Texas Insight Special Report: Tick Tock, Tick Tock, DSRIP Planning as the 1115 Transformation Waiver Winds Down

When the State received approval to address health care in Texas in new ways, it embarked on a path of innovation loaded with uncertainty. After several years of success, the State is moving into the next phase. The innovation of the past approach was marked by several service changes that were new to Texas and Texans served through the public health system. This innovation was accomplished through an 1115 Transformation Waiver. The initial waiver was funded for five years, 2011 through 2016. The waiver provided managed care expansion, allowing for statewide Medicaid managed care services (STAR, STAR+PLUS, and Children’s Medicaid Dental Services) while preserving historical upper payment limit (UPL) funding for hospitals. The hospital financing component preserved UPL hospital funding, but under a new methodology; while innovation at the local level was encouraged through the development of Regional Healthcare Partnerships (RHPs). Under the waiver, historical UPL funds and new