FILE - Hospital, emergency room, medicaid

(The Center Square) – Texas Democratic Congressman Filemon Vela has called on the Secretary of Health and Human Services and administrators within the Centers for Medicare and Medicaid Services to renew Texas’ Medicaid Section 1115 waiver and several Medicaid managed care directed payment programs after several programs have expired and lack funding.

Vela wrote that CMS must “work swiftly” with Texas “to resolve any outstanding issues and reach agreement” to renew the waiver.

“The recent expiration of a number of programs that provide health care services to vulnerable communities in Texas has led to vast uncertainty for both patients and providers,” he said. 

Annual financial support to these programs totals $6.3 billion.

According to CMS, several programs that fall under the 1115 waiver, primarily used by low-income women and children, are either pending or terminated. They include Texas Healthy Women (pending), a quality improvement program (pending), and women’s health waiver (expired).

Section 1115 is part of the Social Security Act (section 1915), which allows states to test new or existing ways to deliver and pay for health care services in Medicaid and the Children’s Health Insurance Program (CHIP).

Not long after Biden took office, his administration rescinded the waiver, not because of any material issues pertaining to the application but because of a procedural issue with the paperwork. Liz Richter, acting administrator for CMS, wrote in an April 15 letter to Texas officials that its approval was rescinded because “it did not go through the full federal rulemaking process.”

The extension, which was scheduled to run through 2030, would have provided $11 billion per year in health care funding to Texas, including for uncompensated care.

Texas Attorney General Ken Paxton sued, arguing, “The Biden Administration cannot simply breach a contract and topple Texas’s Medicaid system without warning. This disgusting and unlawful abuse of power aimed at sovereign states must end.”

In August, U.S. District Judge J. Campbell Barker sided with Texas.

Yet three months later, the state still hasn’t received funding and it’s taking its toll on poorer communities like those along the border in Vela’s district.

“State health care providers fear that without financial support from these payment programs, many of the gains made in increasing access to health care services for the most vulnerable will be undermined and longstanding disparities in health outcomes for the underserved populations living in Texas' urban and rural communities will be further exacerbated,” Vela said.

He asked the Biden administration to come up with an immediate, short-term solution since “further delays threaten the stability of the existing safety net.”

David Balat, who leads health care initiatives at the Texas Public Policy Foundation, told The Center Square, “It's clear from the actions of CMS that it is more important to them to expand Medicaid to able-bodied adults than it is to fund important safety net programs aimed at women and children. Medicaid was created to protect these populations and we need to do what we can to improve the current Medicaid program, not suffocate existing programs in favor of political ideology.”

Rejecting the waiver was seen as an attempt to push Texas into participating in the federal government's oversight of the Affordable Care Act’s Medicaid expansion, a move Texas continues to reject. The Washington Post reported earlier this year that the administration had already forced a dozen holdout states to accept Medicaid expansion by rescinding funding or through other measures. If Texas were to participate, it would receive $3.9 billion in funding over two years and more than two million uninsured individuals would be eligible to receive Medicaid coverage, the Post reported.

Paxton described Biden’s “attempt to force our state into expanding Medicaid – the Biden Administration’s ultimate goal” – as “deplorable” and “illegal.”

CMS hasn’t yet issued a statement or a response to Vela’s request.