Under the Texas 1115 Medicaid Waiver, (see encyclopedic entry: Texas Healthcare Transformation and Quality Improvement Program Waiver (1115 Waiver))these are incentive payments earned by providers, including public and private hospitals, physician groups, local mental health authorities, and local health departments who implement an innovation in health care delivery. Some DSRIP funds also pay for health care infrastructure. DSRIP projects are funded by federal monies matched with state and local funds. DSRIP funds are allocated to 20 regional healthcare partnerships (RHPs) (See encyclopedic entry: Regional Healthcare Partnership (RHP)), which are local groups comprised of counties, health care districts and other local entities that fund the non-federal portion of DSRIP payments and determine how funds will be used.


There are approximately 1,450 current active DSRIP projects, touching 300 providers. A quarter of these projects focus on behavioral healthcare, with another 20 percent making primary care access reforms. The remainder of Texas DSRIP projects involve chronic care management (18 percent), specialty care access (9 percent) and health promotion and disease prevention (8 percent).


Providers earned nearly $8 billion in DSRIP funds in the original waiver period (2011-2016) and provided services to 5.2 million low income and Medicaid-eligible individuals with these funds. Texas DSRIP projects have had success in areas of hospital admissions for hypertension, follow-up care for persons hospitalized for mental health crisis, and all causes of potentially preventable hospitalizations.


DSRIP projects are built around metrics (for example, hospital readmission for substance abuse hospitalization will be reduced by 30 percent) and federal payments to local entities are not made unless targets are met. For this reason, many observers report that DSRIP projects have improved providers’ capacity to measure success.


The original waiver expired in December of 2016, and a 15-month extension was granted, which will expire in December of 2017. The extension provides $2 billion in federal DSRIP dollars. In 2017, a renewal application was submitted for 21 months of waiver funding, which could extend DSRIP programming through September 2019.