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Government & Law

CMS Approves California Medicaid Waiver. How Does It Differ From Texas’ Expiring 1115?


California is the latest state to receive federal approval for the renewal of a waiver meant to pay for reforming the Medicaid program by instituting new care delivery strategies and platforms.

Modern Healthcare reports that California’s waiver is worth $6.2 billion and will help offset the cost of uncompensated care accrued at its safety net hospitals. Texas has a similar request pending with the Centers for Medicare and Medicaid Services. Known as the 1115 waiver, the state had to request renewal by last September.

Texas’ waiver is worth nearly five times as much as California’s ($29 billion over four years) and triggered a brief but bitter fight between Gov. Greg Abbott and the Obama administration, which hinted that it would not renew the waiver unless lawmakers expanded Medicaid. That didn’t come to pass, and CMS vowed to play fair. Texas reapplied last year and is awaiting word on whether it will be approved.

But, at its crux, both waivers seem aimed at doing similar things: Reform the way healthcare is delivered to keep people out of the hospitals. And then prove that you’re doing it. The difference in the states is that California actually expanded Medicaid under the Affordable Care Act, adding another 1.1 million beneficiaries to its rolls, according to Modern Healthcare.

The Obama administration pulled back on how much money it allotted to offset uncompensated care, signaling that it wants more of its residents to enroll in the expanded Medicaid program. Texas doesn’t have that luxury, and about 1 million residents here make too much to qualify for federal healthcare subsidies but not enough to enroll in traditional Medicaid.