Overview
Medicaid Expansion and the 1115
Waiver Program
May 9, 2013
Potential Medicaid Expansion
Estimated Financial Impact for Dallas County
Potential Medicaid Expansion
Affordable Care Act
Under the Affordable Care Act,
• the Federal government has offered 100% funding for
expansion of the Texas Medicaid program
• program expansion would cover Texas residents who earn up
to 138% of the Federal Poverty Level (FPL)
• the 100% Federal funding would be provided through 2016,
after which time the Federal share declines to 90% funding by
2020.
3
Dallas County Impact
Demographic Impact
• Dallas County has approximately 600,000 uninsured residents.
• The Affordable Care Act will provide subsidies to uninsured residents which
• absent Medicaid expansion, should reduce the number of uninsured to
approximately 465,000.
• Medicaid expansion would reduce the number to approximately
334,000
• meaning, an additional 131,000 Dallas County residents would
receive Medicaid coverage
• As a result, Dallas County healthcare providers would be paid $580 million
• Today these must be covered by safety net hospitals
Source: Center for Public Policy Priorities
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Impact for Dallas County Providers
Financial Impact on Providers
Although overall base payments would increase $580 million
• Other supplemental payments (Uncompensated Care / UC) currently
received would be reduced
• Net Dallas County providers would realize approximately $351 million.
• Statewide this would result in additional provider payments of over
$1.6 billion/year
• Without Medicaid expansion there will be no incremental Medicaid
payments
• Costs fall to the taxpayers and charity programs
• Texan’s tax dollars go to fund other states’ Medicaid Expansion
Programs
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The 1115 Waiver
• The 1115 Waiver is known as the Transformation Waiver
• The intent is to change healthcare in Texas to provide better care at
less cost
• The Waiver is divided into two parts
• Uncompensated Care
• DSRIP
• The Waiver is organized into 20 Regions
• Dallas County is in Region 9
• Region 9 includes Dallas, Denton and Kaufman Counties
Regional Healthcare Partnership (RHP) Formation – Region 9
Regional Healthcare Partnership (RHP) Formation – Region 9
Region Nine defined on August 3rd to include Dallas, Denton and Kaufman
counties
Organization of RHP Plan participants is well under way
–Short list of eight potential IGT Entities in addition to Parkland and UT
Southwestern
–Organizing meeting of IGT Entities planned for September 7th
Active RHP Work Groups:
–UC Task Force: focused on financial implications and mechanics
–RHP Plan Writing Work Group: composed of “authorized representatives”
of each participant and charged with writing the RHP Plan
Continue to target a mid- to late-September completion and submission date
–Each Work Group is proceeding with known facts, draft rules and guidance
Funds Flow Mechanics
Anchor Responsibilities
General Duties
 Serves as single point of contact for the RHP with HHSC
 Facilitates RHP meetings with interested IGT contributors in the region and communicates
function and purpose of RHPs
 Includes other stakeholders in RHP discussions
 Ensures public meeting as part of development of RHP and prior to submission of final plan
RHP Plan
 Ensures inclusion of key stakeholders in RHP Plan development
 Coordinates, develops and provides RHP plan to HHSC based on IGT contributing projects
consistent with project menus and on IGT contributors’ input
Administration of DSRIP Projects
 Coordinates required reporting of all project milestones and metrics within RHP for DSRIP to
HHSC
 Provides technical assistance to participating providers
OVERVIEW
• Hospital
o 700 Adult Beds
o 65 NICU Beds
• Community Outpatient Care
o 13 Centers
o 11 School Based Clinics
o 4 Mobile Units
• Parkland Community Health Plan Since 1999
o 200,000 Enrollees
• Dallas County Jail System Health Care
• Parkland Foundation
HISTORY
• Second Largest Civilian Burn Unit in U.S.
• Leader in Disaster Preparedness and Response
• Admissions from 200 of 254 Texas Counties in 2012
STATISTICS
• ED’s average 490 patients per day
• More than 1,000 radiology procedures per day
• More than 1/3 of the total births in Dallas County each year
•
In the past 2 years…
– Parkland’s outpatient pharmacies have filled nearly 4.2M prescriptions
• Averaging more than 5700 fills per day
PHHS-UTSW Partnership
• Primary Teaching Hospital for the University of Texas
Southwestern Medical Center Since 1943
• 2,506 Faculty
• 1,561 Residents in 105 ACGME Programs
• UTSW to Graduate 500 Students in June 2013
• UTSW Represents 1,470 of 1,660 Medical Staff Members
• Fifty Percent of Physicians in Dallas Trained at Parkland
Questions?
Parkland
•Coping with Change- How Healthcare Providers Are Meeting
the Demands of Tomorrow