First Stage of Texas Medicaid 1115 Waiver Extension Comments Closes: What’s Next?

The first stage of the required public notice and comment  process for the “Texas Healthcare Transformation Quality Improvement Program” Medicaid 1115 Waiver ended on Monday June 28, with the closing of a 30-day public comment period to the Texas Health and Human Services Commission (HHSC), the state’s Medicaid agency. 

Every Texan and many others made brief oral comments at four public hearings, and also submitted more extensive written comments (read our full comments here). Our top-line requests of Texas HHSC were:

  1. Revise the waiver to include coverage for adults up to 138% of the federal poverty level as provided for under the Affordable Care Act;
  2. Approve the newly requested “Public Health Provider-Charity Care Program” (PHP-CCP) Uncompensated Care (UC) pool, and continue the current UC pool;
  3. Grant a time period for the extension or renewal that is lawful under the Social Security Act;
  4. Incorporate a new robust program of eligibility and recertification outreach and informing, featuring a strong focus on Texas’ mixed-immigration-status families in which more than 1 in 4 Texas children live; and
  5. Address inequities in Texas Medicaid Managed Care between network adequacy standards and reimbursements for acute care versus long-term Services and Supports.

As noted, this is only the first phase of the process. Here’s what’s next, from the federal Medicaid website:

  • Comments submitted will be reviewed by Texas Medicaid officials, and the comments will be summarized in Texas’ application for Medicaid 1115 funding. Texas HHSC will submit the extension application to the Centers for Medicare & Medicaid Services (CMS).
  • Within 15 days of receipt of the application, CMS will determine whether Texas’ application is complete.
    • CMS will send the State written notice informing the State of receipt of the complete application, the date on which the Secretary received the application.
    • If CMS determines that the application is not complete, CMS will notify the State of any missing elements in the application.
  • After the State is notified that their application is complete, there will be a 30-day federal comment period for the general public and stakeholders to submit comments.
  • CMS will not act on the Texas HHSC demonstration request until at least 45 days after the State receives notice that its application is complete — approximately 15 days after the conclusion of the federal comment period. 

What You Need to Know:

Texas Medicaid is not required to submit the actual comments the agency received to CMS at the US Department of Health and Human Services—only to summarize them.  Because of this:

  • Organizations like Every Texan plan on updating their Texas HHSC written comments and submitting them to CMS during the federal comment period, because the HHSC summary will not fully capture all the issues raised in longer written comments.
  • Comments that were submitted through the Texas portal developed by SickOfItTX and Young Invincibles will be forwarded to federal Medicaid officials, to make sure the diverse community voices raised in the state comment period are also heard in Washington, DC. 

Given the timelines laid out in federal rules, we do not know exactly how soon the federal comment period will begin, but it could start as soon as late July. Stay tuned to Every Texan, Cover Texas Now, and SickOfItTX to hear the latest on how to join in the important federal comment process!

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