Georgetown CCF, the Center on Budget and Policy Priorities and seven other national organizations submitted a letter to CMS for public comment on Texas’ proposal to extend its Section 1115 Medicaid demonstration project, the Texas Healthcare Transformation and Quality Improvement Program. The full comments that were submitted November 16, 2015 can be found here – key points to follow:

• Texas requested a five-year extension of their demonstration; however, the Social Security Act only allows extensions of demonstrations for three-year periods.
• Texas requested a large increase in funding for its Uncompensated Care Pool (UCP), $5.8 billion in the first year, $6.6 billion in the second, and $7.4 billion for the next three years for a total of $34.6 billion over the five-year request. We believe this request is inconsistent with the principles CMS has set forth in dealing with other states, namely Florida, with similar UCP models and in light of the fact that Texas continues to refuse an estimated $6 billion a year in federal funds to extend Medicaid eligibility to adults with incomes below 138 percent of the poverty line. While we do not believe that the state’s uncompensated care pool should be eliminated, we do suggest that Texas should not receive federal funds for uncompensated care for persons that would obtain full coverage through expansion of Medicaid.
• Finally, we wrote that continuing to fund Texas’ DSRIP initiative at full scale ($3.1 billion/year) should be done with caution, as delivery system reform must be coordinated carefully with managed care organizations to ensure that successful projects are sustainable and integrated into the organizations that now cover most Medicaid beneficiaries in Texas.