Texas HHSC is applying for a 1115 waiver extension for Healthy Texas Women with one major change


Maddie McCarthy


The Texas Health and Human Services Commission (HHSC) is applying for a five-year extension to the current Healthy Texas Women (HTW) 1115 waiver. 

HHSC plans to submit the application to the Centers for Medicare and Medicaid Services (CMS) in March. The current waiver expires Dec. 31st, 2024.

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Michelle Erwin, deputy associate commissioner in the office of policy for Medicaid and CHIP services at HHSC, discussed the extension request during an HHSC State Medicaid Managed Care Advisory Committee meeting on Thursday. 

The HTW program currently provides eligible Texans with free women’s health and family planning services. These services include mammograms and other screenings, administration of contraceptives, STI testing, and more. Erwin said almost 463,000 Texans are currently enrolled.

In order to be eligible for the program, she said beneficiaries cannot be pregnant, must be between the ages of 15 and 44, have a household income below 204.2 percent of the federal poverty level, and not be eligible for full Medicaid benefits, the Children’s Health Insurance Program (CHIP), or other coverage like private insurance.

Erwin also noted that 15 to 17 year olds in the program were not covered under the 1115 waiver, but through general revenue funds instead.

While the extension application would keep the HTW program mostly the same, HHSC will request one major change that would transition HTW to a managed care model.

“HHSC does expect that the transition of HTW services to a managed care model will provide a positive benefit for women in Texas by providing healthcare services across their life cycle as many transition across the STAR and HTW programs,” Erwin said. “So as they move between those programs, the same entity, the managed care organization (MCO), they’ll be able to have some continuity there.”

This change is in ordinance with House Bill 133, which passed during the state’s 87th legislative session. 

If the extension is granted, HHSC will have to contract with MCOs. HTW providers will also have to contract through and be certified by the MCO.

The goals of the extension will be virtually the same as the goals for the current waiver, which are to provide safe and effective services to low-income Texans while reducing the overall cost of publicly funded healthcare.

Erwin said HHSC will continue to implement state policy and uphold HTW provider enrollment criteria throughout the extension period. The policy she mentioned favors childbirth and family planning services and does not include elective abortions.

She also said moving to a managed care model will provide even more benefits to reach those goals.

“Additionally, by transitioning to a managed care model we also expect that women in the program will benefit from some of the key managed care … features such as service coordination, disease management, and then access to those additional services that are covered by the MCO but not ‘paid for’ by HHSC.”

— Erwin

HHSC’s estimated timeline includes the notice of award to occur during quarter one of the fiscal year (FY) 2025, and they estimate the start of operations to be during quarter one of FY 2026. The MCO will be unknown until the notice of award.

CMS requires evaluations for all 1115 waivers. Erwin said the evaluations will have to change slightly if the managed care model is implemented, especially given that the managed care model would not begin until partway through the extension.

“In the middle of the extension period, there will be that transition to managed care and so that will influence measures related to access, quality, cost, and so as result the evaluation design for the extension will have to account for that shift,” she said.

The current evaluation for the HTW waiver compares different aspects of care from before and after the implementation of HTW. Those components include access to and use of services,  health outcomes, overall costs, and the impact on provider eligibility criteria.

The extension evaluation will change to evaluate those components from before and after the transition to a managed care model.

Erwin noted that all 1115 waivers must be budget neutral, and that through evaluation, HHSC is confident that the extension will continue to follow this requirement.

“Texas estimates that if the HTW waiver extension is granted, HTW costs per client will remain below what costs per client would be if the waiver extension is not granted,” Erwin said. “So we have positive expectations about remaining budget neutral as we move into the extension.”

The proposed extension is open for public comment before HHSC submits it to CMS. The public comment period will close Mar. 11th.

The 2024 Texas State of Reform Health Policy Conference is coming up on Feb. 27th. You can register here!

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