Medicaid Expansion in Texas: Post Section 1115 Waivers

The COVID-19 pandemic has called attention to inadequate access to health care across the United States. In Texas, one of the primary barriers to health care service is poor insurance coverage. Texas has the highest rate of uninsured individuals in the country. This deficiency also contributes to inequitable health outcomes observed across racial and ethnic categories. For example, 70% of Black families in Texas surveyed in 2019 reported that they skipped or postponed treatment because of cost. Despite the state’s large uninsured population, Texas has refused to expand Medicaid, opting instead to use a 1115 waiver program that compensates hospitals for treating patients without insurance coverage and directs funding to local health departments and local mental health authorities that provide charity care for Texans. On April 16, 2021, the Centers for Medicare and Medicaid Services (CMS) rescinded this 1115 waiver. Without the 1115 waiver program or Medicaid expansion, many Texans will lose critical health care services. The 87th Legislature should consider proposals to expand Medicaid. This would improve the state’s bottom line, increase consumption of preventative care across racial categories, and reduce the cost incurred from remedial medical and life years lost.

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