April 2018 DSRIP Newsletter
Texas 1115 Waiver
Keeping up with Medicaid at the
National, State, and Local Levels
Do your DSRIP measure selections match MCOs’ incentives?
As DSRIP moves into DY7-8, the new program provides opportunities for alignment with Medicaid Managed Care Organizations (MCOs). MCOs already have financial risk or reward tied to achieving quality goals for the Medicaid population. Where DSRIP and MCO incentives overlap providers may be able to collaborate to optimize performance and foster potential for payment reform. 

General information on MCO quality incentive programs can be found in HHSC’s August 2017 Value-Based Purchasing Roadmap and Region 3’s MCO webinar series , however, downloadable here is detailed information showing the overlap between DY7-8 DSRIP and MCO incentives. This Region 3 analysis shows MCO measures per unique MCO matched with measures/bundles RHP3 DSRIP Performing Providers selected for DY7-8. A sample is below. 

To understand your DSRIP/MCO overlap, start with these basic steps:

  1. Check the table to see with which MCOs your organization’s measures/bundles align
  2. Determine how many of your organization's patients per overlapping measure are covered by an MCO by gathering payer data for patients in your organization’s denominators.
RHP3 DY5-6 DSRIP Reporting Achievement
The results are in for DY5 and DY6 milestone reporting.

  • Region 3 achieved $565 million of $620 million in DY5 funds (91%) in the four DY5-6 reporting periods. The remaining $55 million is a loss of funds because October 2017 was the last opportunity for Providers to achieve DY5 funds.

  • In the two DY6 reporting periods, Region 3 achieved approximately $514 million of the $620 million allocated to DY6 (83%). As a result, about $106 million are carried forward to DY7.

  • Most of the DY5 losses stemmed from unmet Category 3 goals (53% of DY5 loss of funds), while less than a quarter of DY6’s carried forward funds were tied to Category 3 (22%).

  • HHSC’s Hurricane Harvey reporting accommodations were put to use for DY6 milestones. Using these, providers achieved $20 million of the $514 million in achieved DY6 funds.
Quick facts: RHP3 DSRIP achievement by Provider type
  • The percent of dollars achieved by Region 3 Performing Provider types generally declined and spread over the DYs.
  • Of all Provider types, local health departments achieved the greatest percent of their allocations in DY4-6.
  • Hospital size did not seem to effect achievement after DY3. Small, medium, and large hospital providers achieved about the same percent of their allocations.
The Impact of Medicaid Work Requirements Waivers
For the first time, the federal government is allowing states to require people to work or volunteer in order to have Medicaid benefits. [1] Ten states have already filed applications to implement the work requirement. Below we explore several questions about this. First, what constitutes work per the requirements? Second, how much of an impact on people will these waivers have? And last, if Texas sought the work requirement provision, how might it impact the state’s Medicaid customers?

On January 11, 2018, the Centers for Medicare and Medicaid Services Administrator Seema Verma tweeted that work requirement waivers would “improve Medicaid enrollee health outcomes by incentivizing community engagement.” [2] Community engagement is flexibly defined and can include work, care giving, volunteering, and drug and substance abuse treatment. [3]  According to the rules, “people who are elderly or disabled and pregnant women and children would be excluded.” [2]

To begin to understand impact, we look to research about work in the Medicaid population. Kaiser Family Foundation research shows that most non-elderly, non-SSI Medicaid adults work (Figure 1). [4] Overall, the Kaiser Family Foundation found that approximately 60% of non-disabled, working-age adults already have jobs, while nearly 80% are part of families with at least one member in the labor force.” [5]   Kaiser found that Medicaid beneficiaries who are not working most commonly cite illness as the reason why (Figure 3). Experts share that “people can have physical or mental health problems -- such as arthritis or asthma -- that don't meet the criteria for federal disability programs, but still interfere with their ability to work.” [6] The second most common reason people give is family care or home obligations (some types of caregiving would exempt Medicaid beneficiaries from waiver requirements).

If Texas were to pursue this waiver, experts do not foresee it having a large impact on Texas Medicaid customers. This is because states can structure Medicaid eligibility, resulting in some states’ Medicaid programs including certain populations and other states’ programs excluding the same group. Texas Medicaid is structured such that the majority of beneficiaries are children, pregnant women, and disabled individuals, all of whom would be exempted from Medicaid work requirements per the new rules. Therefore, it is anticipated that the impact of a Medicaid work requirement waiver would be minimal if implemented in Texas.