Texas Medicaid 1115 Waiver Renewal Evaluation

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: 10/1/2011-9/30/2012
    • DY2: 10/1/2012-9/30/2013
    • DY3: 10/1/2013-9/30/2014
    • DY4: 10/1/2014-9/30/2015
    • DY5: 10/1/2015-9/30/2016
  • Texas Medicaid 1115 Waiver 15 month Extension
    • DY6: 10/1/2016-9/30/2017 (12/31/2017)
  • Texas Medicaid 1115 Waiver Renewal
    • DY7: 10/1/2017-9/30/2018
    • DY8: 10/1/2018-9/30/2019
    • DY9: 10/1/2019-9/30/2020
    • DY10: 10/1/2020-9/30/2021
    • DY11: 10/1/2021-9/30/2022

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.

Official 1115 Waiver Renewal Website


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