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Health Care ‘Waiver’ Limbo Puts Mental Health Funding At Risk For North Texans

Xavier Becerra in black suit with blue tie and black mask sitting at a table in White House.
Evan Vucci
Associated Press
Secretary of Health and Human Services Secretary Xavier Becerra attends a Cabinet meeting with President Joe Biden in the East Room of the White House, Thursday, April 1, 2021, in Washington.

Local officials hope the federal government will issue a partial extension.

Health care and political leaders are worried North Texas will miss out on vital federal dollars after the Biden Administration revoked an extension of a program negotiated under former President Trump.

Carol Lucky, CEO of the North Texas Behavioral Health Authority, said a “substantial loss of funds for mental health services [will] come as a result.”

Lucky spoke on Tuesday at a meeting of the Dallas County Commissioners Court.

Last month, the Centers for Medicare and Medicaid Services (CMS) cancelled a 10-year extension of the “1115 Waiver” that Texas negotiated in the waning days of the Trump Administration. The 1115 Waiver would have sent over $11 billion a year into the state to compensate hospitals and other medical providers for care they provide to patients who can’t afford it.

When the extension was cancelled, CMS said there hadn’t been a good reason for approving it on an expedited basis, which allowed Texas and Trump administration officials to avoid some of the typical public notice requirements. That leaves Texas with the original expiration date of September 30, 2022.

But the state can reapply.

Texas has the highest uninsured rate in the country. Some health care advocates see the current 1115 Waiver as a way to soften the impact of the decision to not expand Medicaid under the Affordable Care Act.

Republican state leaders have consistently refused to expand Medicaid to people with incomes slightly above the federal poverty level. Lawmakers in Austin recently rejected a proposal to do just that.

Charlene Randolph, director of the Dallas County criminal justice department, said the lack of an extension of the 1115 Waiver means funding for certain mental health diversion programs — which keep people out of jail — is at risk.

“The 1115 Waiver has been a great investment for Dallas County,” she told the commissioners. “We really are hoping CMS does extend or approves some type of extension for us.”

Also at the meeting, the commissioners passed a resolution to urge the federal government to extend the “DSRIP” program to 2022. Unlike the rest of the 1115 Waiver, it’s set to expire this September. The DSRIP program, part of the original 1115 Waiver passed with the Affordable Care Act, uses federal dollars to fund regional collaborations to fill gaps in health care options for uninsured people. If the extension doesn’t happen, the resolution asks the state to fill the breach.

“To have this particular program not extended is going to leave Dallas County in particular in a position of having to figure out, okay, so what do we do?” said Commissioner Theresa Daniel, the resolution’s sponsor.

Got a tip? Email Bret Jaspers at You can follow Bret on Twitter @bretjaspers.

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Bret Jaspers is a reporter for KERA. His stories have aired nationally on the BBC, NPR’s newsmagazines, and APM’s Marketplace. He collaborated on the series Cash Flows, which won a 2020 Sigma Delta Chi award for Radio Investigative Reporting. He's a member of Actors' Equity, the professional stage actors union.