Since last year, Texas and Joe Biden’s White House have been in a Medicaid funding feud that has been costing Texas hospitals about $7 million a day. State and federal officials have imposed a deadline over the dogfight for this Friday.
Last April, the Biden administration revoked a 10-year waiver renewal approval of billions in future Medicaid dollars for Texas.
According to The Houston Chronicle, the money, funneled through an 1115 waiver, has brought more than $30 billion to Texas since 2012, accounts for nearly one third of the state’s Medicaid budget, and funds emergency care to patients without government or private insurance.
After being denied the waiver, Republican state leaders sued to reinstate it. A federal judge ordered both sides to negotiate. A year later, they still have nothing to show for it, except the loss of millions of dollars.
Under the initial plan, payments to hospitals would have already begun, but instead, the stalemate is costing hospitals $7 million dollars a day and could force some to roll back medical services or increase charges if the waiver expires this fall, according to John Hawkins, President and Chief Executive of the Texas Hospital Association.
Since the Biden administration’s reversal last year, hospital and patient advocates assumed the waiver would shrink as Texas expanded Medicaid under the Affordable Care Act. Since Republicans have refused to expand, millions of low-income Texans are left without Medicaid or any other coverage.
Texas has both the biggest uninsured population and the highest uninsured rate of any state. The state also has historically low reimbursement rates for providers, including hospitals.
Sarah Rosenbaum, a health law and policy professor at George Washington University, said it’s possible that federal officials are trying to pressure Texas into contributing more toward indigent care.
“They’re now in a game of chicken with the administration,” Rosenbaum said of the state’s position.
The Centers for Medicare and Medicaid Services said the agency is “committed to ensuring a strong and vibrant social safety net across the nation, including in Texas.”
“This includes making sure that providers in Texas receive all Medicaid payments for providing services to Medicaid beneficiaries to which they are entitled,” it wrote, as reported by The Houston Chronicle.
In previous statements, Attorney General Ken Paxton has openly opposed the idea of the state expanding into Medicaid.
“This would be a disaster for our state,” Paxton said last year, “and yet President Biden seems intent on thrusting his bloated model of government on everyone—including Texas.”