top of page

Our Recent Posts

Previewing This Week’s Senate Hearings Pt.2: Senate Health & Human Services

By Tom Aldred, Executive Director. Dec. 2, 2019

While the Senate Finance Committee is delving into the state spending limit and the business personal property tax, the Senate Committee on Health & Human Services will be looking at vaping, as well as the state’s 1115 Medicaid waiver.

Our testimony to the Health & Human Services Committee on vaping draws heavily on our Senior Policy Analyst Russell Withers’s recent post on the same topic, and urges lawmakers to carefully examine the facts surrounding health concerns before implementing new regulations:

"With more than 1,400 serious illnesses linked to vaping and 33 deaths, lawmakers and officials are right to worry. However, research indicates that black market products are likely to blame for these illnesses, rather than products that exist within the legally regulated market, and outright bans fail to acknowledge the potentially positive aspects of e-cigarettes, as opposed to traditional cigarettes.

Texas has a good reputation for taking a reasonable approach to regulation and public safety. As policy makers debate proposals to regulate vaping and e-cigarettes, they should do so with a clear understanding of the underlying facts and how the products are used. Like many products legally available in the marketplace, there are dangers associated with vaping, but calls to ban the products outright are an overreaction."

The committee’s charge regarding the state’s 1115 waiver is broad, encompassing Delivery System Reform Incentive program (DSRIP) funds and the Healthy Texas Women (HTW) program, among others. In December 2011, Texas received approval for a new Section 1115 Healthcare Transformation and Quality Improvement Waiver. The state’s largest Medicaid waiver to date, this new waiver encompassed all of Texas’s Medicaid managed care program, as well as billions of dollars in supplemental funding to hospitals and other “safety net” system providers.

The waiver was renewed after its initial five-year period and is currently operating under an extension that is set to expire on September 30, 2022. The most critical waiver-related issue currently facing the state is the end of DSRIP funding in September 2021. Since its inception, the DSRIP pool has provided approximately $16.3 billion in supplemental payments to about 300 participating providers, with hospitals accounting for almost 70 percent of the total payments.

The 87th Legislative Session will be the final session before DSRIP funding can be extended. It is critical that DSRIP providers adhere to strict quality metrics and transparency reporting requirements so that federal and state leaders, as well as taxpayers, can clearly see how funds are being utilized.

In addition to expiration of DSRIP funding, there are other challenges on the horizon that will most likely impact funding available to safety net providers and how Texas provides the matching funds to draw down the federal share of its supplemental provider payments. For example, SB 750 (86R, 2019 - Kolkhorst | SP: Button) directed HHSC to examine serving the Healthy Texas Women population through a managed care program if the state’s outstanding request to implement a Healthy Texas Women 1115 Waiver is approved.

As our testimony explains, if the Healthy Texas Women program is approved as part of the 1115 waiver, there must be a clause that terminates participation in the waiver and reverts the program back to the state-funded program in place today if, at some point in the future, the federal government does not allow the program’s prohibition of participation by abortion providers and their affiliates. Bringing the program under the 1115 waiver may make sense, but only if its original purpose is not undermined.

Once the Senate committees gavel in on Tuesday, read our full testimony at


bottom of page