In December 2011. the Centers for Medicare & A ; Medicaid Services ( CMS ) approved a presentation release for Texas that is modeled. in portion. on a presentation release that has been underway in California since November 2010. Both releases affect 100s of 1000s of Medicaid donees. involve one million millions of federal Medicaid matching financess. and are designed. in portion. to advance alterations in the wellness attention bringing system that will ensue in better attention for persons. better population wellness. and decreases in costs through system betterments. These 5-year presentations are approved under subdivision 1115 of the Social Security Act. which authorizes the Secretary of Health and Human Services to relinquish certain federal Medicaid demands to enable provinces to carry on presentations with federal Medicaid financess.
They have some of import similarities:
•Both provide for a important enlargement of the figure of Medicaid donees required to inscribe in capitated Medicaid managed attention organisations ( MCOs ) . In California. some 380. 000 seniors and individuals with disablements in 16 counties who had been having Medicaid benefits on a fee-for service footing will be enrolled in MCOs by May 2012. In Texas. about 940. 000 Medicaid donees will be enrolled in capitated managed attention by March 2012. •Both releases provide pools of federal financess known as Delivery System Reform Incentive Payments ( DSRIP ) that are designed to honor infirmary systems for bettering entree to care and the wellness of the Medicaid and uninsured patients they serve. In California. up to $ 3. 3 billion is available over the 5-year period ; in Texas. between $ 11. 4 and $ 15. 4 billion is available.
The releases besides have some of import differences:
•In Texas. persons dually eligible for Medicare and Medicaid are capable to compulsory registration in Medicaid MCOs ; in California they are non. •In California. the release includes a major enlargement of coverage to some 455. 000 low-income grownups in progress of wellness reform in 2014. There is no coverage enlargement under the Texas release. •The Texas waiver limits the pool of federal financess ( “supplemental payments” or “UPL payments” ) used to pay infirmaries for unsalaried attention ; the California release does non.
•The California release allows 50 % federal matching for the costs of designated province wellness plans ; the Texas release does non let such refinancing of state-only plans. •Finally. the California release ( ”Bridge to Reform” ) is explicitly intended to fix the province and its public infirmaries for the execution of the 2014 Medicaid enlargements under the Affordable Care Act. The Texas release ( “Texas Healthcare Transformation and Quality Improvement Program” ) is designed to spread out bing Medicaid managed attention plans and to set up a support pool that will help public infirmaries organize suppliers into Regional Healthcare Partnerships.