Today, I want to talk about the Medicaid 1115 waiver that the Texas Health and Human Services Commission (HHSC) recently received from the Centers for Medicare and Medicaid Services (CMS).  It is a “big deal” and has the potential to bring another $15 billion in federal money to Texas. The term 1115 refers to a section of the Social Security Act that allows states to receive permission to try new approaches to the delivery of health care. HHSC believes that we can develop a program consistent with the CMS’ triple aim, which is to improve the experience of care, improve the health of populations and to reduce the cost of health care without compromising quality.

Taking the place of the Upper Payment Limit program, this waiver program’s intent is to achieve greater flexibility in designing programs to ensure improved access, quality and cost-effectiveness of Medicaid services to eligible recipients. The waiver will allow the state of Texas to receive a 40/60 match in federal funds for Medicaid services over a five-year period.

At the heart of the program is the formation of Regional Healthcare Partnerships (RHP), anchored by either a lead health-care provider or local government entity, to implement the new Medicaid program. The RHP will develop a plan to be submitted to HHSC for final approval.  Texas Tech University Health Sciences Center, for example, could be the anchor, or UMC, or even a county government. (No decision has been made on the anchor for our area nor has TTUHSC decided it is a role we will seek.)

Part of this 1115 activity is for the state to expand risk‐based managed care, which is why we are seeing some new Medicaid Managed Care offerings in the Lubbock area.

P.S. Congratulations to Bill Henderson, senior administrator, TTP-Orthopaedics, for writing a winning article on service excellence.  Bill wrote a fine article and for his efforts received an autographed copy of Dean Berk’s book, Anatomy of a Kidnapping.  You can be next!  Remember, we are writing on our SPIRIT values and the next topic is patient first. Get your submission to me by 5 p.m. Friday and you may be the next winner.  The contest is open to all.