Texas is a step closer to receiving a federal extension for its Medicaid program that helps cover uncompensated care bills for providers.
CMS certified on Dec.15 that the state's Medicaid Section 1115 extension waiver is complete and ready to be approved at any time. Last year, the Texas Tribune reported that the state's 1115 waiver was worth $25 billion.
Texas Gov. Greg Abbott requested an exemption in November, citing the public health emergency as its reason for fast-tracking its Medicaid waiver, which is set to expire in 1.5 years. His office did not immediately respond to a request for comment. With CMS' certification, state and federal officials will be able to sidestep a public comment process that analysts say normally lasts up to three months. Critics claim the Trump administration aims to provide a sweetheart deal to a political ally before the Biden administration enters office. If CMS approves Texas' application, Texas will be ensured the funds until September 2027.
Anne Dunkelberg, associate director of Every Texan, said the lack of public comment period has left advocates unable to fight for expanded Medicaid coverage in the state with the highest number of uninsured individuals in the nation. In 2019, the Kaiser Family Foundation reported that 18.4% of Texans lacked insurance. The most recent state data filed in October found that 4.4 million Texans were enrolled in Medicaid, and just under 300,000 local children were enrolled in the Children's Health Insurance Program.
"We have potentially a dramatically increased need for coverage for low income, Texas workers as a result of the pandemic," Dunkelberg said. "We're concerned about the fact that the process that's moving forward is not addressing those issues and that we haven't had a public comment period for this extension in which we could have raised that."
While the Trump administration has opposed expanding Medicaid, President-elect Joe Biden has said he aims to expand Medicaid to individuals regardless of where they live. Gov. Abbott has called the idea of expanding Medicaid "coercive" on the federal government's part.
"So the thought is, 'Well, we can get our uncompensated care pool without any changes if we do this really quickly. We're not so sure what's going to happen if we wait,'" said Judy Solomon, a senior fellow at the Center on Budget and Policy Priorities. "That's probably one of the things that's at the heart of this is to able to continue that funding."
Joan Alker, a research professor at Georgetown University who serves as the school's executive director and co-founder of the Center for Children and Families, said CMS has previously fast-tracked Section 1115 waivers during hurricanes, after 9/11, or during other national crises. States usually do not file them until about a year until the Medicaid program is set to expire, she said.
Alker said pushing the waiver forward without time for the public to scrutinize how local and federal dollars are spent sets a troubling precedent.
"A lot of really important decisions about Medicaid are made through these section 1115 waivers," Alker said. "Certainly, in the case of Texas, there's a lot of questions with respect to federal funding, how much they're going to get, who's going to get it, and how. And now that the process has gone subterranean, one can assume it will be pretty highly politicized."