The Effect of the Texas Medicaid Waiver Design and Implementation on Regional Changes in Uncompensated Care: Part 2

Abstract

Publisher's Note: This is the second of two related articles.  The first article was published in the Winter 2018 edition of our Journal and may be found at: http://www.healthfinancejournal.com/~junland/index.php/johcf/article/view/149

The Effect of the Texas Medicaid Waiver Design and Implementation on Regional Changes in Uncompensated Care: Part 2

ABSTRACT

The 1115 Medicaid Waiver is an alternative payment methodology that many states have adopted in an effort to redesign their states’ delivery system and not expand Medicaid. This research evaluates the effect of Texas Medicaid Waiver on reducing hospital uncompensated care percentage (UCP) within 20 geographic regions (RHPs) across Texas, while controlling for differences due to hospital characteristics and Waiver funding. Descriptive statistics were used to better understand differences in RHPs. A mixed-effects model was used to estimate changes in UCP between June 2012 and July 2016 at the RHP level.  Independent variables included Fiscal Year, Beds, Underfunded Patient Mix, and Waiver funding amounts. The results show RHPs vary significantly in Medicaid and uninsured rates, number of Waiver projects deployed, and the valuation thereof. Differences across RHPs in UCP suggest varied results of the Waiver at reducing UCP, with five RHPs experiencing statistically significant decreases and 11 RHPs experiencing statistically significant, but small (<0.077%), increases. Three RHPs with the highest rates of Medicaid and uninsured showed decreases in UCP suggesting RHPs with the largest room for improvement had the greatest benefit. Overall, these results indicate the Waiver impact differs across geographical regions.  Future research is needed to understand if the variation is due to the types of Waiver projects, the target population of the Waiver projects, and/or other market level characteristics.

Keywords: Medicaid Waiver, Hospital Uncompensated Care, Regional Healthcare Partnership