Another analysis examining the impacts of the suspension of the 1115 Medicaid Waiver program estimates that Rio Grande Valley hospitals and nursing homes will lose nearly $180 million annually in federally funds.
The Texas Essential Healthcare Partnerships, a nonprofit organization, released a fiscal analysis showing that starting Sept. 1, 18 hospitals and 28 nursing homes in the area are expected to lose $176,864,380 per year combined.
Among those affected is DHR Health which is expected to lose out on an estimated $60 million, according to Roberto Haddad, DHR Health vice president and counsel for Government Affairs and Policy.
“The 1115 Waiver is a lifeline for Medicaid beneficiaries and the uninsured alike,” Haddad said in an email. “The 1115 Waiver provides vital funding for safety-net providers, like DHR Health, to meet the health care needs of our community, including providing essential services and charity care, funding innovative projects, improving quality, and increasing access to health care services for the most vulnerable.”
“The loss of funding would hamper the ability of DHR Health to continue increasing access to health care services for the indigent and low-income Medicaid beneficiaries,” he continued, “which could result in service cuts to certain programs targeting these populations.”
The funds are distributed through two Medicaid Directed Payment Programs (DPPs) each year and those two funds are funded by the U.S. Centers for Medicare and Medicaid Services through the Uniform Hospital Rate Increase Payment (UHRIP) and the Quality incentive Payment Program (QIPP).
They helped pay for maternity care in hospitals and programs to prevent pressure ulcers and falls in nursing homes.
Funding for those programs are currently held up as negotiations continue between CMS and Texas over the state’s proposed DPPs in the wake of litigation over the 1115 waiver program.
First approved in 2011, the 1115 waiver was meant to be a temporary program as the Obama administration hoped the state would eventually transition into expanding Medicaid under the Affordable Care Act.
However, the Supreme Court ruled that states could not be mandated to expand Medicaid and, despite attempts by Democratic state lawmakers to adopt Medicaid expansion, the state has only continued to expand the 1115 waiver every several years.
In January, the Trump administration approved an extension of the program through Sept. 30, 2030, but then on April 16, the Biden administration rescinded that extension and the current extension is set to expire in September 2022.
In May, Texas Attorney General Ken Paxton sued the Biden administration over the decision and last month, a federal district judge temporarily reinstated the extension by granting a preliminary injunction in the case.
“These programs have been especially important to Texans in rural areas, where providers can be few and far between,” TEHP stated in a news release. “Nevertheless, UHRIP and QIPP will go unfunded as negotiations over the 1115 waiver continue.”
They noted that because Medicaid provides health care coverage for individuals of low-income, Valley is likely to be among the hardest hit areas as the percentage of people living in poverty in border communities is nearly twice that of the Texas rate.
“There is an urgent need for CMS to work with the state of Texas and provide funding for these vital Direct Payment Programs,” said Don Lee, TEHP president. “While the state and federal government work on terms for Texas’ 1115 waiver, CMS should maintain its funding for these DPPs.”
“At a time when our hospitals and nursing homes are dealing with the first global pandemic in 100 years, they cannot afford to be left behind,” Lee continued. “If left unfunded, these healthcare providers throughout the Rio Grande Valley area, and the entire state, could see their doors shut, never to reopen.”