5 Things Texas: Comm. Young talks Medicaid, Update from HHSC, Integrating SDOH into business


Eli Kirshbaum


This week’s newsletter features some of the highlights from our recent 2021 North Texas State of Reform Health Policy Conference. From this year’s prolonged legislative activity to the uncertain future of the state’s safety net, needless to say there’s a lot happening in the Texas health policy space.

With so much to talk about, we were honored to have hundreds of stakeholders join us at last month’s conference to engage in the 18 thought-provoking conversations we curated on some of the most pressing issues in state health policy.

Keep an eye out this winter for our Austin conference coming up in early 2022. We hope to see you there. Thanks for reading, and have a great rest of your week!


Eli Kirshbaum

Health Policy Reporter

With help from Soraya Marashi

1. Comm. Young on Medicaid, relationship w/ CMS

Speaking on the Morning Keynote at last month’s conference, HHSC Executive Commissioner Cecile Young said the agency still has a lot of details to hash out with CMS concerning Texas’s 1115 waiver. HHSC has been meeting with CMS every two days to try and reach an agreement on the future of Texas’s health care safety net.

“At stake right now is about $7 billion per year in our state-directed payment programs … These dollars are for you: the providers, the hospitals, the health plans and health care professionals, and most importantly, the patients,” she said. Watch Young’s full remarks on the future of Texas Medicaid here.


2. Legislators share thoughts on Medicaid expansion, vaccine mandates

Republican lawmakers at the State of Reform Conference made it clear they don’t support a state vaccine mandate, but nonetheless encouraged Texans to get the vaccine based on the data proving its effectiveness. To address rising health care costs, the panel of Republicans also encouraged alternatives to the “easy option” of Medicaid expansion, with Rep. Jacey Jetton saying the “Healthy Families, Healthy Texas” initiative made major steps to make health care more affordable.

The Democratic panel expressed frustration that this year’s Medicaid expansion bill didn’t receive a hearing despite its bipartisan support. They said framing the topic as something other than the “buzz word” of “expansion” (“increased access to care,” for example) has been a successful Democratic strategy in getting Republicans to engage. Sen. Roland Gutierrez and Rep. Julie Johnson said the best way for their party to make its voice heard in the Republican-controlled legislature is through continued advocacy around the state and increased electoral participation.


3. Update from HHSC: SDPs, federal financial support

As waiver negotiations between HHSC and CMS continue, HHSC’s CFO Trey Wood said the timely approval of Texas’s proposed SDPs is critical to avoid next year’s looming “financial cliff” — the Sept. 2022 expiration of the state’s current waiver. “That’s why it’s so critical to get those programs stood up and approved by CMS this year … It’ll create that budget neutrality room on a permanent basis going forward so that we can continue to operate those programs,” he said.

Sonja Gaines, HHSC’s deputy executive commissioner for IDD and BH services, detailed how HHSC plans to distribute some of the around $450 million in federal financial support it has received. The agency will invest over $70 million to expand its mental health support system, $44 million to increase SUD treatment capacity, $39 million to conduct a substance use public awareness campaign, $19 million for community development services, and $18 million for advancements in crisis response and overdose prevention.


4. Integrating SDOH into the business model

Our “Putting a business model around the social determinants of health” panel convened health industry leaders to explore how businesses can address SDOH in a sustainable way. Heather Beal, DSRIP & community health manager at Wise Health System, says a critical part of addressing the social determinants is to have strong engagement with community partners. Her organization works closely with non-profits, local government entities, education groups, and others to ensure robust community involvement in health care delivery.

Janice Fagen, senior strategic advisor at Sellers Dorsey, encouraged donations to community-based organizations, saying these groups are working with limited resources and staffing shortages. “We have to be cognizant that these community-based organizations have limits,” she said.


5. Recovering from deferred care and workforce shortages

John Carlo, MD, CEO of Prism Health North Texas, says he believes the country is “only at the very beginning” of understanding the “collateral damage” of deferred care during the pandemic. His comments came during a panel discussion on workforce shortages and deferred care at last month’s conference. He cited a study showing one-third of adults forwent basic primary care during the pandemic, adding that Black and African American individuals had twice the rate of forgone care than white individuals.

Adam Maurer, chief operating officer at OrthoLoneStar, and Winjie Miao, SEVP at Texas Health Resources, questioned the sustainability of Texas’s “traveler model” for addressing the workforce shortage, saying the state should focus on flatter, more equitable compensation rates instead of paying out-of-state nurses more for relocating to Texas. Maurer believes paying nurses from other states three times as much as an in-state nurse for doing the same work isn’t viable.