Rebecca Wells, Ph.D.

Rebecca Wells, Ph.D.

Since Medicaid’s creation as the United States health program for certain people with disabilities and families with low incomes, both the federal government and the states have grappled with the most effective way to administer the program. Faced with the latest Medicaid initiative, the Texas 1115 Medicaid Transformation Waiver, the Texas Health and Human Services Commission has sought the expertise of the Texas A&M Health Science Center School of Public Health (TAMHSC) to serve as statewide evaluator of the program.

“Texas, like every other state in the country, is dealing with rising healthcare costs at the same time that millions of people have inadequate health service access,” said Rebecca Wells, Ph.D., health policy and management department head, who is leading the evaluation team.

“If we can make something work and figure out why it works here, then the rest of the country might be able to learn from that,” said Monica Wendel, Dr.P.H., assistant dean for community health system innovations who is co-leader of the evaluation team. “As statewide evaluators assessing how this waiver works and to what degree it is successful for Texas, we are on the ground floor of something that has important national implications.”

Working with the Texas Health and Human Services Commission, the evaluation will focus on two components of the Medicaid Waiver:  uncompensated care for hospitals and the effectiveness of the new Delivery System Reform Incentive Pool (DSRIP) program that supports innovative projects aimed at improving health care quality and health outcomes, controlling costs, and improving collaborative capacity.

Monica Wendel, Dr.P.H.

Monica Wendel, Dr.P.H.

TAMHSC-School of Public Health will use a prospective comparative case study design to analyze factors affecting project outcomes. They will be looking for projects that deal with individuals facing a high burden of disease. This means a combination of not only those issues that affect a large number of people, but profoundly impact people’s quality of life.

“There are substantial funds available at the federal level that states are eligible for to assist in providing care to people who don’t have health insurance or adequate health insurance to cover the cost of their care,” said Wendel. “The problem is that the state has not been able to historically access all of the funds that are set aside for our state because of the way the program has been structured.”

“How to improve access within public budgets is one of the most pressing public policy dilemmas we face,” said Wells.

The Medicaid Waiver, approved by the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services in December 2011, is being implemented across the state by 20 regional healthcare partnerships. These partnerships are comprised of stakeholders such as public hospitals, hospital districts, public health departments, counties, cities, local mental health authorities, private hospitals, and academic health science centers.

According to Wendel, with the 1115 Medicaid waiver, there will now be a “mechanism for communities to increase involvement, increase access to federal funds, and retain some control over how they deliver care.”

The changes being made in both uncompensated care and delivery systems reform are designed to reform the healthcare system as a whole. A high quality, efficient and accessible healthcare system really does affect whole populations. For example, currently, many people go to hospital emergency departments when their needs would be better met by prevention, primary care, or behavioral health crisis facilities.  This also creates unpredictable surges in demand that in turn can delay other people’s treatment for medical emergencies.  The HHSC-A&M evaluation team will therefore examine a range of projects around the State using care navigators to reduce emergency department use.

There are many states looking at implementing a similar waiver system. Because Texas is such a large and diverse state, not only in geography, which includes frontier communities to highly urban metropolitans, but also ethnically, the findings from this evaluation can have major implications for the nation as a whole. These include increasing the flexibility of the Medicaid standards as well as increasing its adaptability to changing healthcare needs and provider supply in the future.

— Rae Lynn Mitchell

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