Like most public interest groups, Every Texan strongly supports an extension of Texas’ Medicaid 1115 waiver, a funding agreement that makes payments to hospitals for care they provide to uninsured Texans, often after Emergency Room visits. At the same time, we have serious objections to some features of Texas’ initial extension request process, submitted in November 2020. The Trump administration’s decision to skip a meaningful public notice and comment process was a double foul. First, it deprived Texans of a way to call for expansion of coverage to over a million low-wage Texas adults through Medicaid expansion, or coverage for the same adults as part of the 1115 agreement. It also evaded the 1115 Waiver Transparency requirements under federal law.
A solid majority of Texans (69%) support Medicaid expansion, as reflected in recent polls from the Episcopal Health Foundation and the University of Houston’s Hobby School. Federal law guarantees Texans the ability to let both state and federal officials know they support this use of their tax dollars, even in situations like Texas’ where the governor remains opposed to offering the coverage available in 38 states, including every state bordering Texas.
Support for our safety net providers — hospitals and mental health providers in particular — is crucial, but it is not a substitute for health care coverage. Texans deserve real coverage, not just emergency care or patchwork and waitlisted programs for the uninsured. They deserve regular check-ups, ongoing treatment for chronic conditions from diabetes to mental health, and affordable access to medication. And when emergencies do arise, they need access to follow up care that the ER can’t provide.
Texas pursued extension of the 1115 funding agreement in 2020, long before the October 2022 end date for the current program. This was in large part because Medicaid officials hoped to nail down a guarantee of the largest possible upper limit on not just the 1115 pool funds, but also on new and increased supplemental Medicaid payments for care provided to Medicaid enrollees. These payments are not part of the 1115 waiver, but Texas sought through the waiver extension language to lock in older, more favorable policies that were scheduled to change, so that those older policies would govern future-year recalculations of upper funding limits.
While Every Texan does not oppose Texas’ pursuit of increased Medicaid spending authority, we do reject the premise that seeking that funding approval should take precedence over providing affordable comprehensive health coverage for Texas’ low-wage adults who are excluded from the Affordable Care Act’s Marketplace subsidies, and for whom Texas could be receiving a 90% federal match.
Please join us and call on Texas leaders to include coverage through the public comment process. Every comment will be reviewed by Texas Medicaid officials, and comments will be summarized in Texas’ application for Medicaid 1115 funding. In addition, comments submitted through the portal below will also be forwarded to federal Medicaid officials to make sure your voices are heard in Washington, DC. Help shape the future of health care in Texas!
Here’s how to comment:
Use this public comment portal to urge state leaders to include coverage expansion in its new 1115 Medicaid waiver application, and share it with grassroots partners and others who may prefer shorter comments.
We have until June 28th to get in as many comments as we can with this message. Please distribute this action alert broadly and/or use it to make your own.
For organizations, professional health care advocates, and others submitting longer written comments, please refer to this link with extensive talking points when developing your public comments/testimony.