5 Things Texas: 1115 waiver, CHIP funding, primary elections

We were excited to release our Topical Agenda last week for our 2018 Texas State of Reform Health Policy Conference coming up on February 1st.  This year, we’ll be at the newly constructed – and yet to open – AT&T Convention Center on the UT campus. If you haven’t registered to be with us, you can get signed up here to join about 350 of your closest friends in Texas health policy.

DJ 5 Things Signature


1.  A pending approval for the 1115 waiver? 

The governor’s office has been briefing key stakeholders on a tentative deal with CMS to approve a new 1115 Medicaid waiver, according to folks who have been briefed.  I’m told the current proposal from the feds would continue DSRIP funding for a time, but those funds would taper off during the demonstration period. All DSRIP funding would cease after year 5 of the waiver, and that to get the waiver approved by CMS, the state would need to agree to such terms. When a formal letter comes out in the next week or two, CMS will post it here.

The lack of certainty around the waiver has created a “brain drain” according toe Craig Cordola, President and CEO of Ascension Texas. CMS had approved the current waiver only until the end of this month.



2.  Alabama’s impact on Texas in 2018

An unusually large field of Democrats have emerged to run in the 2018 gubernatorial race. Eight Democratic candidates are officially in the running, making this the most crowded Democratic governor primary since the 1980s. Early voting starts February 20th for the March 6th Primary Election. Things will heat up quickly.

After Democrat Doug Jones’ win in Alabama, the Democratic Party has turned its attention to flipping Congressional seats in Texas.  Ted Cruz is facing a Democratic opponent Beto O’Rourke, who noted on Twitter that Trump won Alabama by 23 points. He only won Texas by 9.  Five of the thirteen Republican members of Congress not running for re-election in 2018 are from Texas. However, Roll Call only lists one seat as a “Toss Up.”

Surely, much of the Alabama election was about Roy Moore rather than Doug Jones, and Moore’s total collapse as a candidate. That’s unique to that election and not something we’ll likely see in Texas. Nevertheless, these are volatile times in American politics. A lot will happen in the eleven months before the November elections. #MeToo broke just over two months ago. Eleven months is an eternity.


3. The Texas response to the federal withdrawal from CHIP

Texas agencies are exploring the use of an “accounting trick” to temporarily extend their CHIP funds. HHSC hopes this will cover the 400,000 Texas kids covered by CHIP through February.  The idea is to allocate limited federal dollars that come through Medicaid and apply them to CHIP for a short period of time.  If they use this accounting trick, Medicaid will lose some of its support temporarily, but could recover those funds if Congress reauthorizes CHIP funding. Texas officials have also asked the federal government for $90m in funds to keep CHIP running.

President Trump signed a short-term budget bill that provides government funding until Dec. 22. Republicans hope to have a tax bill done by that deadline. They may include a spending deal, though Freedom Caucus members have introduced a spending bill that increases defense spending, but doesn’t add CHIP (or other) funds.  I take that as a sign that the most likely outcome in the next two weeks is a straightforward, no changes continuing resolution (CR) that maintains existing authorization and spending well into next year.

Recall, CHIP is not authorized under current law. So, any CR that doesn’t explicitly include CHIP funding (none likely will) continues the federal withdrawal from the program.



4.  Video: Colm O’Comartun

Colm O’Comartun is the founding partner at 50 State, a public affairs firm focused on state level issues and strategies. He’s served as the Director of the Governor’s Office for Maryland Governor Martin O’Malley and as the Executive Director of the Democratic Governors Association.  He joins us in this edition of “What They’re Watching” to talk about block grants and Medicaid.

“The first thing I say to people to set the stage for a conversation about block grants and Medicaid is: governors care about Medicaid more than any other aspect of health care because it affects their budget more than any other aspect of health care.”  That sort of sensitivity to the budget has been increasingly true in Texas as the Medicaid line is now the largest single line item in the budget (state and federal contributions combined).


5. Continued health impacts of Harvey

Three months after Hurricane Harvey, one in six residents impacted by the storm report they, or someone in their house, has a new or worsening health condition. A new survey from Kaiser Family Foundation and Episcopal Health Foundation evaluated the status of the health and property damages of 24 counties seriously impacted by Harvey. Of those reporting a new or worsened health condition, 38 percent report worsened respiratory conditions including infections, allergies, and asthma.

The mental health of those impacted by Harvey has also taken a hit. Of those who took the survey, 13 percent say their mental health has gotten worse, 22 percent say they have a harder time controlling their temper, 7 percent say their alcohol consumption has increased, and 6 percent have started a new medication due to new mental health problems. “The conventional wisdom that Texans hit by Hurricane Harvey have recovered is wrong,” said Drew Altman, president and CEO of the Kaiser Family Foundation. “The people in the hardest-hit areas are telling us that they still face major hurdles before their lives return to normal.”