The Healthcare Transformation and Quality Improvement Program (Program) aims to improve access to health care, increase quality of care, and reduce cost of care by expanding Medicaid Managed Care (MMC), revising the Uncompensated Care (UC) system, and creating a Delivery System Reform Incentive Payment (DSRIP) Program. The Texas A&M University (TAMU) team led the first evaluation focused on the initial five years (FFY 2012 to 2016). There was a temporary 15 month extension of the initial Program, followed by the official Texas Waiver renewal (FFY 2018 to 2022). The detailed timeline of the Texas Medicaid 1115 Waiver is as follows:

• Initial Texas Medicaid 1115 Waiver

  • Demonstration Year (DY) 1 to DY5: (12/1/2011-9/30/2016)

• Texas Medicaid 1115 Waiver 15 month Extension

  • DY6 (10/1/2016-12/31/2017)

• Texas Medicaid 1115 Waiver Renewal

  • DY7 to DY11 (1/1/2018-9/30/2022)

• Texas Medicaid 1115 Waiver 10 Year Extension

  • Approved on 1/15/2021 through DY19 (9/30/2030)

Official 1115 Waiver Website

Texas Medicaid 1115 Waiver 10 Year Extension Evaluation (2021-2030)

The 10 year extension approved on January 15, 2021 allows Texas the continued flexibility to pursue the goals of the Waiver. Specific aims of the Extension include transitioning additional services to MMC while improving the overall quality of the MMC service delivery model, promoting access to care and value-based incentives achieved under DSRIP, and sustaining the financial stability of Medicaid providers.

The evaluation aims to answer the following questions:

• Evaluation Question 1: Did the programmatic changes associated with the carve-in of NEMT into MMC improve healthcare outcomes for MMC clients?

• Evaluation Question 2: Does STAR+PLUS HCBS improve healthcare outcomes for MMC clients?

• Evaluation Question 3: Did the MMC service delivery model improve access to and quality of care over time?

• Evaluation Question 4: Do the SPPs financially support providers serving the Medicaid and charity care populations?

• Evaluation Question 5: Did the implementation of UHRIP support the hospital delivery system during the transition of the UC program to charity care only?

• Evaluation Question 6: What are the costs of providing health care services to Medicaid beneficiaries served under the Demonstration?

• Evaluation Question 7: What are the administrative costs of implementing and operating the Demonstration?

• Evaluation Question 8: How do directed and supplemental payment program support providers and overall Medicaid program sustainability?

• Evaluation Question 9: Did Texas’s quality initiatives impact the development and implementation of quality-based payment systems?

The evaluation will involve several activities, including secondary data analyses of various state administrative data sources, surveys, interviews, as well as workshops conducted by a diverse project team. Drs. Hye-Chung Kum, Robert Ohsfeldt, and Eva M. Shipp will lead the evaluation team comprised of members from the Population Informatics Lab in the Department of Health Policy and Management at the School of Public Health at Texas A&M University and other affiliated institutes. 

Please contact Seoyoon Lee (sy.lee@tamu.edu) for any further information.

Texas Medicaid 1115 Waiver Renewal Evaluation (FFY 2018 to 2022)

The current 1115 Medicaid Waiver Renewal Evaluation builds on the work previously conducted by the TAMU project team and will focus on the Demonstration renewal timeframe. The renewal evaluation, as outlined in the Centers for Medicare & Medicaid Services (CMS) approved evaluation design plan, is based on the Demonstration renewal timeframe, building upon the evaluation conducted during the initial approval timeframe (Texas Health and Human Services Commission, 2017). This evaluation aims to assess the DSRIP Pool throughout demonstration years (DY) 7-11, the five years covered through this renewal (appending previous years, if feasible), UC through federal fiscal year (FFY) 2021 (ten years of the Demonstration), and MMC populations and services carved into MMC during and after FFY 2015 through FFY 2022. The various timeframes for each component reflect the anticipated availability of data for each Demonstration component.

The evaluation aims to answer the following questions:

• Evaluation Question 1: Did the DSRIP program incentivize changes to transform the health care system for the Medicaid and Low-income or Uninsured (MLIU) population in Texas?

• Evaluation Question 2: Did the Demonstration impact unreimbursed costs associated with the provision of care to the MLIU population for UC providers?

• Evaluation Question 3: Did the expansion of the MMC health care delivery model to additional populations and services improve healthcare (including access to care, care coordination, quality of care, and health outcomes) for MMC clients?

• Evaluation Question 4: Did the Demonstration impact the development and implementation of quality-based payment systems in Texas Medicaid?

• Evaluation Question 5: Did the Demonstration transform the health care system for the MLIU population in Texas?

The evaluation will consist of several activities, including secondary data analyses of various state administrative data sources, surveys, as well as two stakeholder and expert workshops conducted by a diverse project team. Drs. Hye-Chung Kum, David Washburn, Robert Ohsfeldt, and Eva M. Shipp will lead the evaluation team comprised of members from the Population Informatics Lab in the Department of Health Policy and Management at the School of Public Health at Texas A&M University and the Texas A&M Transportation Institute. See below for full list of investigators. To address the complex nature of the evaluation, the team has also recruited a stakeholder and expert advisory board who will provide consultation throughout the evaluation.

Please contact Amber Trueblood ( trueblood at tamu dot edu) for any further information.

TAMU/TTI

• Faculty & Staff

  • Hye-Chung Kum (PI)

  • David Washburn (co-PI)

  • Robert Ohsfeldt (co-PI)

  • Eva Shipp (co-PI)

  • Michael A Morrisey (co-Investigator)

  • Qi Zheng (co-Investigator)

  • Amber Trueblood (project director)

  • Michelle Mellers (post-doctoral research associate)

  • Jennifer Meier (project manager)

  • Brandy Sebesta (account manager)

• Students (more will join the team)

  • Nikita Wagle

  • Geng Zhang

  • Sulki Park

Stakeholder and Expert Advisory Board

• William M. Sage

  • The University of Texas at Austin School of Law James R. Dougherty Chair for Faculty Excellence Professor (Department of Surgery and Perioperative Care) Dell Medical School

• Lisa Kirsch

  • The University of Texas at Austin Dell Medical School Senior Policy Director, Dean’s Office

• David C. Warner

  • The University of Texas at Austin Lyndon B. Johnson School of Public Affairs Wilbur J. Cohen Professor in Health and Social Policy Professor of Public Affairs

• Avik Roy

  • President and Co-Founder of the Foundation for Research on Equal Opportunity (FREOPP)

• W. Stephen Love

  • President and CEO of Dallas-Ft. Worth Hospital Council