the waiver, but consider pursuing after waiver approval through waiver amendments.

  • Renove coverage for former foster care children ages 21 to 23 and enrolled in higher education and address through another avenue.

Weekly calls between HHSC and CMS have focused on:

  • The ability to use market based insurance coverage options, including employer-sponsored insurance where available, affordable and qualifying.

  • Benefit package parameters and cost-sharing.

    • Balancing costs with benefits.

    • Hypothetical and demonstration populations.

  • Use and requirements for unmatched state and local funds (also called Designated State Health Programs or DSHP). These are “unmatched” state or locally funded health care programs and services for low-income uninsured individuals. “Unmatched” means these programs are not already supported by federal funds through Medicaid or similar federal programs.

  • Discussing and revising financing and budget neutrality models.

  • Delivery systems and eligibility functions.

  • System transformation funding (grants).

Correspondence