5 Things Texas: 1115 waiver update, Early Bird registration, Maternal mortality

This may be the calm before the storm.

Thursday is the last published day on the Supreme Court calendar to release opinions from its current term (though they have a few more weeks for orders). It’s a term that saw a meaningful challenge to the ACA last November. It was a case many in the media thought could not be overturned, based on the line of questioning from the justices. But for that to happen, Justices Roberts and Kavanaugh both will need to break from the 6-3 conservative majority to craft a majority opinion with the three more liberal justices. That seems a tough reach.

Anyone who tells you they know what’s coming should probably not be listened to, including me. But, for what it’s worth, I’d offer this is not a binary moment. The range of options which I think may be on the table for the justices to land a majority on is wide. Like the first NFIB case, expect the unexpected. You can read my break down of the Texas case from 2019 here, or my incorrect prediction of the 2012 NFIB case (and subsequent explanation of Roberts’ creative opinion here).




                                                                                                                                                                                                                                                          With help from Emily Boerger

1. Update on the 1115 waiver

HHSC released the draft extension request for its Medicaid 1115 waiver in late May. The request is fundamentally the same as the recently-rescinded waiver extension and asks for a ten year extension – an abnormally long extension granted by the Trump administration for Texas’s initial extension request. Every Texan’s Anne Dunkelberg told State of Reform President Biden’s CMS will likely only approve a five-year extension, which is the typical length of such waivers.

The state is holding a public comment period for stakeholder input before sending the application to CMS, which will then hold a second, federal public comment period prior to issuing a decision. CMS cited the lack of a public comment period as its reasoning for rescinding Texas’s previous waiver extension.

2. Early Bird Registration now open

Early Bird Registration is now open for the 2021 North Texas State of Reform Health Policy Conference coming up on September 30th. It’ll be a hybrid event, with an in-person option and an integrated virtual experience, so folks can choose how best to participate based on their comfort level.

A big thank you to our Convening Panel who got together last week to talk through the issues and topics that will be teed up for discussion at the event. We’ll release the product of that meeting, our Topical Agenda, in a few weeks’ time, so if you have any topics, speakers, or content ideas, we would love to hear them. And, if you already know that you want to join us on September 30th, be sure to take advantage of the discounted price and register today!


3. Expect “clean up” bills in 2023

“Loose ends, missed opportunities, and wrong turns.” That’s how one legislator described the policy-making process in the 87th Legislative Session in private comments to me last week. Legislative advocates were just as sour on the experience, saying that there would need to be quite a few clean up bills in the next session to make up for it all.

Another advocate told me the tension and partisanship this session was unlike any they’d seen in the decades that they’d worked in Texas public policy. The end result, they said, is that a lot of good bills died this year, and several of the bills that passed are “problematic” and will need a lot of work to make them functional. Stakeholders said to be prepared for some complicated rule making activity as the administration is forced to try to make heads or tails of some of this work.

4. Efforts to improve maternal mortality in TX

In the last week of session, lawmakers sent Rep. Toni Rose’s HB 133 to Gov. Abbott’s desk. The bill will transfer Healthy Texas Women program services to a Medicaid managed care model and extend the Medicaid eligibility period for new mothers from 60 days to six months – something advocates say will help lower Texas’s high maternal mortality rates.

Experts are also evaluating how to reform the funding model for maternal health care, with some saying a bundled – or “episodic” – system of payment is more effective. At a recent “5 Slides We’re Watching” conversation with State of Reform, Ken Janda, Principal at Wilde Blue Health Solutions, said providing one-time payments for the entire maternal health “episode” of care, including prenatal and postpartum care, can both save costs and improve health outcomes.


5. SCOTUS ruling opens door for text messaging health outreach

A recent US Supreme Court ruling opens the door for health plans to interact with members and provide outreach via text messaging by making changes to the Telephone Consumer Protection Act. Abner Mason, CEO of ConsejoSano, says the ruling is a “game changer” for health care stakeholders and their ability to communicate with hard-to-reach patient and member populations.

“We really believe this is a health equity issue. This is part of meeting people where they are and the shame is that it’s taken this long,” said Mason. “The fact that health plans have been unable to engage their members in the way the member prefers is just an example of how our health care system needs to change.” Mason and Marcia Augsburger, Partner at law firm King & Spalding, explain the ruling and its impacts in detail here.