HAS ITS FLAWS Transformation. Accountability. Coordination. Local solutions.


1115 WAIVER


These are just a few terms used to describe the lofty goals of the Medicaid 1115 waiver the state is undertaking to reform health care delivery for Medicaid patients and the uninsured. The waiver has two charges: expand Medicaid managed care across the state, which began March 1, 2012, and replace the Medicaid Upper Payment Limit (UPL) program. The supplemental payment program allowed hospitals to recoup some of their uncompen- sated care costs by paying them up to Medicare rates. The overarching goal: Bring together local players — public and private hospitals, physicians, and others — in regional health partnerships (RHPs) and reward them for developing community-based innovations for improv- ing quality and reducing the cost of indigent care. The idea is to incentivize more efficient care, instead of the state writing a blank check for uncompensated care.


BY AMY LYNN SORREL PHOTOILLUSTRATION BY JOHN KUCZALA


March 2013 TEXAS MEDICINE 13


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